Tuesday, September 25, 2012

Messy Monday

Humboldt Bay
I haven't written about my patients for a while, so I thought I would do so today after my shift yesterday...

The morning started off with Geriatric Clinic.  I don't think I had any patients under the age of 70 for the first couple of hours.  Unfortunately, several had to be admitted;  mostly because age was finally catching up and their families could not longer care for them at home.  We have a lot of admissions for "weakness."

Things started to pick up as the morning progressed, and we started to get the chronics who won't go home.  Why do some people want to come to the ED just to sleep?  We have several patients who will come in with some random complaint of "nausea and abdominal pain" who get an IV, some medications and then pretty much establish a home base and milk out the stay for hours.  They'll be complaining of 10/10 pain even though they've been sleeping for hours, demand more pain medication, and are asleep before the RN can even get back in the room with it.  These are the ones who miraculously improve when they are placed in the hallway because a more urgent patient needs the room and, more importantly, the cardiac monitors.

Lunch time arrived and we had a reasonably full house.  Chronics sleeping in a few rooms, seniors waiting to be admitted, then the random "waited all weekend and now can't get into the doctor's office because it's a Monday and their schedule is booked" patients come in.  There's a flurry of activity as they come in and out almost like a revolving door.  Charting takes longer than it actually takes for me to see the patient, do a physical exam and plan for discharge.

The afternoon wears on and I start to dread the "after school" or "after work" rush.  School has started and there are sports injuries galore as kids who have sat around all summer start actually doing some physical activity.  Then there's the "it's bothered me all weekend, but I had to go to work today and I must be seen now" group.  Kinda like the previous group, but employed.  Sort of.  Or wish they weren't.  Like one patient that jammed their finger playing basketball and wanted me to write them for a week off work... really?  Listen up 18 year old... you've got a lifetime of work ahead of you, so you better get used to it because you're not getting off to a good start.

Evening comes.  The RN's are antsy because they're on their last hour.  The flotsam and jetsam of society starts to roll in, and I see the kind of patient I can't stand... the "waste of my time" with the "I demand everything be done" family.  Let me get this straight, the police "kicked the &*^% out of you" for being involved in a fight with your pregnant daughter's baby daddy, dragged you to jail where supposedly you got further assaulted.  You were released before midnight last night at which point you came to the hospital to see your daughter who was injured in the original fight but were not allowed to see her because police said you were threatening her but during which time you refused to be seen for your "injuries."  You then proceeded to "disappear" per your "concerned" family members only to reappear late this afternoon and "collapse on the couch."  Family calls 911 to bring you for evaluation so they can "sue those *&^%( police" who did this to you.  You refuse to speak to EMS, myself, the RN, and only interact with your family members.  When the words "drug screen" are mentioned you suddenly are able to stand and walk and communicate to the extent that you sign out AMA (against medical advice) and storm out of the ED.  Meanwhile the "concerned" family members inform you that "don't worry, if he passes out again we can always call EMS."  Thanks, that will be an excellent use of resources.

It's end of my shift, and I am waiting for a woman to deliver her baby.  This is not a joyous occasion.  She's from out of town and things started to go wrong.  It's too soon, and the baby is too small, but Nature has already started the process.  She keeps asking why it's like labor.  I tell her it's because it is labor;  her body only knows how to do one thing.  After almost an hour it's over.  I have to change my scrubs before finally heading home.  What a way to end the day.

I drive home mentally reviewing my shift.  Did I really help anyone today?  Did I display something close to empathy even though some patients really pushed my level of patience?  Was there something I should have done that I didn't?

Luckily, self-doubt is all but forgotten as I cross the bridge for home.  There's bigger issues to think about... and, lots of distractions to help erase the memories of the day.

 




Monday, September 17, 2012

Requiem for a Goat

I know I haven't written in a while, and I honestly thought I would be writing about the new puppy in our life.  Instead I find myself writing about another death on the farm. 

Boots was born on May 15th of this year.
She died on Sunday the 16th, just a day past turning 4 months old.

And, today we buried her.

I've been feeling like a bit of failure.
When we had the massacre weekend, I promised Boots that I would take care of her.
We took her to the breeder and then brought her back after 3 weeks.
And, as I wrote back then, she was never quite the same.
I called it goat PTSD.

Then we left for an extended trip to get our new puppy and when we came back
Boots had developed "bottle jaw."  She became severely anemic and within 10 days she was gone.

At one point, I thought she was going to recover, and she fought so hard, 
but then she became much worse despite all my efforts to help her: 
 bottle feedings, antibiotics, IV fluids, etc.
In the end, all I could do was sit by her side and make her comfortable.
She called out once, and then was still.  She'd lost the fight.


She died on a beautiful sunny day.  
We'd actually sat out in the sunshine for about an hour earlier,
I had wrapped a blanket around her to keep her warm.
All the other animals seemed to surround us.
It was a lovely scene.



This morning my husband picked out a spot on our property amoungst the pine trees;
just a little bit down the path from the back of the barn where she was born.

I wrapped her in the blanket that had helped to keep her warm during her illness;
a pink ribbon secured everything in place just as it had helped keep the blanket on her while she was alive.  She seemed so tiny as I laid her down.

We said a few words about what a good goat she was,
and how a lot of people who had never met her loved her through my photos and blog.
I apologized that I hadn't been able to protect her the way I promised.
And we told her that at least now, she was with her mother, her auntie Betty,
and her playmate Jazz in some goat heaven somewhere.

My husband who considers all animals as utilitarian rather than pets actually got misty.
I openly cried.

I hesitated as I tossed down that first shovelful of dirt.  I didn't know that I could do it.
But, there really was something kind of cathartic about doing the work.
In the distance, the other two goats, Laverne and Shirley started to bleat.
We called it the "two goat salute."


I made a small cross, we laid down a stone as a marker, and I planted flowers.
You can call it sacrilegious, but I believe in a God who loves all of His creation,
and in a Heaven where all creatures are welcome.


As the first creature born on the property, you became my hope
As I watched you grow, you became my joy.
You were loved, and you will be missed.
You will never be forgotten.