Sunday, July 27, 2014

Smoky Mountain Adventures, Cosby style

 My skills are rusty.  I'm not sure where to begin this tale.  I suppose we will start at the beginning of an adventure.  See that road?  It leads into Smoky Mountains National Park, the Briarwood section, to be precise. 

This is the Little Pigeon River.  It was quite lovely.  And clear.  And noisy.  All things that rivers are NOT in Oklahoma.
 But the river is not where the adventure begins, but rather where it ends.  This is where the real adventure began.  The Grapeyard Ridge trail.  It is 3.2 miles long, as you can see.  Do you know what happens when one hikes up a trail?  You must hike back DOWN the trail.  So, it is really a 6.4 mile round trip.  I just felt the need to brag there a bit. 
Of course, if one adds the hike from the car to the trail, it is another half mile or so...
But we won't dwell on that, as surely that is too braggerly.

When I was looking at this photo in my phone I tried to remember what it was about. Then I remembered our first bear encounter.  See that round dark shape up the trail from Grace?  It was just past the first switchback on the hike.  Maybe a tenth of a mile in...Grace froze, ducked down, and said "I see a bear."  I froze.  Brent and Mindy kept walking.  The bear didn't move...

Fortunately, this particular bear was NOT a bear, but was a stump.  But it got our adrenaline going in any case!  See that marred spot in the moss near Brent's hand?  That was our first real live bear track.  And then the adventure got a little more real.

 About that time I picked up a big stick.  Becuase all I could remember in that moment about bear attacks was to back away, make loud noises, and if they continued to come at you, grab a big stick. I decided that having the stick beforehand was quite practical.  See those tracks in the above photo?  Grace spotted those.  She turned out to be an excellent tracker and spotted every set of tracks we saw.  

Fun fact:  There are two bears for every square mile of the Smoky Mountains.  Well, it's a fun fact unless one has hiked up a trail and suddenly realizes they have not seen one single soul, and surely one is nearly half way up the trail...

The thing about the forest is...There are a lot of trees.

Trees are everywhere...

So much so that if one wanders off of the trail more than a few feet (you can see the trail in this photo if you look closely) you can become quite lost.

Now about this time in the picture we are beginning to question the wisdom of this climb.  And whether we were even on the right trail.  It was no longer as wide as it had been.  And there were no human prints to be discerned.  Just bear and deer.  You can't help but wonder if perhaps the park rangers should do a better job of educating the bears on what is game trails verses people trails.
A very short while after this photo was taken......
Yes!  We had stopped for a short breather, evaluated that yes we WERE determined to reach our goal, and Mindy was faithfully carrying two stones and clacking them together, and we were singing quite loudly...
And then Brent began to yell.
I nearly had a heart attack!  THE BEARS ARE GETTING HIM!  
I turned around to look and he was flopping his arms.  
Then waving his arms.
And he was making strange warbling sounds...
Then he took his hat off and began to wave it frantically around.

You will be relieved to know that we kept a safe distance from him, trying to determine what the danger was.
It turned out to be a yellow jacket.  
And it stung him 8 times.
 And after the eighth sting, he finally gave up on killing the thing, and ran away...
But he ran back DOWN the trail...

Away from his laughing family. 

Yes, we were laughing.  It was like something like out of the Great Outdoors, or when the squirrel comes out of the tree in Christmas Vacation.

And that is just funny, folks!
Besides, it's not like he was dying or anything.
Just in store for some major pain.

Yes, I'm sad that he was stung repeatedly (please note that one should RUN when being attacked by wasps, not stand in one spot and try to swat it with a cap), but I'm even more sad that I didn't VIDEO the whole episode!

Besides, after I'd been nervous about bears for the past thirty minutes, I was easily tipped into hysterical laughter.

 At last we reached our destination.  See that round dark shape under that tree?
That is a steam engine!

This engine fell of the side of the mountain in 1920.  It was sent up the mountain to get wood to build a school for Briarwood.  The driver was unable to maneuver a switchback and crashed the engine.  How scary is that?
Brent had not allowed the girls to snack as we went up the trail.  He didn't want the smell of food to draw bears to the trail.  
Since we still had to hike back DOWN and all.

You may look at this picture and see more forest and rhododendron.  However, it is not just forest.  It has a pile of rocks up in the middle.  And that pile of rocks is the chimney of Dolly Parton's grandfather's homestead!  Seriously!  And yet we still didn't see another soul!  If you won't hike up a mountain to see a steam engine that fell off the mountain, surely you will go to look at a pile of rocks!

I include this photo to show you what a great comfort obviously sawed off logs are when one is not sure they are still on the designated trail.  I must confess as the trail narrowed that I did fear we had mistakenly gotten on a game trail at some point.

You see, the trail had no designated foot bridges.  At one stream we crossed over on a handy log that was across the stream.  After I did some foolish balancing stick and eagle poses, then fell off of the log into the stream, I realized that there was the trail to and away from the log...

(Even worse than the fall in the stream?
I got my legs all muddy on the side of the log. 
And grass stains on my yoga pants!)

And another trail that was further up stream that popped out on the other side.  We debated about which trail to follow and by the grace of God we picked the right one!  

If I had read the scavenger hunt guide book I had bought thoroughly BEFORE beginning the hike I would have been aware of this potential hazard.  And I would have known the bear statistics before we were three miles up a mountain with no source of protection!

As we hiked down, Brent tended to lead with the girls behind him and I took up the rear.  Surely the bears were going to attack the lead or rear?
See that pile of rubble in the middle of this picture?  It's an old homestead.  All that is left is a portion of a wall.  Thanks again, handy dandy scavenger hunt book!

We had all looked forward to a lovely break at the steam engine wreck.  However, Brent's legs were giving him trouble from the stings (my first aid kit was in the car, 3 miles down the mountain), so we decided to eat and walk.  Except Grace decided she was no longer hungry.  

Instead she became terribly cranky. 

And then she decided that she did not need to wait on us to dawdle our way down while I took lovely pictures.
I offered her snacks.  She stated she had her own snacks, but was hungry for real food, so she was going to RUSH down the mountain to get to her sandwich...

This plan worked fine until she walked into about the seventh spider web.  Then she had a complete freak out moment which resulted in screaming, stomping, throwing her water bottle on the gound and jumping up and down on it repeatedly...Apparently she was determined to make the lid fly off.

And it didn't.

How frustrating.  

She had a great plan to vent her wrath.
And it didn't work.
And then her whole family laughed at her. 
While they kept walking, of course.
I said in my best mom nurse voice "Now, since you've made a fool of yourself, eat some crackers.  You're cranky because you need carbs.  No more arguments."
And so she ate as we continued our trek.

See the fence post?  Yet more evidence of settlers! 
Shortly after this post I made a fool of my own self.  I was following Mindy.
Mindy is exuberant in all things.
She was picking up bits of bark and stones and would toss them off the trail.
Then they would hit trees.
And then they would ricochet back and I would have to duck to avoid them.
And I would tell her "STOP."
So, then she picked up a very long flexible stick.  It made a nice whipping sound as she swung it.  "I will scare the bears off with my whip!"  Then she reached back to get a really good sound...
And fortunately I put my hand up because the stick wrapped around my arm and hit me in the head.  I barely protected my face.
 I glared at her.
She gave me an "Oops" face and  continued on her way...
Fast forward twenty feet...
She jumped up and grabbed a rhododendron bush, then let it fly.
It slapped me full in the face.

 I think my head spun completely around before I grabbed her by the jaw.  Naturally, she tried to duck away.
So, I grabbed her by the back of the head.
And I said in my scariest mommy voice EVER "Do. Not. Hit. Me. Again."
And then I let her go and began to hike as if nothing happened.
She walked very quietly up ahead of me...
You see, Mindy is manipulative.  She always goes off and pouts in hopes that I will feel bad for scolding her.
It didn't work.

 Okay, see that log at a right angle to the moss covered log?  That's the log of deception. Instead, you need to walk up the stream a ways, in the water (as you can see it's very shallow) and come out on the correct trail.  See how one can get lost?

At last we finished our hike. 
We decided to picnic on the rocks along the Little Pigeon River.

But not too closely together.
We needed some carbs to quiet the bears in all of us.

Who knew that the only bears we encountered would be ourselves?
Hey!  I'm including this picture because I need to tell you about this restaruatnt!
If you ever go to Gatlinburg, you need to drive east to Cosby.  Drive down 321 until you get to Kyle Carver's Orchard.  They not only have beautiful orchards with a fabulous produce market, and their restaurant is not only wonderful, but their prices are very reasonable.
I had chicken and dumplings on the advice of our resort staff.
Brent had fresh grilled trout.
Grace ate shrimp.
Mindy had barbecue cooked in their special apple barbecue sauce.
Each of us loved our food, but I gotta say, the chicken and dumplings were the best in my opinion.
Each entree comes with apple fritters, apple butter, apple cider, an appetizer of soup or salad, and fresh made rolls! The food was great!  The view fantastic! The wait staff accents were priceless!
All around, it was a great way to end the day.

That was a really long post, no?  

Thursday, December 26, 2013

The Excitement

Yesterday was a pretty ordinary Christmas day.  We got up early to open gifts and admire our Santa gifts.  I cooked and cooked and cooked while Studmuffin assembled a 375+ piece marble run that was a gift for Popcorn. 

Then we overate...

The day progressed in the usual fashion including the part where the four of us sat down to play all of the games we received.  The girls started to spat, and then their father lost his temper due to bickering and sent them to bed at 7:30....We all three sat there quietly, hoping that he would relent.  He didn't.  And I drew on all of my submissiveness and said not a word as my beloved adolescent daughters slunk off to bed.

Then I got wrapped up in a jigsaw puzzle which I obsessed over until nearly midnight.  As I began to clean up stray glasses and napkins from the day of overindulgence, Chesney (Brent's golden retriever) began to sniff about the house.  I did a quick check of the counter tops and put away the last bit of food so that she wouldn't "retrieve" any snacks as she's been known to do. 

So, I had lain in bed maybe fifteen minutes, trying to find a comfortable position as I have a self diagnosed pinched nerve in my neck and I couldn't scavenge enough time in my day of over indulgence to stretch out my tightened muscles.  I began to hear a chinking sound, like when one is emptying the dishwasher.  Only I was 99% sure my children were NOT emptying the dishwasher after midnight since I can barely FORCE them to do it during the day.  I sighed and twinged as I climbed out of bed to go see what the matter.  I flicked the light on  over the piano as I strolled by in order to avoid the various debris that results from Christmas. 

I rounded the couch and Kelsey (my dingo) came out from behind the dining room table, near the bay window, and Chesney, the biggest fraidy cat in the history of EVER came out growling from the other side.  I scolded her for growling and continued to approach.  I told her "be quiet" again, then made the mistake of reaching down for her.  She continued to growl and low and behold next thing I knew there was a genuine dog fight going on right at my feet!  I yelled and drug them apart, and they just continued to bark and growl and snap at each other.  About this time Studmuffin showed up to yank them apart for good and sent Chesney to bed.  Kelsey then slunk over to her own bed.  I gave them both a full once over and discovered that they were fine. 

After a brief investigation I discovered the cause for the fight.  I had forgotten a bowl full of dinner rolls on the table that was draped in a cloth to keep them warm.  The dining room chairs were not tucked in properly.  Apparently the dogs had gotten up ON TOP of the table and were greedily scarfing down dinner rolls and then they heard me approaching.  The chinking sound was the bowl bumping against some glass candle holders. They scrambled down before I could catch them, and apparently Kelsey ate more than her share because Chesney was voicing displeasure.  Then I made the mistake of approaching Chesney in her first ever attempt at bravery and dominance.  Kelsey decided such insubordination was NOT to be tolerated and dove into her before I could even blink...

At least that's the scenario I came up with as I lay awake another two hours trying to come down from my adrenaline rush.

Brent insists HIS dog was on the floor waiting for Kelsey to throw her a roll because she would NEVER climb up on the table.  Apparently climbing on top of tables is limited to the dingo breed, not the super obedient submissive golden retriever breed.  In Brent's story the growling was simply because I came in before Kelsey held up her end of the bargain.

Oh, did I mention Kelsey weighs 50 pounds and Chesney weighs 60?  I've been chuckling over the image of those two monsters on my dining room table all day.  When I wasn't debating never allowing them in the house again.

What was the most exciting part of your day?

Saturday, November 16, 2013

The Twilight Zone

Do you ever sit back and say "Did I really just DO that?  Who's life am I livin' anyway?"
This weekend my brother was nearby visiting his daughter and going to a football game with her.  I invited him to watch Bookworm play at our local high school play off game.  They let the junior high band play for the last home game...
Apparently, there was a football game going on. 
And I actually enjoyed it.
Until my brother and niece left at halftime, because her lactose intolerant self ate cheese at a Mexican place before coming...
Then it was just mostly Popcorn and I, sitting and freezing with me watching people and her complaining of being cold and that she hates football and her head hurt...
"We can't leave.  We are here to hear your sister play."
Because surely that's why 99% of people go to games...To listen to the band.
Popcorn's reply? "The band is playing?" 
My child is 4th flute from the left

So, she was loving all aspects of the game.
The best part of the game for me?  Well a gentleman behind me was watching his grandson play.  At one point he yelled "HELLFIRE!"  And I couldn't help but turn around, look at him and laugh.  Then he asked what was so funny...And then I felt weird and decided he must not have yelled "HELLFIRE" in the game.  And then he wouldn't let it drop.  And then I told him what I THOUGHT he said.  Turns out a good understanding of the game would've helped here as he was yelling "HORSECOLLAR!" 
He was still laughing at me when the game was over.
Then, today out of the blue Popcorn informs she'd like some Miss Me jeans.
Excuse me?  Who's child IS this?  "Mom, everyone has them..."  
"Everyone?  Does Jordan?  Or Amanda?  I know Austyn has them, but only as a hand me down from a sister who was GIVEN them as a hand me down.  I can put rhinestones on your jeans."
HOLD THE FRONT DOOR!  Did I just say I'd bedazzle something?  And did I just mix my euphemisms?  Is that a euphemism?  WHAT is a euphemism?  Oh, wait.  I googled.  It's an idiom.  Here's the deal:  Does one need to know the correct label for such things once they aren't required to label them by a grammar teacher?  I think not.

Next thing ya know I'm buying a bedazzler for $9.99 at Walmart and trying it out on a pair of jeans she doesn't like.  BIZARRE.  There is a big downside here.  The thing doesn't fit in her pockets so she will officially not be able to use her pockets now.  If she ever did anyway.
Don't worry.  I'm feeling like my old self now.  I went on a manic quick clean up spree before Brent gets home from scouting deer, and I'm about to lie down and read a book.  Then everything will be back to normal.
I hope.

Saturday, November 9, 2013

Street Cred

Yesterday Bookworm and I were eagerly choosing outfits for "White Christmas,"  Popcorn was working on math, and Brent was about to shower after a day spent in the concrete yard.  The doorbell rang.  I immediately guessed it would be our neighbor boys wanting Popcorn to come jump in the mud puddles with them, so I rushed to get the door before she could get sidetracked with fantasies of mud.

I opened the door to see C, a girl Bookworm's age who comes to her grandparents house after school until her parents can get off work.  They live directly east of us, one street over.  Remember, everyone in our area has minimum one acre lots in our neighborhood.

"Hey C!  How are you?  Girl, what are you doing running around in shorts in this cold weather?  And where are your shoes?  Did you run over here in socks?"  And in the midst of my maternal lecture I notice there are muddy footprints leading down the sidewalk to the front door..."And did you run through the mud?" 

At this point I notice C is pale.  And she is panting and clutching her chest.

"Are you okay?"  Never say my assessment skills aren't mad, Gentle Reader.

"There's someone in my Grandma's house,"  she panted out and is now bent over with her hands on her knees.


Apparently she was on the phone with a friend, standing in the kitchen when the phone went dead.  And this event coincided with something falling from the direction of her grandparents bedroom.

"And my grandparents are out of town and they took the dogs with them, and I just took off running, and I stopped at three different houses on my way over, but nobody's home, and I fell in the mud..."

"Okay, sweetie, come in this house.  I will get Brent and we will check it out."

"My feet are all muddy..."  I had her bring her shivering little self in and told Popcorn to go get her a pair of shoes while I got Brent.

I went to get Brent, "Don't get in the shower, C came over and she thinks there is someone in her grandma's house..."  And we repeated the tale of woe to him as he grabbed his keys, threw his feet in his work boots and we headed to his truck.  Because it was muddy.  And we didn't want to get our feet muddy. 

And we needed to be able to make a quick getaway in case a crazy axe murderer was hiding in Grandma's closet.

Can we just pause and say kudos to C who didn't "Run up the stairs when clearly she should run out the front door."  Because when she told me her tale, I immediately went to Scary Movie in my brain. 

So, we get to her grandparents, and the garage door is wide open.  "I left it open because I was just running."  And after questioning about the layout of the house, Brent ascertained that the front and back  doors should both be locked. 

Brent just strolled into the house through the garage door like he owned the place. And C just followed him right in! 

Wait!  Where is his gun?  Don't we have like 27 of those in our house?  And why is she following him IN the house?  And now back into the hallway?  Good grief. 

"C, honey, you stay here with me while he checks it out."  So, she scampered back to me in the kitchen and clutched her tummy and rocked back and forth and rattled out about she was on her grandma's cordless landline and it just went dead then a big bang came from her grandma's bedroom and she just took off running and didn't get shoes or her cell phone or anything...

"You did the right thing.  Come over any time..."

And about this time  Brent came back into the living room and spotted a can of bug spray sitting on the TV console.  "Good idea, I'm going to take this."  And I confess my brain said, "Yes, because we didn't have 58 guns at our house along with about 200 boxes of ammo.  Nope.  That's someone else's house..."

But I showed restraint.  I simply continued to reassure C with my presence as Brent checked every closet and cabinet and even shower...

After determining that we could find no evidence of anyone in the house, or sign that they had been in the house, it was decided that C would come home with us, so she gathered up her school gear and shoes and headed to Brent's truck.  As we headed to the truck, I noticed a container of applesauce lying in the yard, along with a spoon resting perfectly in it.

"Were you eating apple sauce?"  And I picked up the container to show her.

"Yes!  I just ran out so fast, I still had it in my hand, then I realized I had it so I threw it as I ran to the neighbors."  And for some reason this was uproariously funny to all three of us.  We laughed the rest of the way home.  (You know, the whole 45 seconds.)

Within minutes of getting home C's mom came to get her.  I went back to bemoaning my wardrobe and absolute lack of ANYTHING to wear, and Brent resumed his efforts to shower away the concrete residue...

"Apparently C keeps bug spray out all of the time when she's alone.   And when she gets scared she grabs it," I yelled from the depths of my closet.

"That's pretty smart.  I was glad I saw it."

At this point I came out and said, "So why did you go over there with no gun?  What if someone WAS in the house?  What was your plan?  You didn't even bang on the door and yell 'HELLO!'  I was somewhat surprised by your approach."

"Babe, I work with 80% convicted felons.  I don't need a gun.  I have STREET CRED."

Good to know.  Good. To.  Know.

Thursday, November 7, 2013

Elder Ott and Elder Frock

So I worked Monday.

Popcorn had tumbling.

This means that Brent has to grab the girls directly from the bus rush her to throw on some tumble appropriate attire and head out the door.  Apparently in the midst of this chaos and rush, rush, rush, our neighborhood LDS boys came by for an offer of prayer.

"Hi, I'm Elder Ott and this is Elder Frock.  We were wondering if there was anything you needed to pray about today."

Elder Ott and Elder Frock?  Surely he misheard.  So, he took a gander at their handy dandy name tags, complete with religious affiliation.  Just in case he wasn't clear on who they were based on white shirts and black ties...Sure enough.  Elder Ott and Elder Frock.

He's so mature.  He immediately began to grin great big and swallow back his laughter.  "No, not today.  But we go to a great church if you'd like to come join us on Sundays.  Our pastor is great.  He does a lot of teaching out of the Bible.  We'd love to have you come visit."  And he told them the location and times of service.

"Yeah, we know that one, it's a really big church.  Well, do you know anyone in your neighborhood that might need prayer?"
Brent helpfully said, "You can visit the house at the end on the left.  Knock on their door and maybe you can get them to come."

"Do you know their name?" asked one of the Elders.

"No, you rarely see them, but maybe you can get them to come out in the daylight." 

"Is this a setup?"  Apparently Elder Ott and Elder Frock haven't always experienced love and kindness in their prayer walks...

"No!  I've just never seen them outside.  It's like the Sasquatch that lives in your neighborhood.  You KNOW he's there, but you never see him."

And at this Elder Ott and Elder Frock turned around and walked away.

Huh.  Such a surprise.

Stay tuned, there's more to come!  Tomorrow we will learn about Brent's "street cred."  It promises to be an exciting adventure!

Friday, October 11, 2013

What a Patient Should Know

I think I've been admirably quiet when it comes to the Affordable Care Act.  (Others may disagree. LOL)  However, after just 10 days into the month of October, here are some changes that have already hit the healthcare system that I think every patient should be aware of.

If you come to the hospital bring ALL of your medications with you.   If you are to be admitted on an observation status, Medicare will no longer pay for the hospital to give your medications, unless they are newly prescribed.  This means that my patients who rushed to the hospital with chest pain, but left their Lopressor, Norvasc, Plavix, and Aspirin at home will now be billed for these pills unless their spouse goes home to get them.  These pills will cost anywhere from $20-$200 EACH.  The other option was that the doctor could write them a prescription and they will go to Walgreens in the hospital to get enough pills to last the hospital stay.  This  is not a good option to a patient who just had a three month supply filled, but it is certainly cheaper than paying the hospital itself.  This is an interesting change in mindset, because in the past we gave you OUR pills because then we knew that the pill was truly correct.  I can't tell you how many times I've opened a patient's prescription bottle from home to see several different colored pills.  They had just dumped them all together if the doctor changed the prescription, not realizing that he changed not only the frequency, but the dose also.

Another change is that nurses are now required to chart twice as often on patients who are in observation status.  I don't understand this mindset, other than they want to be sure the patient justifies being there at all.  But in a job where you are lucky to take a potty break, much less a lunch break, this is an interesting challenge added to the day. 

Third, and scariest of all is this:  My hospital system is laying off 500 hundred employees. 


So far they are not eliminating nurses, but I am already anticipating that they will change the patient to nurse ration in an effort to save money.  Obviously, this will affect my job as I currently work all over the hospital covering shortages.  A higher patient to nurse ration means less need for fill ins like me.  Again, while most nurses will rise to the challenge as we are adaptable by nature, this will affect the care you receive.  More patients means less individual care, and I can't tell you how many times I've  had someone tell me their nurse never came to see them.  My answer is this: That usually means there was a much sicker patient that demanded their time.  Be glad you weren't that patient.

Whether the lay offs are nurses or not, your care will be affected.  Less housekeepers means longer to get the room clean between patients, so the longer you will be stuck waiting in the ER with little to no privacy on an uncomfortable stretcher.  It means more housekeeping falling onto the nursing staffs shoulders, because we realize when the housekeepers are being ran ragged trying to get rooms clean, so we end up cleaning our occupied patient rooms ourselves.  Again, affecting the individual time you have with your nurse.  Less dietary workers means longer times to get food to the patients.  Fewer maintenance workers means shoddy equipment, and believe me equipment issues and money to buy new/repair existing equipment has been an issue in every hospital I've worked in.

After being in healthcare for 19 years as of May, I can assure of one basic fact:  If the housekeeping isn't done well, the nurse takes responsibility.  If your food isn't what you like, or doesn't come as soon as you want, the nurse takes responsibility to fix it.  We will even try to do maintenance if the repairman is busy.  It all comes back to your bedside nurse.

Now, while at this time the changes in procedure are in response to Medicare billing changes you need to understand this:  Private insurance always follows Medicare on billing policies.  For example when Medicare changed to reimbursing hospitals a flat rate based on admission diagnosis, private insurance followed. 

Oh, and that brings up an interesting topic.  How will hospitals be paid under the Affordable Care Act?  Here is an example.  I had a patient a few weeks ago who was a physician's assistant.  She has had to stop working because for the last year she has had issues where she suddenly begins "dumping."  This basically means she begins to urinate nonstop, her blood pressure bottoms out, and twice she has ended up comatose on a ventilator.  She has been in every hospital in the Oklahoma City area, and even the Mayo Clinic trying to get an answer.  So far, nobody has come up with a cause.  One of our neurologists felt she should have a PET scan of her thalamus and pituitary gland to see if she perhaps had a tumor there that does not show up on CT or MRI.  Well, the way a PET is normally ordered is when a known tumor is found.  The PET is a follow up to see if it had spread.  In days past the doctor would call the radiologist and ask what he thought, and would he support his decision to do the test.  In fact, the doctor did this and the chief of radiology agreed that in this situation we needed to think outside the box.  Well, here's the kicker:   She couldn't get the PET scan because the insurance would not pay for it without a known previous mass.  While she could do it as an outpatient where she would agree to pay out of pocket if insurance won't cover, we couldn't do it as an inpatient because the hospital would NOT get paid.  So, here is a woman who has lost her livelihood due to a condition that has never been diagnosed.  A doctor thinks outside of the box and tries to see if he can find the root cause.  The INSURANCE decides she can't have the test while in the hospital, and we were hoping to keep her long enough to reproduce the "dumping" so lab work and test could be ran in the process, again hoping to find the root of her illness.

While that may seem like a long and tedious story, here is the most frightening thing I heard during the conversation with the patient.  The doctor said that hospitals will now be reimbursed a FLAT rate on every patient, regardless of diagnosis.  So, whether you come in with appendicitis or a stroke, the hospital gets a certain amount of dollars to treat you per day.  This means that hospitals will have to figure out how to keep costs to a bare minimum so that when they get paid for cheaper hospitalizations, there is some left over to cover the complicated diagnosis.  According to this doctor, and I am not sure where he got his numbers, thirty percent of US hospitals are expected to close their doors within the first three years of the Affordable Care Act.  Here's why this hit me even harder:  This doctor is in favor of the care act saying "Our current system is broken.  We will see if this one is better."  So, here's a doctor in favor of Obamacare stating that THIRTY PERCENT of hospitals don't expect to survive the reimbursement changes.

Wow.  I've gone on and on.  And I don't have an answer.  I do know this:  Big changes are coming to healthcare.  I will stay in nursing, as I know it's my calling from God.  But things will certainly look different.

P.S.  Before this post goes viral courtesy of my mom, I feel compelled to say that I do not know exactly what positions are being eliminated, other than some big administrative ones.  However, there are not 500 administrators in system (and I read an article this morning saying it was closer to 600).  Take away nursing, and I just went with my gut on what positions will be most vulnerable..  My gut can be wrong though!

Friday, May 17, 2013

Oh NUTS! I needed a laugh

Happy nurses week!  In honor of this special occasion, I'm blogging for the first time in months...And it will be a nurse story.  Because it's nurses week.  And because I keep wanting to tell this story to every person I encounter, and I'm quite certain they will get sick of the retelling. 

Or be shocked at my crassness.

But the crassness is what makes it so great!

Tuesday I went in to say hello and do an assessment on a 66 year old gentleman who was in mental status change.  He had suffered from a stroke, and he did not have any residual effects physically, but as he told me over and over, "My head is messed up."  Whether it is due to his stroke, history of drug abuse, or seizures, I'm not sure.  But he was confused.  He would get an idea in his head, and he would say it over and over and over.  For example, he had wanted me to call his son to go check on his wife at the nursing home, only he couldn't remember the number.  I looked it up in the computer, but before I got a chance to help him with the call (any activity with this gentleman took a good amount of time due to his mental processing deficit), he remembered the number. 

867-5309!  867-5309!  867-5309!

He shouted it out from his room so LOUDLY that I could hear it clearly in my patient's room two doors down.  And, fortunately he had learned to use the call button...

"May I help you," asked the unit secretary.

"867-5309!  867-5309!  867-5309!" 

Okay, that's not the real number he gave.  He gave the correct number, which I memorized due to him hollering it for a good 20 minutes straight, but I cannot give it to you, lest you call his son and harass him.  Besides, 867-5309 will be stuck in your head all day.  You're welcome.

Anyway, all of that drawn out background was to get a base of his mentation for you. 

I was charting his assessment in the computer.  "I have to pee!" 

"Okay, go ahead and go.  The bathroom is right there."  I indicated the door, and knew full well he could get up and walk, as he'd been wandering the hall all night long, and had in fact gotten himself tied up for not staying in his room, and wandering into other patient's rooms...

"I gotta pee!"

"Okay..."  And I repeated the instructions as I continued to chart....And I repeated.  And repeated.

And repeated.

After I had completed the charting, I turned to him and said, "Alright, let's get you  up to the bathroom."  And thus began a 10 minute step by step instruction session to get this six foot man out of bed and to the bathroom, where he walked to the toilet....and stood.

"Lift your gown up so you can pee."

"Okay."  And he did.

"Alright, you might want to pull down your diaper."

"Okay."  Nothing....I said again, "You need to pull down your diaper."

"Okay." Still standing with his gown wadded up in his hands.

 And with a mental shrug I undid his diaper and pulled it off.  "Alright.  You can pee now."

And he proceeded to pee all over the floor.  "Sir, you need to grab hold of that thing and take about two steps forward.  You are missing the toilet."  Now, some of you may be shocked at my bluntness, but sometimes I wish I had that gumption when I was 16 working at our local gas station and cleaning pee up daily after specific men came in for their morning coffee and gossip session.

Anyway, he said, "Oh my!  Oh no!  I peed all over my nuts!  This is TERRIBLE!  And the floor!  How TERRIBLE!  TERRIBLE!  TERRIBLE!"

"It's okay.  Just step closer, and aim a little better."  And he did.  But he continued to rant, "I peed on my nuts!  You will have to wash my nuts!  It's awful!"

I got a warm washcloth, waited for him to finish, and when he said, "Well, that ain't much, but that's all I can do these days," I handed him the rag and said, now clean yourself up.  Which he thankfully began to do, WITHOUT step by step direction.

"This is terrible.  You are washing my nuts!  You don't get paid enough to wash my  nuts!  Oh no.  I'm so sorry I peed all over my nuts and you have to wash them."

"It's okay, sir.  You are washing them, not me."

Yet he continued to dutifully scrub and apologize..."I'm so sorry I peed on my nuts!  You have to wash my nuts!  It's terrible!

At last I deemed that they were certainly clean.  "Alright, that's good.  Now throw the washcloth in this bag, and wash your hands." 

So he did, and continued to say, "I peed on my nuts!  I'm so sorry!  Now you have to wash them!  You don't get paid enough to wash nuts!"

At last I convinced him that he could stop washing his hands and to return to bed.  Of course, all the way to bed he chanted in a loud voice, "You have to wash my nuts!  I peed all over my nuts!  This is TERRIBLE!"

And I continued to say "It's okay," and "You already cleaned your nuts, now let's get a diaper back on and get you back in bed" all the while fighting to not burst into laughter lest I hurt his feelings.  Because, rest assured Gentle Reader, men do NOT enjoy laughter that involves their nuts.  Life experience as a nurse, I promise this is fact.

After spending five minutes convincing him to get in bed, I finally was able to leave the room with him apologizing all of the way out the door....

"I peed on my nuts!  This is TERRIBLE!  You have to wash my nuts!  I'm so sorry!  You don't get paid enough to wash my nuts!"

And I stepped out in the hall and around the corner of his door.  And collapsed against the wall shaking with silent laughter.

Happy nurses week!