Friday, March 29, 2013
Thursday, March 28, 2013
Romy's Appendix Ruptures: Day Six
This morning a meal arrived for Romy but it was a gluten meal (cream of wheat and french toast). We were never notified that he could eat again, so it was surprising. Apparently, late last night the doctor responded to the nurses calls, but the nurses never told us Romy could eat or drink (with the most important part being that he could drink!) I kindly told the man who delivered the food to take back the plate because Romy needed a gluten free plate (as he was getting previously) but they did not return. We figured since he got a meal (even though it was the wrong one), that meant he could eat or drink again, even though we were never notified officially by any nurse or doctor. After an hour later when no replacement meal came, we asked for it again by way of a nurse. One hour passed after this, and he still did not have a meal. Every time a nurse came in to check on him we notified them that there was no food yet. Two of Romy's doctors came in and we told them also that he didn't get food yet, and they told a nurse. It was literally like this for so long. We would tell somebody, they would tell somebody, and supposedly a food order was placed. However, it does not take 3 hours to whip up breakfast. Finally a nurse said she would put in an order for yogurt and fruit separate from the breakfast order. That never came either. Finally at 12:30pm I got so fed up, I went to Whole Foods to buy Romy something and notified the nurses at the front desk that he still did not get food and I was going to buy him something. I was so mad at this point! I yelled at the nurses and they kept apologizing, but didn't actually do anything. I figured that if he still didn't have food by the time I got back from Whole Foods, then I would talk to the charge nurse. 20 min later, I was back, and Romy still didn't have food!!!! I requested the charge nurse, and spoke to her regarding yesterday and today and asked for a manager. I kept asking her who is responsible and who is held accountable, because it didn't seem like anybody gave a damn. Finally around 1:30pm he received a gluten-free lunch (but never got breakfast).
Romy is well and walking the halls.
I finally got to speak to the manager around 2:00pm. She was very nice and identified that there were multiple areas and incidents where mistakes and oversights were made by the nurses and the doctors. I told her that I was concerned mostly about yesterday when we kept asking the nurses if Romy could eat or drink anything, and they never allowed him to have anything, but also didn't give him the IV we asked for either. She said that although the nurses were not allowed to give IV without an order, they are supposed to advocate to the doctor and they were supposed to relay our request for an IV yesterday when he was not allowed to drink anything. No request was made by the nurses. When we asked Dr. Westeguard personally if he could eat or drink, and she deferred to Dr. Fowler, she did have the power to recommend IV fluids since he couldn't drink, but she did not! On top of all this, when he didn't get food this morning, it just made things worse. He didn't eat anything at all yesterday, and now today, for no apparent reason, he didn't get food until lunch! What a dysfunctional hospital!!! ALTA BATES SUCKS! Why is it so hard for them to relay simple information? What's scary is that supposedly this is one of the better hospitals in the bay area!
After everything calmed down, and the nurses changed shifts, things were back to normal. The doctors came back with Romy's blood cell count, and his white blood cell count was going down and it was now within the normal range (below 10 units). Amidst all of the drama earlier today, the doctors decided that Romy could go home today with IV antibiotics taken at home. This required that Romy get a PICC-line in, because they didn't allow patients to keep an IV thing in their arm after they leave the hospital. Romy kept asking if there were other options, like coming in everyday to get the antibiotics instead. Nobody knew of any other options until the infectious disease doctor mentioned an outpatient diffusion center just a few blocks away. He said that they should be able to give him the IV antibiotics everyday, as long as Romy didn't mind getting poked with a needle everyday and sitting there for an hour. Romy thought this was preferable to the PICC-line, and at least if he goes to the diffusion center, a nurse will be able to check on him everyday and if he needs blood work done, they can take his blood there too. The infectious disease doctor thought this was preferable too.
Romy passes the time talking to friends and relaxing.
So things were arranged to get everything worked out with our insurance plan. But the insurance was sooooo slow authorizing the diffusion center care, so we couldn't leave the hospital until they worked it all out. It was already close to 4pm by the time everything was decided. The case counselor woman told us that it typically takes 24 hours to get insurance authorization on something like outpatient care at a diffusion center. So guess what. . . we had to spend one more night at the hospital! How exciting!
The Polish guy with the broken leg next to Romy left this afternoon. He does body work on the head and back, and invited us for a free practice session (he is learning so he practices on patients for free). We exchanged information. Almost immediately after he was wheel out the door, the cleaning people came in and changed all of the sheets and wiped everything down. They were so fast. The bed was left empty for maybe one hour before the hospital wheeled in another old Japanese man. He just had surgery to remove a quarter of his colon! He was kind of funny and alert. I never saw somebody so persistent in calling the nurses. He made some funny jokes too.
There was a lot of down town, sitting around and waiting today, so I graded homework and lab reports, and I tried to do some work on my paper. It was in general a slow day with lots of frustrations, but hopefully we get the hell out of here already. I am afraid to look at the bill when we finally do get out!
Romy is well and walking the halls.
I finally got to speak to the manager around 2:00pm. She was very nice and identified that there were multiple areas and incidents where mistakes and oversights were made by the nurses and the doctors. I told her that I was concerned mostly about yesterday when we kept asking the nurses if Romy could eat or drink anything, and they never allowed him to have anything, but also didn't give him the IV we asked for either. She said that although the nurses were not allowed to give IV without an order, they are supposed to advocate to the doctor and they were supposed to relay our request for an IV yesterday when he was not allowed to drink anything. No request was made by the nurses. When we asked Dr. Westeguard personally if he could eat or drink, and she deferred to Dr. Fowler, she did have the power to recommend IV fluids since he couldn't drink, but she did not! On top of all this, when he didn't get food this morning, it just made things worse. He didn't eat anything at all yesterday, and now today, for no apparent reason, he didn't get food until lunch! What a dysfunctional hospital!!! ALTA BATES SUCKS! Why is it so hard for them to relay simple information? What's scary is that supposedly this is one of the better hospitals in the bay area!
After everything calmed down, and the nurses changed shifts, things were back to normal. The doctors came back with Romy's blood cell count, and his white blood cell count was going down and it was now within the normal range (below 10 units). Amidst all of the drama earlier today, the doctors decided that Romy could go home today with IV antibiotics taken at home. This required that Romy get a PICC-line in, because they didn't allow patients to keep an IV thing in their arm after they leave the hospital. Romy kept asking if there were other options, like coming in everyday to get the antibiotics instead. Nobody knew of any other options until the infectious disease doctor mentioned an outpatient diffusion center just a few blocks away. He said that they should be able to give him the IV antibiotics everyday, as long as Romy didn't mind getting poked with a needle everyday and sitting there for an hour. Romy thought this was preferable to the PICC-line, and at least if he goes to the diffusion center, a nurse will be able to check on him everyday and if he needs blood work done, they can take his blood there too. The infectious disease doctor thought this was preferable too.
Romy passes the time talking to friends and relaxing.
So things were arranged to get everything worked out with our insurance plan. But the insurance was sooooo slow authorizing the diffusion center care, so we couldn't leave the hospital until they worked it all out. It was already close to 4pm by the time everything was decided. The case counselor woman told us that it typically takes 24 hours to get insurance authorization on something like outpatient care at a diffusion center. So guess what. . . we had to spend one more night at the hospital! How exciting!
The Polish guy with the broken leg next to Romy left this afternoon. He does body work on the head and back, and invited us for a free practice session (he is learning so he practices on patients for free). We exchanged information. Almost immediately after he was wheel out the door, the cleaning people came in and changed all of the sheets and wiped everything down. They were so fast. The bed was left empty for maybe one hour before the hospital wheeled in another old Japanese man. He just had surgery to remove a quarter of his colon! He was kind of funny and alert. I never saw somebody so persistent in calling the nurses. He made some funny jokes too.
There was a lot of down town, sitting around and waiting today, so I graded homework and lab reports, and I tried to do some work on my paper. It was in general a slow day with lots of frustrations, but hopefully we get the hell out of here already. I am afraid to look at the bill when we finally do get out!
Wednesday, March 27, 2013
Romy's Appendix Ruptures: Day Five
Early this morning, when the nurse came to give Romy's morning dose of antibiotics, she decided that his IV was getting old. It was a little sore and painful for the last day, so this morning they finally changed it out, and poked a new hole a few inches away. It was near his wrist, a stupid spot since it has very thin skin and its close to a joint where there is a lot of motion. Romy complained about it later, and said that if he was fully awake, he would of stopped the nurse from putting it there.
We learned at breakfast that the CT scan was going to be scheduled for 11am. Instead of a breakfast plate, Romy got two liters of contrast fluid. It was berry flavored, but it looked like white liquidy chalk. Romy said it was gross and made him gag, but he downed the two liters over the next two hours. He couldn't eat anything before the CT scan. I scheduled an appointment to call one of the scientists at DRI who might be my potential boss if I get hired, so I stepped out of the room for about an hour and a half to talk to him. When I came back in, I barely had time to tell Romy what I learned over the phone call before he was wheeled away to the CT scan! I waved goodbye as he was wheeled down the hall. I had a bunch of laundry to do now at this point, so I decided to go home and wash some cloths, and download a few programs on my computer while he was in the scanner.
Romy is feeling better and he is out of bed internetting on a chair! We have a nice view of the Berkeley hills out the window.
Romy told me that when he went in for the CT scan, the contrast agent was injected at a high rate. Romy mentioned his vein swelled up. By afternoon, when he was getting his antibiotics, it swelled up again but apparently Romy was able to tolerate it. Soon it will have to be replaced. Nicole and Marcel came by to visit again. It wasn't very nice out, kind of cloudy and rainy, so we staying in the hospital room. I ate lunch and N&M were munching on stuff. The guy in the bed next to Romy's got his lunch plate, but nothing came for Romy. We were wondering since his scan was over, if he could get some food and drink now. When the nurses went to go check, they said the doctor ordered him to have nothing by mouth until they could decide what to do after analyzing the CT scan results. So we waited until we heard back.
Soon Dr. Fowler came by to tell us what we did not want to hear! He said that there were still many small abscess sacks but nothing that coalesced into something drainable. He said that there would not be any procedure done today to drain the abscess. Also, it looked like the appendix was still very inflamed and messed up. Even though Romy was feeling better (he did not have any pain medication at all today) his appendix was not very much better. So the doctor ordered that he stay on antibiotics for longer. He wanted Romy to stay one more night so that he could monitor his progress and see if his white blood cell count would go down to normal. Then tomorrow he would arrange for him to go home and continue the antibiotics at home. At least he could go home soon!
Happy to be spending our last night in the hospital!
We were so excited and also bummed by the news. Soon after Fowler, a nurse came in and we asked if Romy could eat now that there was no procedure that was going to be done that day. She said she didn't know but she would check with Fowler, because the order for 'nothing by mouth' was still on the charts. That meant he couldn't even drink water either! So Romy waited to hear anything back. Every time a nurse came in that afternoon, we asked if Romy could eat or drink anything. When the dinner plate came for the guy in the next bed, we asked again if Romy could eat or drink anything. Every time we asked, we got no answer. Every time they called the doctor, they could not get through to him, and just assumed that he was in surgery. Romy was starting to get really thirsty. We asked that if he could not drink, then could he get an IV at least? The nurses kept saying that they could not get through to his doctor and they did not have the power to give him an IV. Even the second doctor, Dr Westeguard, kept deferring to the one that was not available, instead of making an order herself for him to drink! It was getting very frustrating!!!
By 8pm, we got so annoyed that Romy just drank water and ate a few strawberries anyway. This was starting to get upsetting. It seemed like they didn't care if Romy was gonna go thirsty or hungry. Unbeknownst to us, Dr Fowler did call back by 9pm but it was never communicated to us. We were already going to sleep by then. In general, the end of the day turned sour. Dr Fowler should've changed his diet orders as soon as he determined no procedure would be done that day. Also, it should be automatic of you have a 'nothing by mouth' diet order, that you should be able to get an IV for fluids without any doctor's order!!!! WTF!?
We learned at breakfast that the CT scan was going to be scheduled for 11am. Instead of a breakfast plate, Romy got two liters of contrast fluid. It was berry flavored, but it looked like white liquidy chalk. Romy said it was gross and made him gag, but he downed the two liters over the next two hours. He couldn't eat anything before the CT scan. I scheduled an appointment to call one of the scientists at DRI who might be my potential boss if I get hired, so I stepped out of the room for about an hour and a half to talk to him. When I came back in, I barely had time to tell Romy what I learned over the phone call before he was wheeled away to the CT scan! I waved goodbye as he was wheeled down the hall. I had a bunch of laundry to do now at this point, so I decided to go home and wash some cloths, and download a few programs on my computer while he was in the scanner.
Romy is feeling better and he is out of bed internetting on a chair! We have a nice view of the Berkeley hills out the window.
Romy told me that when he went in for the CT scan, the contrast agent was injected at a high rate. Romy mentioned his vein swelled up. By afternoon, when he was getting his antibiotics, it swelled up again but apparently Romy was able to tolerate it. Soon it will have to be replaced. Nicole and Marcel came by to visit again. It wasn't very nice out, kind of cloudy and rainy, so we staying in the hospital room. I ate lunch and N&M were munching on stuff. The guy in the bed next to Romy's got his lunch plate, but nothing came for Romy. We were wondering since his scan was over, if he could get some food and drink now. When the nurses went to go check, they said the doctor ordered him to have nothing by mouth until they could decide what to do after analyzing the CT scan results. So we waited until we heard back.
Soon Dr. Fowler came by to tell us what we did not want to hear! He said that there were still many small abscess sacks but nothing that coalesced into something drainable. He said that there would not be any procedure done today to drain the abscess. Also, it looked like the appendix was still very inflamed and messed up. Even though Romy was feeling better (he did not have any pain medication at all today) his appendix was not very much better. So the doctor ordered that he stay on antibiotics for longer. He wanted Romy to stay one more night so that he could monitor his progress and see if his white blood cell count would go down to normal. Then tomorrow he would arrange for him to go home and continue the antibiotics at home. At least he could go home soon!
Happy to be spending our last night in the hospital!
We were so excited and also bummed by the news. Soon after Fowler, a nurse came in and we asked if Romy could eat now that there was no procedure that was going to be done that day. She said she didn't know but she would check with Fowler, because the order for 'nothing by mouth' was still on the charts. That meant he couldn't even drink water either! So Romy waited to hear anything back. Every time a nurse came in that afternoon, we asked if Romy could eat or drink anything. When the dinner plate came for the guy in the next bed, we asked again if Romy could eat or drink anything. Every time we asked, we got no answer. Every time they called the doctor, they could not get through to him, and just assumed that he was in surgery. Romy was starting to get really thirsty. We asked that if he could not drink, then could he get an IV at least? The nurses kept saying that they could not get through to his doctor and they did not have the power to give him an IV. Even the second doctor, Dr Westeguard, kept deferring to the one that was not available, instead of making an order herself for him to drink! It was getting very frustrating!!!
By 8pm, we got so annoyed that Romy just drank water and ate a few strawberries anyway. This was starting to get upsetting. It seemed like they didn't care if Romy was gonna go thirsty or hungry. Unbeknownst to us, Dr Fowler did call back by 9pm but it was never communicated to us. We were already going to sleep by then. In general, the end of the day turned sour. Dr Fowler should've changed his diet orders as soon as he determined no procedure would be done that day. Also, it should be automatic of you have a 'nothing by mouth' diet order, that you should be able to get an IV for fluids without any doctor's order!!!! WTF!?
Tuesday, March 26, 2013
Romy's Appendix Ruptures: Day Four
Romy is continuing to get better today. Early this morning, they took his blood again so that they can continue to monitor his white blood cell count. Today we think he may get his CT scan to see how well he is healing. But we won't know until we hear about his blood cell count. Romy finally got the energy to take a shower this morning and he is looking better than ever! Nicole and Marcel came to visit today. It was such a nice and warm day, we decided to see if we could find a wheel chair for Romy and go outside. The 6th floor didn't have any available, but Romy thought he might be able to walk. He hobbled out of his hospital bed and we took him to the elevator.
We went to check out the roof. It was really bright and sunny.
I think it must have been pretty unusual to see Romy walking around, holding a coat over his arm. The nurses looked very alarmed and tried to stop him. They thought we were stealing him from the hospital and he was escaping! Once they realized we were just going for a walk, everything was ok. We got down to the first floor, the lobby, and then walked over to another set of elevators. We passed by a whole rack of wheel chairs so we asked the people at the security desk if we could borrow one. They gave us a really nice wheel chair, and we wheeled Romy to the elevators. They took us up to the 3rd floor roof over the south side of the building.
Romy's hair is all clean after his shower this morning.
The roof was really nice. There was a garden and a fountain. We also found a sun dial. We stayed up there for a while, but Romy started to feel a lot of pain after a while. So we decided to go back to his room so he could get more pain medication and relax again. The pain medication that Romy was getting was pretty strong (dilaudid, 7 times stronger than morphine), and Romy didn't want to keep taking it since the pain wasn't as horrible anymore. The nurse offered him Tylenol as the other option. She went to go investigate how much he could get, and when she came back, she was able to get something more intermediate. It was a pill that was somewhere in the middle between something really strong, and something you can buy over the counter. I think it was called Norco. Romy liked it much better. He was much happier for the rest of the day.
When we got back from the roof, we heard from the blood people that Romy's white blood cell count was still too high (11.8 units, down from 13 yesterday). The goal was to try and get it below 10 units before the CT scan would take place. They figured since the trend was going down, they would schedule the CT scan for tomorrow morning. That was exciting news! If the appendix shows a drainable abscess tomorrow, he only has one more day in the hospital!
Romy is very happy to have real food now, even if its kind of bland.
Other good news too. When lunch came around, we discovered that the doctor upgraded Romy's diet again today. Now he can eat "soft foods," which apparently is anything soft, like cooked veges. It seems it has nothing to do with fiber though. Not sure how soft foods are any different from normal foods, as once it gets into your gut, the food should be already mushed up and soft. It was the first time Romy got a nice plate of food (although it looked better than it tasted). Mashed potatoes, cooked carrots, and some beef roast. Nothing fresh though, all cooked and mushy.
Nothing very eventful happened later in the evening. We just relaxed and watched a movie on the TV screen above the bed before we fell asleep. We did learn one thing from Romy's nurse today about the weekend staff. She told us that the nurses are learning how to use a computerized system for all of the patient files. Currently, they carry around clipboards and binders with all the paper records of what happened to each patient and when. Substitute nurses are being hired for only a few days at a time while the real staff nurses are getting trained somewhere on the new computerized system. So the nurses we had that sucked were all substitute nurses. That makes a lot of sense. Too bad Romy came in during this bad timing!
We went to check out the roof. It was really bright and sunny.
I think it must have been pretty unusual to see Romy walking around, holding a coat over his arm. The nurses looked very alarmed and tried to stop him. They thought we were stealing him from the hospital and he was escaping! Once they realized we were just going for a walk, everything was ok. We got down to the first floor, the lobby, and then walked over to another set of elevators. We passed by a whole rack of wheel chairs so we asked the people at the security desk if we could borrow one. They gave us a really nice wheel chair, and we wheeled Romy to the elevators. They took us up to the 3rd floor roof over the south side of the building.
Romy's hair is all clean after his shower this morning.
The roof was really nice. There was a garden and a fountain. We also found a sun dial. We stayed up there for a while, but Romy started to feel a lot of pain after a while. So we decided to go back to his room so he could get more pain medication and relax again. The pain medication that Romy was getting was pretty strong (dilaudid, 7 times stronger than morphine), and Romy didn't want to keep taking it since the pain wasn't as horrible anymore. The nurse offered him Tylenol as the other option. She went to go investigate how much he could get, and when she came back, she was able to get something more intermediate. It was a pill that was somewhere in the middle between something really strong, and something you can buy over the counter. I think it was called Norco. Romy liked it much better. He was much happier for the rest of the day.
When we got back from the roof, we heard from the blood people that Romy's white blood cell count was still too high (11.8 units, down from 13 yesterday). The goal was to try and get it below 10 units before the CT scan would take place. They figured since the trend was going down, they would schedule the CT scan for tomorrow morning. That was exciting news! If the appendix shows a drainable abscess tomorrow, he only has one more day in the hospital!
Romy is very happy to have real food now, even if its kind of bland.
Other good news too. When lunch came around, we discovered that the doctor upgraded Romy's diet again today. Now he can eat "soft foods," which apparently is anything soft, like cooked veges. It seems it has nothing to do with fiber though. Not sure how soft foods are any different from normal foods, as once it gets into your gut, the food should be already mushed up and soft. It was the first time Romy got a nice plate of food (although it looked better than it tasted). Mashed potatoes, cooked carrots, and some beef roast. Nothing fresh though, all cooked and mushy.
Nothing very eventful happened later in the evening. We just relaxed and watched a movie on the TV screen above the bed before we fell asleep. We did learn one thing from Romy's nurse today about the weekend staff. She told us that the nurses are learning how to use a computerized system for all of the patient files. Currently, they carry around clipboards and binders with all the paper records of what happened to each patient and when. Substitute nurses are being hired for only a few days at a time while the real staff nurses are getting trained somewhere on the new computerized system. So the nurses we had that sucked were all substitute nurses. That makes a lot of sense. Too bad Romy came in during this bad timing!
Monday, March 25, 2013
Romy's Appendix Ruptures: Day Three
It is now day three in the hospital with Romy and things are beginning to look a lot better. The report this morning on Romy's white blood cell count is good. His count is down to 13 units, whereas yesterday it was 18 units. The normal range has to be below 10 units, so he is getting there. That means that the antibiotics that the infectious disease doctor prescribed are working to get rid of the bad stuff in Romy's gut, and the white blood cells could take a little break.
Dr. Fowler came in again today and said that based on the lowering white blood cell count, he thinks that Romy will be able to take a CAT scan tomorrow. The new scan will image the rupture and help determine if it is healing properly. He assigned an anticipated discharge date today for Wednesday March 27 - that's in two days! That is good news!
The white board has been filled out almost completely for the first time!
The PICC-line specialist also came in today to check in with Romy. He said that based on the news that he is beginning to get better, the PICC-line will be delayed again until it is absolutely necessary. He might have to have a PICC-line put in once he goes home so that he can continue the antibiotics through IV, but we aren't sure right now if that's still the plan. Since Romy has been feeling better, the nurses reduced his pain medication dose in half. On the first and second day, he needed a 2 mg dose of dalaudid (which is 7 times stronger than morphine) every 4 hours or so to control his pain. Now he only needs 1 mg every 5 hours or so. The pain is going down, so that's good. Hopefully it is a sign that he is healing.
Another piece of good news is that the nurses took Romy off the IV when he is not receiving antibiotics. This means he doesn't have to be connected to the IV rack, which is easy to get all tangled up in while sleeping. The IV has a lot of nutrients in it, so it kind of sucks that they took him off the IV, but it is also good that he is getting well enough he doesn't need it. Its easier for him to walk around without having to push the IV rack everywhere he goes. I have been going with him on mini walks around the hospital floor to get his blood moving in his legs. Romy really doesn't like the inflatable pillow massager thing, so its good he can walk a bit instead of wearing them.
Romy can now sit up without feeling pain at his appendix but still feels tired.
Also today, the doctor ordered an upgrade to Romy's diet. He is now allowing him to eat 'full liquids,' which means he can have creamy things (before he could only have clear liquids like apple juice and soup broth). For lunch he had some vanilla pudding. Today for dinner he had cream of celery soup and some lemon pudding. He also gets tea and milk, although he hasn't been drinking the milk at all. No solids yet. We have been amazed at how void of nutrition all the hospital food has been so far. Maybe the solid food that they serve is better, but the liquid diet food is horrible in terms of the nutritional content. The juices that they give are mostly juice cocktails, meaning its about 10 or 20% real juice, and the rest is sugar water. The only good thing they gave Romy so far was the milk and pudding. Now that he can have a full liquid diet, most of what they give is dairy based.
There is a Whole Foods store one block away from the hospital. I go there every morning for a latte and I have been picking up coconut water and real 100% juices that are organic for Romy to drink while he is here. Since he is off the IV, the only source of nutrients he gets now is from what he can eat (well, drink really). Based on the labels of the food he has been given so far, the hospital food is very void of nutrition. It is a lot of sugar and fat, with little fresh food, and very few vitamins. Romy needs good food to help him heal that has a lot of vitamins. Everybody in this hospital should get better food!
Romy is now feeling good enough to make jokes. He is drinking tea with his pinky up.
On a more positive note, the nursing staff has completely changed! When Romy came in, it was a Saturday. The weekend nursing staff was horrible (except for Elita the nurse aide who loved to travel). Sunday, the nursing staff was equally as bad. But something changed after midnight on Sunday (basically very early this morning). It seems the weekday nursing staff is so much better! Romy's first nurse this morning was named Sharon and she was from Las Vegas. She was the best nurse we had so far! She had been nursing for 20 years and you could just tell by how she operated that she was very competent and with it. She came back when she said she would, she was organized and on schedule, and she was very considerate. The nurses are supposed to narrate what they are doing to you, be it injecting drugs, taking blood pressure, etc. She was the first nurse to explain very clearly what she was doing at all times, and she went over many points of information that the previous nurses never mentioned, like how to do breathing exercises to avoid getting pneumonia, and other stuff. Nurse Bende from Denmark replaced Sharon for the day shift. She was wonderful too and also very competent and with it. The nurses so far today like to talk to Romy and in general attempt to understand what is going on and are sooooo helpful. What a world of difference from the weekend staff!!!! In comparison, the weekend staff were lazy, mean sometimes, and not prompt. They just seemed to not care, and many acted like it was only a 9-5 type thing. Elita was the only nice person over the weekend. Elita was the one to let us know about the charge nurse.
There is a white board on the wall at the foot of Romy's hospital bed where the nurses are supposed to write some information. At the top should be the doctor's name in charge, the nurse and nurse aid in charge, and the charge nurse on duty. Under that should be the plan for the day. Below that should be the time of last pain medication, and below that the current pain level. Over the weekend, the only part of that board that was filled out was the plan for the day which said, "Pain management, IV fluids, antibiotics." Occasionally, the nurse wrote her own name down. However, we were confused about who the doctor was because it wasn't written down. We often forgot when the last time Romy had his pain medication given to him, so I actually started writing it on the board! Now that the weekday nursing staff is working, that white board is always full of info, and the nurse updates it every time she walks in to check on Romy. What a nice change! If this is how it was when Romy first came in, we would have no complaints.
Romy is now on a full liquid diet and they are allowing him to walk around if he wants!
Very very early this morning, a new patient was put in the bed next to Romy. It was a Polish guy who broke both the bones in his lower leg playing soccer at the soccer field next to the race track by I-580. The break was a complete break, so he was put on pain medication and was waiting for surgery to put a permanent metal rod in his leg. He and his girlfriend who stays with him are very nice and considerate (much better than the old dude with the hernia and his annoying wife). They were here for most of the day, and then were sent off to the basement for surgery in the afternoon. They returned later in the evening when it was getting dark, after I came back from teaching Romy's physics class at Dominican. He will be here for another day to recover after the surgery, I think.
Today is the first day Romy feels like taking a shower. But every time he felt like taking one, the nurses hooked him up to the IV for more antibiotics. Maybe he'll take one tomorrow. Also, Mike, our landlord called to ask if Romy was feeling better.
Dr. Fowler came in again today and said that based on the lowering white blood cell count, he thinks that Romy will be able to take a CAT scan tomorrow. The new scan will image the rupture and help determine if it is healing properly. He assigned an anticipated discharge date today for Wednesday March 27 - that's in two days! That is good news!
The white board has been filled out almost completely for the first time!
The PICC-line specialist also came in today to check in with Romy. He said that based on the news that he is beginning to get better, the PICC-line will be delayed again until it is absolutely necessary. He might have to have a PICC-line put in once he goes home so that he can continue the antibiotics through IV, but we aren't sure right now if that's still the plan. Since Romy has been feeling better, the nurses reduced his pain medication dose in half. On the first and second day, he needed a 2 mg dose of dalaudid (which is 7 times stronger than morphine) every 4 hours or so to control his pain. Now he only needs 1 mg every 5 hours or so. The pain is going down, so that's good. Hopefully it is a sign that he is healing.
Another piece of good news is that the nurses took Romy off the IV when he is not receiving antibiotics. This means he doesn't have to be connected to the IV rack, which is easy to get all tangled up in while sleeping. The IV has a lot of nutrients in it, so it kind of sucks that they took him off the IV, but it is also good that he is getting well enough he doesn't need it. Its easier for him to walk around without having to push the IV rack everywhere he goes. I have been going with him on mini walks around the hospital floor to get his blood moving in his legs. Romy really doesn't like the inflatable pillow massager thing, so its good he can walk a bit instead of wearing them.
Romy can now sit up without feeling pain at his appendix but still feels tired.
Also today, the doctor ordered an upgrade to Romy's diet. He is now allowing him to eat 'full liquids,' which means he can have creamy things (before he could only have clear liquids like apple juice and soup broth). For lunch he had some vanilla pudding. Today for dinner he had cream of celery soup and some lemon pudding. He also gets tea and milk, although he hasn't been drinking the milk at all. No solids yet. We have been amazed at how void of nutrition all the hospital food has been so far. Maybe the solid food that they serve is better, but the liquid diet food is horrible in terms of the nutritional content. The juices that they give are mostly juice cocktails, meaning its about 10 or 20% real juice, and the rest is sugar water. The only good thing they gave Romy so far was the milk and pudding. Now that he can have a full liquid diet, most of what they give is dairy based.
There is a Whole Foods store one block away from the hospital. I go there every morning for a latte and I have been picking up coconut water and real 100% juices that are organic for Romy to drink while he is here. Since he is off the IV, the only source of nutrients he gets now is from what he can eat (well, drink really). Based on the labels of the food he has been given so far, the hospital food is very void of nutrition. It is a lot of sugar and fat, with little fresh food, and very few vitamins. Romy needs good food to help him heal that has a lot of vitamins. Everybody in this hospital should get better food!
Romy is now feeling good enough to make jokes. He is drinking tea with his pinky up.
On a more positive note, the nursing staff has completely changed! When Romy came in, it was a Saturday. The weekend nursing staff was horrible (except for Elita the nurse aide who loved to travel). Sunday, the nursing staff was equally as bad. But something changed after midnight on Sunday (basically very early this morning). It seems the weekday nursing staff is so much better! Romy's first nurse this morning was named Sharon and she was from Las Vegas. She was the best nurse we had so far! She had been nursing for 20 years and you could just tell by how she operated that she was very competent and with it. She came back when she said she would, she was organized and on schedule, and she was very considerate. The nurses are supposed to narrate what they are doing to you, be it injecting drugs, taking blood pressure, etc. She was the first nurse to explain very clearly what she was doing at all times, and she went over many points of information that the previous nurses never mentioned, like how to do breathing exercises to avoid getting pneumonia, and other stuff. Nurse Bende from Denmark replaced Sharon for the day shift. She was wonderful too and also very competent and with it. The nurses so far today like to talk to Romy and in general attempt to understand what is going on and are sooooo helpful. What a world of difference from the weekend staff!!!! In comparison, the weekend staff were lazy, mean sometimes, and not prompt. They just seemed to not care, and many acted like it was only a 9-5 type thing. Elita was the only nice person over the weekend. Elita was the one to let us know about the charge nurse.
There is a white board on the wall at the foot of Romy's hospital bed where the nurses are supposed to write some information. At the top should be the doctor's name in charge, the nurse and nurse aid in charge, and the charge nurse on duty. Under that should be the plan for the day. Below that should be the time of last pain medication, and below that the current pain level. Over the weekend, the only part of that board that was filled out was the plan for the day which said, "Pain management, IV fluids, antibiotics." Occasionally, the nurse wrote her own name down. However, we were confused about who the doctor was because it wasn't written down. We often forgot when the last time Romy had his pain medication given to him, so I actually started writing it on the board! Now that the weekday nursing staff is working, that white board is always full of info, and the nurse updates it every time she walks in to check on Romy. What a nice change! If this is how it was when Romy first came in, we would have no complaints.
Romy is now on a full liquid diet and they are allowing him to walk around if he wants!
Very very early this morning, a new patient was put in the bed next to Romy. It was a Polish guy who broke both the bones in his lower leg playing soccer at the soccer field next to the race track by I-580. The break was a complete break, so he was put on pain medication and was waiting for surgery to put a permanent metal rod in his leg. He and his girlfriend who stays with him are very nice and considerate (much better than the old dude with the hernia and his annoying wife). They were here for most of the day, and then were sent off to the basement for surgery in the afternoon. They returned later in the evening when it was getting dark, after I came back from teaching Romy's physics class at Dominican. He will be here for another day to recover after the surgery, I think.
Today is the first day Romy feels like taking a shower. But every time he felt like taking one, the nurses hooked him up to the IV for more antibiotics. Maybe he'll take one tomorrow. Also, Mike, our landlord called to ask if Romy was feeling better.
Sunday, March 24, 2013
Romy's Appendix Ruptures: Day Two
Once Nicole and Marcel left last night, another patient was rolled in and took the other bed spot in the two-bed room. He was an old guy who had a ruptured hernia after it was supposedly fixed two years ago. Over night, the nurses kept coming in to check on Romy's antibiotics, IV, and his vital signs like temperature, and blood pressure. The pain medication wore off, it seemed before any of the nurses would come with more. I kept asking them when Romy would be scheduled for more pain killers, and they always reported a time. However, it seemed like we always had to buzz the nurse to actually get it. It was only until 6am or so this morning that one of the better nurses told us that the pain medication is by request only, and it is not given automatically like the IV or antibiotics. I wish somebody would have said that earlier! By morning, Romy was feeling a lot better, and his fever went away. However, Romy could not eat or drink anything, so no breakfast tray came for him.
A doctor that Romy nicknamed the "douche" came in (yet another different doctor) mid-morning (or yesterday? I can't remember) and asked Romy to recount his version of what happened. They do this to check if you are ok, I guess. So Romy said the whole story about how the first doctor ordered appendix removal surgery based on the wrong CAT scan, and then a second doctor changed the plan due to the misread CAT scan. This new doctor tried to cover for the other doctors saying that nobody misread anything. This just seems hard to believe. How do you decide to drain pus from a clear abscess, but then get another doctor to say that its totally too messed up to drain anything? At this point its very confusing. It seems like the doctors are going back on what they said, and trying to save their own ass because they totally didn't realize they were looking at the wrong CAT scan at first.
Romy felt a lot better this morning after sleeping and getting drugged up on pain medication.
The day progressed kind of slow. Romy was just resting and sleeping. The nurses were monitoring his urine and it seemed to be very dark. The nurse kept saying, "Oh that's dark, let me check if you can drink anything." But then they never came back with an answer if Romy could drink anything. Another doctor came in and he was the infectious disease specialist. He just asked a bunch of questions to determine if Romy was at high risk of begin infected with something already prior to entering the hospital. He determined no, and then left. He also said he would check to see if Romy could drink fluids, but never came back. Then we asked the nurse aid if Romy could drink fluids because we felt he might be getting dehydrated. She was very helpful. She was one of the only nurses (even though she was "only an aid") that we felt did her job properly. She told us to be demanding and keep bothering the nurses if we felt something wasn't right. She said a lot of them are bad nurses and they don't care. She said if we felt we were being ignored, to call the charge nurse (the one in charge of all nurses). So that's what we did. We called the charge nurse and 45 minutes later he came in. We asked about the fluids and the dark pee and told him how we've been asking all morning multiple times and nobody gave us any answer. He said he would ask the doctor and get it taken care of. Almost immediately, (he must of yelled at Romy's nurse) the nurse came in and told us the doctor said that now he could drink clear fluids and eat things like jello only. The nurse bought in cranberry juice and water. Romy drank it and his pee wasn't as dark anymore. Things were starting to get better.
The I.V. is constantly dripping, giving Romy fluids and antibiotics.
Also at some point today, the nurse brought in these inflatable pads that wrap around Romy's calves. They hook up to a machine that automatically inflates them in a pattern that massages his legs to keep blood flowing around in his veins. This is supposed to prevent blood clotting since he is laying in bed all day. I think they are good. I tried them today, and I liked them, but Romy thinks they are annoying.
The nurse brought Romy some air balloons that wrap around his calves and automatically inflate and massage his legs to prevent blood clots.
Also at some point, a PICC-line specialist came in, who was ordered by one of the doctors that wandered in today. He wanted to replace the IV in Romy's hand with a catheter that goes up Romy's bicep and up the arm, stopping right outside of the heart. This just seemed a bit unnecessary at this point. We said that we would rather not have that done, and the PICC-line specialist agreed, but said he was order by one of the doctors (we nick-named this doctor the douche doctor). So that was held off for now.
By the end of the afternoon, we gathered enough information about who Romy's doctors actually were (there were so many, it seemed, in the beginning). There were three in the end today (two in the ER, and a third that appeared today). There was the old guy (Dr. Fowler), who was the one to admit to us in the ER that the February CAT scan was mis-read, then the douche doctor, which might be the one who mis-read the CAT scan (the one who today denied any CAT scan was misread), and then the third woman doctor (Dr. Westergard) who wandered in after the PICC-line specialist. She also agreed that the PICC-line was unnecessary. She then told us that she was going to take over the douche doctor. So I guess now Romy has two doctors - the old dude and the woman doctor. We are okay with that so far. The PICC-line guy was held off, and there was also the infectious disease specialist who is analyzing Romy's blood samples everyday he will be here to monitor.
We found out that the old man in the other bed was a veterinarian doctor. He operates on dogs and cats. He was released later this afternoon and his semi annoying wife came to pick him up. Nobody was assigned to the other bed for the rest of the evening. Yay!
A doctor that Romy nicknamed the "douche" came in (yet another different doctor) mid-morning (or yesterday? I can't remember) and asked Romy to recount his version of what happened. They do this to check if you are ok, I guess. So Romy said the whole story about how the first doctor ordered appendix removal surgery based on the wrong CAT scan, and then a second doctor changed the plan due to the misread CAT scan. This new doctor tried to cover for the other doctors saying that nobody misread anything. This just seems hard to believe. How do you decide to drain pus from a clear abscess, but then get another doctor to say that its totally too messed up to drain anything? At this point its very confusing. It seems like the doctors are going back on what they said, and trying to save their own ass because they totally didn't realize they were looking at the wrong CAT scan at first.
Romy felt a lot better this morning after sleeping and getting drugged up on pain medication.
The day progressed kind of slow. Romy was just resting and sleeping. The nurses were monitoring his urine and it seemed to be very dark. The nurse kept saying, "Oh that's dark, let me check if you can drink anything." But then they never came back with an answer if Romy could drink anything. Another doctor came in and he was the infectious disease specialist. He just asked a bunch of questions to determine if Romy was at high risk of begin infected with something already prior to entering the hospital. He determined no, and then left. He also said he would check to see if Romy could drink fluids, but never came back. Then we asked the nurse aid if Romy could drink fluids because we felt he might be getting dehydrated. She was very helpful. She was one of the only nurses (even though she was "only an aid") that we felt did her job properly. She told us to be demanding and keep bothering the nurses if we felt something wasn't right. She said a lot of them are bad nurses and they don't care. She said if we felt we were being ignored, to call the charge nurse (the one in charge of all nurses). So that's what we did. We called the charge nurse and 45 minutes later he came in. We asked about the fluids and the dark pee and told him how we've been asking all morning multiple times and nobody gave us any answer. He said he would ask the doctor and get it taken care of. Almost immediately, (he must of yelled at Romy's nurse) the nurse came in and told us the doctor said that now he could drink clear fluids and eat things like jello only. The nurse bought in cranberry juice and water. Romy drank it and his pee wasn't as dark anymore. Things were starting to get better.
The I.V. is constantly dripping, giving Romy fluids and antibiotics.
Also at some point today, the nurse brought in these inflatable pads that wrap around Romy's calves. They hook up to a machine that automatically inflates them in a pattern that massages his legs to keep blood flowing around in his veins. This is supposed to prevent blood clotting since he is laying in bed all day. I think they are good. I tried them today, and I liked them, but Romy thinks they are annoying.
The nurse brought Romy some air balloons that wrap around his calves and automatically inflate and massage his legs to prevent blood clots.
Also at some point, a PICC-line specialist came in, who was ordered by one of the doctors that wandered in today. He wanted to replace the IV in Romy's hand with a catheter that goes up Romy's bicep and up the arm, stopping right outside of the heart. This just seemed a bit unnecessary at this point. We said that we would rather not have that done, and the PICC-line specialist agreed, but said he was order by one of the doctors (we nick-named this doctor the douche doctor). So that was held off for now.
By the end of the afternoon, we gathered enough information about who Romy's doctors actually were (there were so many, it seemed, in the beginning). There were three in the end today (two in the ER, and a third that appeared today). There was the old guy (Dr. Fowler), who was the one to admit to us in the ER that the February CAT scan was mis-read, then the douche doctor, which might be the one who mis-read the CAT scan (the one who today denied any CAT scan was misread), and then the third woman doctor (Dr. Westergard) who wandered in after the PICC-line specialist. She also agreed that the PICC-line was unnecessary. She then told us that she was going to take over the douche doctor. So I guess now Romy has two doctors - the old dude and the woman doctor. We are okay with that so far. The PICC-line guy was held off, and there was also the infectious disease specialist who is analyzing Romy's blood samples everyday he will be here to monitor.
We found out that the old man in the other bed was a veterinarian doctor. He operates on dogs and cats. He was released later this afternoon and his semi annoying wife came to pick him up. Nobody was assigned to the other bed for the rest of the evening. Yay!
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