Belle

April 22, 1993 - November 28, 2007

Today, Mom and I went to the vet and put Belle down. It was hard. It was sad. It was time. She really had no quality of life anymore. She couldn't see, couldn't hear. She whined a lot from pain. She shook at times from pain. She constantly had dermatological infections. She couldn't play anymore. She couldn't run anymore. She slept most of the day. Scratched all the time. Cried a lot.

It's different to think about death and dying in regard to a dog. But the loss of an attachment hurts no matter what form the attachment was in. I was blessed to have her in my life. She was a fun dog. A good dog.

Should I blog or not?

Today in school, we talked, in 2 different classes, about the importance of privacy and respecting HIPAA. HIPPA is a warranted, yet quite annoying act. If you haven't heard of it, you will. I have personally taken great pride over the past 4+ years of my personal practice of HIPAA. I do my best to not reveal, disclose, or transmit any information about any pt that I come in contact with. At times my personal observation of HIPAA has even offended those I know when I won't discuss the current health status of a joint friend. Not following HIPAA guidelines can have serious consequences as outlined in section 1177:

"WRONGFUL DISCLOSURE OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

"SEC. 1177. (a) OFFENSE.--A person who knowingly and in violation of this part--

"(1) uses or causes to be used a unique health identifier;

"(2) obtains individually identifiable health information relating to an individual; or

"(3) discloses individually identifiable health information to another person,

shall be punished as provided in subsection (b).

"(b) PENALTIES.--A person described in subsection (a) shall--

"(1) be fined not more than $50,000, imprisoned not more than 1 year, or both;

"(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and

"(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.

The class discussions today, brought of different aspects of HIPAA which have caused me to feel quite perplexed. I fear that many of my blogs may in fact be in violation of the law. I question at this time what I can and can not share. I question whether I should blog at all about my experience. I pondered today shutting down my blog altogether, but I have really enjoyed it. So I ponder if I should or should not blog. Without the mention of pt cases it is not very interesting. However, I wouldn't want to go to jail for 5 years or pay $100,000 in fines. I will have to ponder this more.

Feeling Thankful

I worked yesterday. It was good to see friends and feel the building excitement of Thanksgiving and the approaching holidays.

Working also helped me to reflect on what I have to be thankful for.

Yesterday, I saw the worst wounds I've ever seen. This woman was literally coming out of her skin. The wounds were huge and the skin was decaying all around. She had been at home literally rotting away and admitted the night before for treatment. I am not sure if we can treat her. She was in so much pain; it hurt her to sit, to stand, to lay on her back, on her stomach, on her side.

Last Thursday I had a 26 year old pt at the hospital. She had been shopping in a store that was being robbed. The robber came up behind her and slashed her throat three times and then stabbed her in the face twice. She only spoke Spanish. My Spanish is muy picito y mal. We laboriously conversed all morning and I discovered that she has been in the country for 3 years and has a ten year old daughter. At the end of the day she discharged home. She was petrified though. She came to a new land to have a better life and got assaulted.

Last Friday I had a 53 year old pt who was in the hospital for a gastric bypass sx that went bad. Her husband left her, one of her sons died, she can't eat, she has no energy, she has chronic abdominal pain, and her hair is falling out.

At times working with so many sad situations can be depressing and can cause one to feel somewhat hopeless regarding the fate of this world we live in. But at times, working with so many sad situations can reaffirm how completely and totally blessed I am.

I have great friends. Friends who encourage me and lift me up. Friends who know me and understand me. Friends who laugh at my jokes (or suttle sarcasm). Friends who tell it to me straight even when they know it's not what I want to hear. Friends who listen. Friends who truly care about me and I about them.

I have a beautiful family. One that is quickly multiplying. A family who encourages me, lifts me up. A family that makes me feel appreciated, wanted, needed, and loved. I have two parents who have always guided me and been there to cheer me on or pick me up. I have three sisters who have always been and will always be my friends. I have three pretty great brother in laws who respect me. I have three little friends who make my heart smile.

I have a strong healthy body. My extremities work. I can breathe. My heart pumps. My skin's intact. I have no difficulty with my bowels or bladder. My senses are all working allowing me to feel, taste, hear, see, and smell. My mind works well. I have good energy. I can communicate with my friends and family. I can play with my little friends. I can learn. My liver and pancreas function well. My hormones are balanced.

I've been able to travel and go places. Four countries, hundreds of cities, a multitude of states. On my travels I've been able to eat some excellent food, see some great shows, see God's magnificent creations, experience new cultures. Grow.

Hawaii

Las Vegas

Panama

I was allowed the opportunity to quit my full time job and go back to school to push myself farther, reach higher, and pursue.

I have so many many more blessings than those I've listed. I am truly truly blessed. I have a lot to be thankful for.

Liver

My second week of clinicals was a little less exciting than the first week. I had a 72 yo African American male. He was fun and I had a good time hanging out wit him. Most the time when people are in the hospital it is not a joyous occasion. Births are the only real joyous hospitalizations. Well, my guy had HCC or hepatocellular carcinoma or liver cancer. So he was admitted to the hospital to have a right hepatic lobectomy. They went in and took out 3/4 of his liver. The tumor they removed was ~20cm which is a little more than 7 inches. The medical student who came in on Thursday jokingly said he actually delivered a small baby. The pt got a kick out of that. This type of cancer is not generally followed up with chemo or radiation, so pretty much the treatment for his HCC is complete. The doctors said they got it all, so I suppose this was actually a joyous occasion. The pt said he could tell a big difference. He said that before he could feel his liver protruding from his belly. It was actually pushing on his kidneys and causing him to have trouble urinating also. He said over and over how good he felt.

I did get to remove his catheter, his IV's, and do his discharge education. We talked a lot about his alcohol and tobacco habits and how they would negatively impact his healing and length of life. He said he had no need for any of that anymore, but who knows. Overall, he was a fun guy to talk with. He had been a concrete worker before he retired and laid many of the bridges on I-24. He also has 11 children with his wife. He was a fun guy to take care of last week.

Last week was the most hectic week. We had 3 tests and 4 major projects due in one weeks time. To make things even more difficult, we had all of our tests outside of class time and two of them were on my days off. This made it really hard to get my projects done. The week was so hectic that some people even dropped out last week and some are still thinking about it this week. I'll admit it's tough, but not unconquerable.

Next week is Thanksgiving and I get the whole week off!!

Laptop Girl 2

So what happens when you sit for 6 hours a day and look at celebrity blogs on your laptop instead of listening to important lectures reguarding treatment you are going to give to sick patients in hospitals???

Answer: Your drop out of school when you make bad grades.

Urine and Shoo Shoo

Last week was full of excitement. Thursday and Friday we went to the hospital. It was really funny being there as part of a different team. It is truly amazing how much nutrition and nursing interact. It's funny to be on the other side. While I was at the hospital on Friday there was a dietitian on the floor with 2 interns. This time last year I had 2 interns following me around. And now I'm less than an intern. Hadn't really thought about that before hand; funny how things turn around.

Thursday was fun. I had a middle aged female who was 1 day post op gastric bypass surgery (nutrition stuff again). She was super nice and let us poke and prod and look and inspect. She was very gracious to my partner and I. She was a true pleasure. She had a 10" incision in her abdomen - it was very pretty. There were 28 staples. Good times. Although she was a perfect pt, she was a little boring to take care of since she was so independent. But then some excitement came about. Another pt down the hall needed a catheter. Her catheter had been dc'd the day before and she had not urinated since, so she needed an in and out cath. An in and out cath goes in, gets all the urine out, then comes out. So they told my partner and I that we could put it in. I was extremely excited. Put a catheter in a real pt and not just a mannequin with a huge pee hole!!! So I was nonchalant with my nurse partner for the day.

"you can do it if you want" I said thinking she doesn't want to.

"are you sure?" she said, "don't you want to do it?"

"yeah" I said, "I'll flip you for it. do you have a coin?"

"no" she said, "lets rock, paper, scissor it."

"okay" I say - I have to win this!!

1-2-3 both scissors. do over

1-2-3 she's scissors. I'm rock. I win. I get to do the catheter!!!

The pt is a young woman who was in a car accident and broke her pelvis. We go to her room and find her walking to the bathroom trying to urinate so we won't have to cath her, but she got nothing. so in we go. Now when you cath a woman you prefer for her legs to be as far apart as possible so that you can clearly see the urethra (also known as the pee hole). Unfortunately, when your pelvis is broken it is difficult to spread your legs. So I got about a 3" spread (this is very small). So her legs are very large and she is African American and I can't see anything. My partner is holding the flashlight and I'm looking and thinking maybe I should have chosen paper. Oh yeah, and the pt keep screaming in shear pain due to having her legs slightly spread with a broken pelvis. So I go in, only it was the wrong hole. I tried to cath her vagina. Just so you know I didn't get any urine. So I pulled out resterilized my field and went in again. I still saw nothing. It was like a wall and then all of a sudden this little window came open and a hole appeared. I threaded the catheter in. Poof, we made contact. A flood of urine field my bag. I got 400 mL. It was very dark. I pulled the catheter out. We covered her back up, she screamed some more. We were gone. I charted. Task completed. Urine retrieved.

Friday wasn't nearly as exciting. We started our morning evaluating our patients and taking vital signs. We had some down time and one group had a job to do, so the rest of us joined them. So all 6 of us went in to take care of an older man. He has 2 broken arms and a broken leg(that's what happens when you are walking down the street drunk). Oh yeah, and he's delirious. So as he said he had a shoo shoo. So we all go in to bathe him and change his sheets and he's laughing and doesn't have a clue that 6 girls are in there who don't have a clue what there doing and we're laughing and he's laughing and the whole thing was really funny. The rest of that day was super boring. I mean when the highlight of the day is cleaning up a delirious man's shoo shoo....well, you get the idea.

This week I have three tests, a paper due, and two more exciting days at the hospital. Can't wait.