Friday, June 20, 2008

The new job is busy

And, lo and behold, I really like it. I forgot that I like working with grown-up-people-patients too. Some are exceptionally nice, some are downright loony tunes. Some are exceptionally nice and loony tunes. Most are just normal folks, which may be why it surprises me how much I like working with them. I guess what I'm trying to say is that the last time I had adult patients was in the ER and that's not always a place to catch people at their best, she says diplomatically.

The people never cease to amaze me. I've met people who would wake up and be at dialysis at 5am(the am stands for Areya Mad!) 3 times a week and then go and work a full time job. And I whinged and moaned because I had to do a bowel prep once (seriously, by 9am I was like "how many more hours of clear liquids?" AND you can't eat red jello! Why do they even MAKE other flavors?!) I'm also the one who, after all my talk of natural childbirth, crawled out of the elevator and said, "Get the anesthesiologist, I want my epidural NOW!!!"

All this means that if I'm ever your patient, please just point to something shiny and hit me over the head with a large rock while my back is turned-because I am just that much of a pain in the ass when I'm sick.

And sick I've been. The third week of work the plague struck everyone and the office sounded like a consumption ward. I called out 2 whole days because of fever and general malaise and because I didn't think it was cool to cough on all the people on immunosuppresion. Then I was out for a day when Pooter had her surgery. Then, the VERY NEXT DAY, I woke up with-yes, that's right-fever and all-over ickyness and called out again. The next week I got a stern talking-to. Me. Whose husband yells that I go into work when I can't talk from laryngitis and I'm coughing up a lung. Who gives him a hard time if I have to stay home with a sick baby(that's why they make tylenol). I'm a rotten mother, but I show up for work, dammit. Now I'm working with people who never call out and eat lunch at their desk. Sigh.

Another reason for the long delay since my last post, beside being plague-ridden, is that I'm a little leary blogging about the J-O-B and I'm not sure what I'm going to do about it. If I thought the OPO would give me hard time, this place would definitely put the keebosh on it, so I'm wondering what my next move's going to be. And I would lerv to talk about work. There are some real characters, staff and patients alike. I really like everyone. Well, I really want to like everyone, and isn't it the thought that counts? Today, someone brought me 3 Twizzlers and left them on my desk. Isn't that nice?

I'm splitting up the post patients with another coordinator-and we do about 100 transplants a year, and the program's been around for a while, so it's like-a gazillion patients. 1/2 a gazillion for him and half a gazillion for me. Once I lose the water wings, we're going to split the alphabet. Hubby informs me that he read somewhere(probably reddit) that if you split the alphabet by last names, the first half is unfairly burdened. I suppose that's true. If I really wanted to (and had the time), I could go into the chart room and start counting, but I s'pose I'll just take my chances. So far, it does seem like A-M has more crazies, and if you see yourself or your family members in that statement, don't come complaining to me-I didn't pick your last name. For example, I know a guy whose last name is pronounced "Co" as in Codependant or Co-defendant, but it's written like a part of a man's anatomy that rhymes with rock. And he gets pissed off when people mispronounce it. For the love of Pete, I know it's your proud family name and all, but just change the spelling already. From now on I'm going to say his name is Rick-the "P" is silent.

But I digress. Mondays and Thursdays we have clinic from 8-12 noon. Folks sign in at the clinic, go down a floor to the lab to get their blood work done, then return to clinic, where they go over their medications with the TC (moi) and see one of the docs. First come, first served-somedays we see a few, but most days are nonstop patients for 4 hours. One TC starts the clinic, the other rounds with docs until about 8:30. At noon, I run for a bite to eat and return to my little office where we write down all the labs onto one overview sheet for the docs to review, then transcribe each person's labs into their chart, because our brand new fancy computer system cannot print out lab trends. Then, around 1:30 the prograf levels come back and we start scribbling again until the doc comes in. Chart by chart, we review the labs and meds and write down in each chart what changes need to be made. THEN, we call everybody with their changes, book biopsies and call in prescriptions until it's time to go home.

The other thing that amazes me is the time committment this takes for the patient. For the first three months following transplant, they come in for clinic and/or labs 2x a week for several weeks, then once a week and then finally every other week. And that's the minimum. If anything's out of whack, or they look like they're going into rejection, it's more frequent. Each visit takes at least 2-3 hours and some of them come from pretty far away. Most of them don't ever complain-"it beats going to dialysis" I've heard more than once, and that's the truth, I'm sure. By the end of 3 months we're like old friends. I've seen some of these people more than my own parents in the last couple of months.

The other days are filled up with filing, patient phone calls, reviewing blood work and tests sent in from outside facilities, the weekly staff meeting. It's a far cry from the office days at the OPO, where I'd arrive at a leisurely 10am, take an hour lunch and be out by 3 or 4pm. But then again, I don't have to jump up in the middle of the night and drive to Pennsyltucky any more, either. I like the 9-5, I like having weekends off and regardless of what my husband thinks, I come home at a reasonable hour and spend some time with my family before going to bed, which is nice, too.

Friday, June 06, 2008


Well, it's about 4:30am and I can't get back to bed. Late last night, after we got the baby to bed, I started coming down with yet another head cold. I try and think back to any infectious people I might have touched in the last 24 hours, but I can't. And, of course, yesterday I toughed it out and went to work when I just felt like staying home in bed and came home to baby crankasaurus, whose mouth is sore and my husband has no sympathy ("but my temp is 99.8!") And I got banished to the futon because a. I'm snoring and b. I'm on call and have 2 phones under my pillow threatening to go off at any time. Then I felt all good and sorry for myself and had a big 'ol pity party, population 1.

Fortunately, call's been-well, I don't really want to say-I still have 4 hours to go. And while I want each and every patient to get a kidney, if you could just keep those offers to yourself for 4 more hours, I'd be real appreciative.

As for the pity party, all it takes is a visit to Revive Hope and think about my friend Steve turning blue and coughing up a lung, or go over to Falling Down is Also a Gift and pray for little Anni who looks like she'll need that next liver transplant sooner, not later, or even over to 'Ole PJ with his gimpy leg to realize that I've got nothing to complain about.

Last night, after we got our little post-op patient settled in bed, my husband hugged me and said, "We're so lucky. Like 'win the lottery' lucky." And that is very, very true.

Thursday, June 05, 2008

My friend Steve wrote a touching post about paramedics and remembers the team from the University of Michigan who lost their lives last year in the service of organ donation.

They were:

Dr. David Ashburn
Richard Chenault II
Rick Lapensee
Dr. Martin Spoor
Dennis Hoyes
& Bill Serra.

You can see their bios on the Umich site here…

Tuesday, June 03, 2008

If you think being a patient is bad...

try being a patient's mom. Or dad. Pooter had surgery on her teeth today. 2 1/2 hour surgery. Let me tell you, it is no fun at all to kiss your little one goodbye and send them off into the depths of the OR.

I'm also ashamed to say that Poot has bottle mouth caries. Or booby mouth caries, as the case may be. The dentist says the breastfeeding is to blame, although it would be more realistic to say that my practice of breastfeeding her to sleep is to blame, not breastfeeding in general. That's a habit that I never should have started. They start off wailing little wee ones and you think, "It's all right if I nurse her to sleep tonight." and the next thing you know you're paying more for dental work than I've spent on some of the cars I've owned. God forbid she should need braces-I've used up her dental allotment for the next decade, at least.

I've also got a good whopping dose of mommy guilt. Everything I had learned up til now made me think that breastfeeders were practically immune to cavities. Now research I've found says that while breastmilk alone is protective of teeth, breastmilk combined with sugars can be worse than either alone. If you're interested, I'll be posting an article on that over at Laughing Baby. It doesn't matter. I still feel like the worst mother ever. I called the dentist's office this afternoon to see if sucking would damage the caps and they said, "stop breastfeeding your toddler this instant, you freak." or words to that effect.

The other thing which I was unprepared for, but have since found out is common, is how rapid the progression is. We just saw the dentist 6 weeks ago and in that time it got a lot worse. We knew we had to have the work done in same day surgery because it was so extensive, but what was supposed to be a one hour case took more than twice that time. I was just glad that it was done in the hospital I work at-it has a children's hospital, pediatric anesthesiologists and, worse comes to worse, a great PICU (natch). I certainly didn't want to give her sedation in his office-I would have had everyone opening their wallet and showing me their PALS cards before they began.

Last week we went in to tour the pediatric same day area with a child life specialist. Pooter thought it was great fun-she was climbing on the stretchers and playing with everything she could get her hands on. This morning we arrived and she was right at home, driving the Little Tykes cars around and generally have a grand time. We got weighed and our vital signs taken-she even let them take her temperature in her ear which she never lets US do. I knew the anesthesiologist, so that was a great relief. Then they gave her a little liquid versed and before you know it, she was getting a little wobbly driving the car around and slurring her words. Before you could say, "Pull over, ma'am" she was snuggling into me and I settled her down onto the stretcher.

Daddy went in with her. He was a wreck the night before, but I knew I'd be ok until the moment came to say goodbye, so he went into the OR until she went to sleep and I headed upstairs to PICU to get hugs and mommy support from my friend Colleen. Then we met up and went to get some breakfast. After she had been in their about an hour, my husband said, "Ok, this has been fun, but I want my daughter back now." I agreed-I don't think she's been out of both our sights for 3 hours since-I don't know, I think we went on a date in 2005. At about that time my pastor came in to visit and we sat and chatted for a bit and so that passed another 1/2 hour talking about nothing, for which I was very grateful.

We got her back around 11:30. Recovery wasn't too bad-she was a little disoriented and crying, but consolable for about 20 minutes, then she woke up and drank 4 apple juices and announced, "I want to go home". So we did. They took out the IV and gave us an ice pop for the road and we went home and snuggled on the futon and watched Nemo and ate some pudding. Around dinner time she was feeling more herself and so we went in town to get some take out Thai and while we waited we went into the toy store and got her a present for being a brave little monkey.

As she was falling asleep, I asked her how her day was:
"We went to the doctor with daddy."
"That's right, we were at the hospital."
"Yeah, the obspittle."
"Was it fun?" I ask skeptically.
"Yeah, it was fun! I want to go to the obspittle 'gain." I'm grateful that she's not traumatically scarred by the experience. "Ok, we'll go to the hospital again." And I kiss her little head goodnight.
Yeah, I know I haven't posted in a bit. The little one is having surgery tomorrow-nothing major, but you know, anesthesia and all that. Please keep her in your thoughts. Thanks.