Crush of the week.

I have a new one, which is always a good thing, because it means people are stepping up to the task at hand in a big way.

My hospital, recently, lost it's heart surgeons. We had two cardio-thoracic-vascular surgeons (both of them really good) up and decamp to another hospital. They left for lots of reasons, major dinero being first and foremost. Anyway, after a nation-wide search, we have, as of the beginning of the year, two new surgeons. Now, we just had to deal with the vascular butcher last summer -- the doc (lower case) who caused complete mayhem. Understandably, all of us, from the CVOR, to SICU, to CVTU, were apprehensive. Well, maybe a little more than that. Our ARNP was feeling out of the loop. The anxiety in the staff was palpable.

January, 2011. Dr D has assumed CVT responsibility, all of it. Dr W is out of the game for a bit, because he broke one of his fingers. Everyone knows the story behind it, and it endears him to us all. Sight unseen. It is that kind of story. Dr D makes a point of rounding and meeting all the nurses -- all million of us. It has got to be overwhelming, but he is gracious, and seems kind, calm and caring. And he talks, really talks, to his patients. That is huge. It doesn't hurt that when he writes orders his last is always, "Thank you kindly". He is the kind of Doc that nurses will go the extra, extra mile for. That doesn't happen often.

But, my crush of the week goes to Dr W. He actually told an under 50 year old, 2 pack a day smoker, 12-pack+ a day drinker that he wasn't going to operate on the patient's heart. The blockages weren't critical, and maybe lifestyle modification was in order. He re-consulted cardiology for medical management. CRUSH.OF.THE.WEEK. You don't take your meds (all of which, but plavix, on the $4 pharmacy list) but you continue to smoke and excessively drink, and you end up with yet another heart attack. Bypass is your last option. It takes a strong, confident doc to put the patient's problems back on the patient. Lifestyle modification. Hard to do, but necessary for the future in successful heart bypass. The message: We will fix you, but you have to invest in yourself first. Do your homework and we will do our part.

One instance of our tax dollars not being mis-spent.

Crush of the week. (and Dr W calls me by name, so he gets extra points.) I thought our CVTU program was going to take a major hit. I was wrong. We had a very small speed bump. I expect great things going forward.

And, because this is first and foremost a running blog: I ran 5 miles yesterday and 4 miles today. First runs since I decided to move to a new house. It isn't much, but it counts. I am sore, but my knee isn't complaining. I have DWD to get ready for and a Monkey to run. I take the little bits where I can get them.

I have a Crush

I have a friend on a running site who designated the "Crush of the Week". I now have one. Dr D., a hospitalist of the female persuasion, internal medicine on-call. Crush. Of. The. Week. (Maybe the MONTH. Or longer. It depends on who else steps up.)

Malingering. It means what it says. Docs shy away from saying it, because our society is so stupidly litigious. Nurses, not so much. Nurses don't get sued so easily, therefore we can call a spade a spade. We see patients all the time who love being sick for sake of being sick. Some people just like being in the hospital. They love the attention, and can go on forever about all their ailments, real or perceived. They know the buzzwords, they know the system, they take real dollars and real health-care away from people who really need those services.

I had a patient that no one would get rid of. NOTHING was wrong with this man, outside of his normal state of health. He just kept saying the right words, therefore the docs kept working him up for things that weren't wrong with him. Malingering. Walking the halls, hounding the nurses, being inappropriate with other patients, taking advantage of the nursing assistants. Everyone knew that he was fine, but no doc would stand up to him. Lawsuits, you know. Malpractice -- the driving force behind healthcare.

Anyway, Dr. D walks in and discharges the guy (with no narcotics). 8 hours later, after much drama (yelling, crying, wailing, begging, berating) he finally leaves. We send out surveys so that patients can tell us how good of a job they think we did. I don't think that Dr. D will fare very well.

Crush. Of. The. Week.

"WHEN IT DON"T COME EASY" (PATTY GRIFFIN)

Night-time, all alone at home music.

Monday night meltdown.

The single Mother, Runner, Nurse thing is hard. Lately it is harder still, as I am making progress in our lives and buying a house. I have a 7 year old and a 9 year old to help me. Off and on, when his classes permit, I have a 19 year old to help. Mostly, though, I have me.

How can I complain about buying a house that will be a home for my little family? How can I complain about making a place that will be a touchstone for all of my children? How can I complain about being able to afford such a luxury? How can I complain about providing us a home and maybe, (Good Lord willing and the water don't rise) a dog for my Small People. How can I complain?

I can't. I am blessed. I know that. I am just tired, and worried, and stressed. I have to do this all by myself. The mortgage, the closing, the painting, the flooring, the moving...it is all on me. I am good with it. But, wow. It all has to be done soon. And I have to do it. It really sucks that the guy I was spending time with chose to walk away right now because I am unappreciative. The loss of support is huge, but I am going to make it anyway.

Super Bowl Sunday --messy post

I ran today, outside, for the first time in a long while. Not a good run, but who am I, anymore, to say what a good run is? I finished. I ran outside. As of 10:15 pm, I am still walking. So, a BIG checkmark in the win column.

I love pro football. I just do. And, as a single mom who loves football, I am passing this on to my small people because rooting for and being invested in the home team is important. It grounds you. It gives you roots. It gives you a reason to connect to the city/town.

I am trying to give my small ones the best parts of me. I am teaching them to cook. ( I can make something out of nothing. Give me a few staples and some castoff stuff in the fridge, and I can make something you will want to eat again. Except that you can't, because I don't keep track of what I do.) Not really a recipe kind of girl, here. I am trying to pass that on to the small people. Katie can, carefully--under close supervision-- chop things. She cannot mince herbs, but she is killer with carrots, peppers, parsnips and the like. She knows how to saute, but still needs some help with the strength of her utensil. She is only 9, after all...her hands are only so big. But she is learning to turn meat and veggies, and to take them off heat at the right time. WIN!!!

The best part of the Super Bowl is the party. Today our party was just the 3 of us, but we had a loud TV, lots of football and snacks. The snacks were really good, but the commercials? Ummm.

Fajitas and fish tacos at half-time (yeah...dinner for the next week) were wonderful. Katie helped. And Small People thought the Black-eyed Peas half-time show was really cool, too. All in all, a Super day. It may be only us, but our "us" is all sorts of fabulous.

Night music for tonight

Simple running

I have run 5 miles every non-work day since the end of January. I am running indoors at present, but that might have to change. The treadmill deck is soft, which makes the idea of running on asphalt and concrete a bit frightening. However, the boredom-factor of running indoors make running outside highly enticing. Perhaps tomorrow I will give it a whirl.

So, apparently I can run again. Not far and not fast, but it counts. The orthopod? He can go screw.

Vaudeville.

Remember those performers in the old vaudeville shows that spin plates? They run back and forth frantically wiggling sticks to keep a bunch of plates on the top of those sticks from crashing down. Lately, I am that person. Actually, I am always that person, just with fewer plates. Right now, my plate complement is full. Buying a house. Getting a loan. Moving. Starting to run again. Mother. Nurse. Dealing with my daughters' deteriorating relationship with the step-mom. Spin and wiggle...wiggle and spin.

I lost one plate. I no longer am seeing the guy that I was kind of seeing. He needed more than I could give, and I couldn't give him what he wanted. So, he walked away. It's okay, actually. I just am not in a place where I can be somebody's someone. The timing sucked (he is really good with tools and fixing and all that handyman stuff), but the relief of not having to give to yet another person is palpable. I guess that means I am okay with it.

I ran five miles again today. Legs were tired from yesterday, and it wasn't as good as a run as yesterday's. However, I ran five miles today, and I can still walk without much pain or sponginess. That's money, baby.

It Is Almost Midnight.

In just a few minutes it will be a new month, February. I started this blog last year, in February. I suppose it is time for a retrospective. I know. I am late to the party. Most people do the assessment, resolution, betterment plan in late December. Or no later than Jan 3 (when the hangover is really, really gone and the bowl games are over). But, I am not really that way. The people who really know and love me get this about me, but only one person in my life has been able to put my "sarah-ish-ness" into words.

I took Modern European History when I was a senior in high school, at Chatham Hall in Virginia (girls' boarding school...awesome place. I still love it). Modern European History was NOT what I was expecting. Renaissance? Middle Ages? What did that have to do with MODERN?? Anyway, there were five of us in the class. Five. 5. Sooo....bluffing was not an option. Dr Reilly knew every single one of us flat out cold. Tests were several short answer questions and an essay. Rarely in college did I have exams that were that focused or that difficult. Rarely. I sweated those exams, probably as much as I should have. I was given a very narrow topic, one that would tax my knowledge of a subject, and I would have to deliver a well thought out argument.

Dr. Reilly, one day after handing us back our test results (to all 5 of us), had me stay after class. I had gotten an A on the exam, and he had never asked to talk to me after class before. It wasn't worrisome, it was just strange, odd. I looked at him, with his straight, dark, bowl-cut hair and his round glasses -- with his tweedy jacket with the worn elbow patches, incredibly intelligent and knowledgeable, but yet willing to teach teenagers -- and wondered what the hell he had to say to me.

That man captured the whole of me in a couple of sentences. He got me. He understood how I see things. His words to me, after class: "I always look forward to reading your essays. I know how everyone else in the class is going to answer the question, except for you. You always answer the question sideways." It wasn't a criticism, it was a compliment of the highest nature. A thinker who complimented a student on her thoughts. For almost 30 years I have carried that compliment with me. I have carried the knowledge that at least someone understood that i see things sideways, and that sideways isn't bad....it is interesting.

This year. The goal and the treat. Goal. I guess there are two. Buy a house (which will happen in the next few weeks...along with the flooring and yadda yadda),
get my knee well enough to do Dirt and run the Monkey. (notice I didn't mention time...that part is over for me. all good)

Treat. No brainer. A week in Sanibel, making Sanibel memories for the kids. What could be better than that?

Oh. I ran 5 miles today, with one water-stop. Slow, but steady, says the turtle. And I am walking pain-free tonight. HA.

Lola (December 2010)

Lola has been a resident of CVTU for nearly 4 months. She is one of the lingering remnants of the surgeon who should not have been. She is a fem-pop gone wrong, but gone wrong due as much to her own hyper-coagulation problems as to her surgical fiasco. She may have been kind of doomed from the start, but who knows?

Lola came into our ED with a cold right foot and intermittent claudication. She was dually assessed and it was determined that she needed to have the circulation restored to her leg by a femoral-popliteal artery bypass and graft. She came to my floor and struggled to heal. The bypass failed and not long after, Lola had a below-the-knee amputation of her right leg. Then, much of the re-vascularization of the upper leg was compromised, and Lola had her right thigh filleted open like a sturgeon. It was one of the biggest leg wounds I have ever seen, and one of the most painful. Wound care nurses changed the wound-vac M-W-F, and it took them close to 2 hours each time. Lola bled and bled. And bled more than that. She formed clots the size of softballs under the vac film. She got countless units of blood and blood product. And of course, with all this pain, she got addicted to dilaudid.

A couple of surgeries later, by the plastic surgery guy (nicest guy in the world...) and we thought Lola was going to be able to go home and get better. Then her amputation incision got necrotic. 3 surgeries and 2 months later, Lola has a nicely healing mid-thigh amputation. She is off all IV pain medication. She takes a high dose of oxycodone, but she takes much less than she used to. She like to stay up late, and sleep in. When she is in my team of patients, I don't wake her before 10am. There is nothing that Lola has to do before 10am, kinda like there is nothing College-Boy has to do in the morning when he is on break.

Lola moans and cries. When she is in pain, the entire floor knows it. She wants her Mommy to help her. But in these last 2 weeks, Lola doesn't cry anymore. She looks forward to going home. I was her nurse the day that the ortho guys told her that she was going to have an above the knee amputation, that she wasn't healing, and that her dreams of a certain kind of recovery of life weren't going to happen. That was a hard day. But, she is my age and she chose wisely for a woman my age. She chose to continue the battle.

I don't ever, ever, EVER get attached to patients. I learned the hard way more than once. I plan, God laughs. He gives me, no, he gives my floor, Lola. I took care of her this weekend. But at this point, I'm not her nurse anymore. I am her friend, and she is mine. Her fiance (oh yeah...he has hung in for all of this and that makes me just adore him) brought jelly beans, cause Lola had a craving. 'cept I ate most of them. It was a quiet weekend for me, and since I wasn't actively saving lives, I pulled up a chair in Lola's room and we watched TV together. Don't tell my manager. But those are the kind of moments that help a long-term patient recover. Those are the kinds of moments that help her nurses stay sane.

Well, Happy New Year. 2011. Geez.

Yeah, so I lasted posted about, oh, 2 years ago. Right around the time the Uber-Ortho drained my knee and life was good. (That lasted about a week. My knee and I, with the full-court press of 20ccs of fluid drained and some steroids infused felt fine and dandy for a week. Maybe 2 -- its Christmastide and I am feeling generous.)

The difference in strength in my quads was remarkable enough that the PT and the Uber-Ortho commented on it. Which kind of means nothing. But the muscle wasting in my right quad made cycling, well, interesting. The bike "skittered" underneath me. I am a novice rider, and a single rider. But I passed someone doing 22mph (not fast for most people), and I almost bought the farm. My bike skated on me. The more I rode, the more it did it. They tell me that it skates because one leg is so much stronger than the other. *sigh* I stopped cycling because my bike scares me now. I hate that. I really hate that.

So, 6-week follow up with Uber-Ortho. He says, looking not at me but at my MRI from the initial injury, that my PCL isn't an issue anymore. What I have is arthritis and some severe cartilage damage in my right knee. All my issues are related to that tissue damage. (Let me say that my knees never hurt me until I spilled from my bike. I said as much. His response was, "I didn't have any gray hair until I got my first gray hair.) He talks "when" not "if" about a knee replacement. When. Partial replacement. Perhaps not total. He says, not looking at me, only at the old MRI, that it is a kind of race between whether my "ticker" or my knee gives out first. Seriously? My heart or my knee. I don't have any cardiac issues, and am a healthy, active, middle-aged female. I have no concerns about my heart. Apparently, although we have talked about it before, he has forgotten that I am a cardiac nurse. But he is the ortho expert and talks about WHEN. When my knee gets replaced. He says that you only get so many stides, and that I have gone through mine. 20 minutes looking up and down and backwards and forwards though that scan. And you know what??? I am bone on bone in a small place in my right knee. But don't tell my knee, because she doesn't know it. Per the MRI, I am supposed to have a whole lotta pain going on. But. I. Don't.

I have seen those films. I have seen that cartilage loss. It is kind of impressive. It happened before I fell from my bike, and has never, ever bothered me when I run. Still, it is there. I think that if I am a WHEN and not an IF about a knee surgery, I am going to follow that slide in sideways philosophy. If I have to give it up, it will be on my terms. I have seen the MRI films. I know the score. I miss running. I miss it like the loss of a friend, or a lover. It is my decision. I choose to not go gently into that good night.

So. 1/1/11. 6+ miles. Ran more than I walked. Maybe 4 miles running, 2+ walking---mostly because I am not in shape to run. But, I did it. And, since it might be the LAST time I did it, I loved it. I loved the lake. I loved the birds, and I loved the people. I made sure to love this run/walk.

1/3/11. Slow, with walk breaks, mostly because I am so out of shape. I last really ran in September. Now I am running with a possibly delicate knee. Well, it is delicate. I just choose to ignore that.

1/3/11. Walked a bunch of miles in Epcot. I got some unexpected money for Christmas, and decided to do the Disney thing this year. We live in Florida, about an hour from Disney and never go. Not anymore. Smallest of All had a school field-trip to Epcot in December. She just adored it. A Princess Day anyway you slice it. So, Small One wanted to experience Epcot, too. Yay again! When I got home, I did some serious icing of my knee.

Onward.

Happy New Year to Everyone!!!!!