Warning...Depressing and Morbid Post Ahead

Well, the last few weeks have been very rough at work. We rotated positions, which happens every six months, and I am now a floater again. My main responsibilities are to my cancer patients, the LTAC, and then to the hospital, if I have extra time. In these first two weeks, most of my time has been spent on the LTAC, where EVERYONE IS DYING!

Working with old people who have dysphagia, we know that death is a very real possibility. However, it is very rarely staring at us at the end of the hall. In the last two weeks on the LTAC, two of my patients have died, one has coded and gone back on the ventilator, and one has aspirated and gone back on the ventilator. Ick...

I was on the unit when one of my patients died. Though she was 85, her family had still not decided to make her a DNR - Do Not Resuscitate. Friends, I highly encourage you to discuss "code status" with your parents and loved ones. When an older person codes and is resuscitated, the physical trauma their body endures is horrific and they usually don't survive anyway.

So, when my patient coded, they attempted to resuscitate her; they gave her CPR and shocked her heart. She had a trach, and from my position in the nurses station, I could hear the air rushing out of it every time they compressed her chest. It was the most awful sound. They had to continue resuscitating her until her family could be reached. The case manager makes those calls..."Mrs. XXX, your mother's heart stopped and we are trying to revive her. But you need to come now because she is not going to survive."

When they finally stopped, everyone in the nurses station just sat there. My patient was the second person to die on the unit during that week. It was just too much. Though I never really had any meaningful interaction with my patient (she'd had a stroke and was quite unarousable), hearing the air rushing out and knowing the physical trauma her body went through really shook me up.

I went to the chapel in our building and prayed and cried. She wasn't my family, I didn't really know her, but she was my patient. Being a Catholic, I know she is in a better place. Unfortunately, that only makes it a little easier to deal with.

A Big Scare!

Well, Monday turned out to be the strangest day ever! I called the retinal specialists office on Monday and they couldn't see me until 3:00 pm. Until then, they told me I couldn't eat because I might be having surgery. I was super pissed that they couldn't see me earlier, so I was crabby all day.

When we went it, they dilated my eyes again and we waited for the doctor. He came in, took a good look at my eyes, and plainly said "You're fine. You don't have a detached retina." Of course, I was in shock, since I had been told I was for sure having eye surgery on Monday. The retinal specialist told me that what my eye doctor had seen was something I've probably had since I was a baby. It's called old peripheral retinal neovascularization and it happens when scar tissue forms from blood vessels breaking through the eye and then retracting. Since I wasn't a preemie, he said it probably happened spontaneously.

Though I am quite appreciative of my eye doctor's thoroughness, I think next time she should take a breath before jumping to such drastic conclusions. Nevertheless, I'm just thankful that everything is fine!

Head and Neck Cancer

So I know I’ve been missing in action for a bit, but it’s time for a work update. I recently had the privilege to dive into a new area of speech pathology that I never thought I’d have the chance to experience, much less enjoy. …Head and Neck Cancer.

Our hospital has its own cancer center and through a series of events, we learned that their head and neck cancer patients were not receiving routine dysphagia/speech intervention. I ended up being asked to give a presentation to three oncologists and two radiation oncologists about speech pathology services for head and neck cancer patients. And, long story short, I know see all of our head and neck cancer referrals.

At first, I thought it would be a depressing group of patients to serve, but I’ve actually come to like it…a lot! I think the most thrilling part is problem solving for these people. They’ve been told they have cancer and that they’ll need very invasive treatment to cure it. What they haven’t been told is that the side effects of that treatment may be worse than the actual treatment itself.

Could you imagine living a life where you have no saliva, where everything tastes like drywall dust, where you’re not hungry, where your food gets stuck in your throat and won’t go down, and where you neck is literally as hard as a rock?!? But, you’re alive!

My very first head and neck cancer patient (nasopharyngeal cancer) has been very challenging. At first, I had no clue what I was doing. I read some books, did a lot of research, and then just had to go for it. Surprisingly, my patient has made some pretty significant progress and I couldn’t be more thrilled. She went to being totally dependent of her feeding tube to tolerating liquids to eating soft solids and swallowing whole pills! My speech pathology friends out there will know what a big deal this is!

I can’t wait to see where this new venture takes me. If you work with head and neck cancer patients and have any good resources to share, please pass them my way!

Nervous!!

So, I thought this weekend was going to be a relaxing weekend at home, but alas, that never happens. Jon’s friends came in from Austin to go to the Renisance Festival with Jon while I planned to get some things taken care of at home. One appointment I had was with the eye doctor. I know, an eye doctor who makes Saturday appointments is awesome!

At 11:00 am I went for my appointment. My new doctor was very through and quite nice. They had this fancy new machine that can take a picture of your retina instead of having your eyes dilated. Of course the fancy eye camera is not covered by insurance and is an extra $40 bucks. So, I opted to have my eyes dilated. After she dilated my eyes, I had to wait about 20 minutes and then have her re-exam my dilated retinas.

As she tested my right eye, I could tell something was wrong. She would have me look to the right several times, check another direction, and then have me look right again. When she was finished, she let me know that I had two holes in my retina and that it was detaching from my eye. SCARY! Being in healthcare, I know what retinal detachment means. My doctor wasted no time in conveying how serious my condition was (retinal detachment = blindness) and quickly explained how I would be visiting the retinal specialist on Monday.

Needless to say, I’m a little freaked out. My eye doctor told me that retinal detachment is common in people who are very nearsighted (me!) and in people with diabetes. So, in addition to visiting the retinal specialist, I also have to be tested for diabetes. UGH!!! I’m not quite sure what Monday holds, but my eye doctor said I’d probably have laser surgery tomorrow, if not very early next week.

So, please pray everything goes well. Oh, and go make an eye appointment!

Toby

So, our first order of married business was getting a dog. We didn't think we would get one so soon, but Toby found his way into our life and is here to stay. Toby is a French Boston (half French Bulldog, Half Boston Terrier) and is the cutest thing you've ever seen!

Cuteness, however, does not make up for extreme sickness. We are praying that Toby will one day be healthy. We'll let you know when that day comes because we are waiting for it with baited breath. About 2 weeks after Toby came home with us, he got a case of Tape Worms. How did we know it was Tape Worms? Use your imagination. Then, he got a nasty case of Giardia, which we are still fighting. At the tail end of his Giardia sickness, we had to go to a wedding in PA and had to board him. And of course, when we picked him up from the kennel, he had a sinus infection. So now we're dealing with green doggy snot.

Who says dogs aren't good practice for kids?!?! (Not that we need practice anytime soon!!!)

So, for your viewing pleasure, I give you Toby Jarvis!

SEX....and "until death do us part."

So, I haven't blogged about work in a while and it is high time I reported another funny story. This happened a few months ago, but it is definitely worth telling.

We'll call my patient Mr. Yellow. Mr. Yellow is a pretty unlucky man. He's had diabetes since age 10 and now, at age 59, his body is giving up on him. Mr. Yellow has a wonderful, wonderful wife. I have never met a woman so devoted to her husband. When I first met Mr. Yellow, he was in the hospital for aspiration pneumonia and had developed dysphagia (swallowing problems resulting in food going down into his lungs) with no known cause. I had explained to Mrs. Yellow that we had a therapy (VitalStim) that retrained the swallowing muscles. We've had great success with this therapy on people who've had strokes, but I couldn't promise her it would work on her husband.

Now, Mr. Yellow has been too sick for many years for Mrs. Yellow, who still works, to take care of him. So, he lives in a nursing home. Mrs. Yellow comes and visits him everyday. When I told her about VitalStim, I informed her that it would be quite difficult to get Mr. Yellow's nursing home to bring him to therapy. Mrs. Yellow told me she would do everything in her power to get Mr. Yellow in for VitalStim therapy.

So, a little time passed and Mr. Yellow finally came in for VitalStim swallowing therapy. Now, if you could see Mr. Yellow, you might at first think he was dead. Mr. Yellow's diabetes has blinded him, so he always keeps his eyes close. His diabetes has also caused him to loose feeling in his legs and back, so he is wheelchair bound. When you live in a nursing home, you get stuck using their crummy wheelchairs. Mr. Yellow's chair was quite old and usually jimmy-rigged in someway to make it work.

Mr. Yellow's diabetes had also decreased his auditory processing time. When ever he was asked a question, he took forever to answer and usually had to be reminded by his loving wife that someone had asked him a question. Mr. Yellow's responses were always very short, rapid, and to the point.

So, one day during therapy, Mr. Yellow was being especially quite. I asked him, "Mr. Yellow, what are you thinking about?" He didn't respond. Usually when he didn't respond, I'd move the conversation in a different direction and brush off his non-response. This time, however, Mrs. Yellow said to her husband, "Mr. Yellow, Emily asked you what you are thinking about?" Very loudly, and quite to the point, Mr. Yellow responded, "SEX."

I just had to snicker and ask Mr. Yellow if he might want another bite of pudding, which he did. Afterwards, I commented to Mrs. Yellow that her husbands response was a good thing and that at least he still had a passion for living. I'm sure my comments made her feel only slightly less awkward.

I'll never forget Mr. Yellow and his declaration. I'll also never forget Mrs. Yellow. She showed me what real love is and taught me the real meaning of "until death do us part."

Personal reminder...

This is a reminder to myself to blog about sex. No, it's not what you're thinking. Stay tuned to hear the story!