Friday, August 09, 2013

Wow oh wow! The week I've had. The stories and events that take place in a skilled nursing unit/nursing home.....these are better than the best drama or comedy currently on television. I'm not even kidding!

Today I was told I was skinny and beautiful. More beautiful than "Tweety bird"....which let me tell
you, must be a very high compliment!

With the heat index soaring here, our building temperature fluctuates wildly.  After freezing for the entire morning, I entered a patient's room around noon to discover it was uncomfortably warm and muggy. I started to take off the jacket that I wear over my scrubs and was informed that I needed to "take off a few pounds as well," because he could tell based on my figure that I had had a few children.  I can't get too offended, because with the clientele I work with, these things happen all-the-time. Part of my job is to help people become more pragmatically appropriate. Unfortunately, sometimes this means dealing with insensitive people with zero filter. My patients are endearing, exasperating and above all surprising.

I had three patients that had to have modified barium swallow studies today to determine their least restrictive diets and to confirm that the diets we are currently trialling are safe and that progress is being made with therapy.

They all 3 did AMAZINGLY, which makes me excited that what we're doing is paying off, and thrilled that they are going to be that much closer to eating and drinking a consistency that they want! When I have to tell a family that their loved one is not safe on a particular consistency of solid or liquid, it makes me feel horrible. We are so constrained by time and insurance when patients's don't make progress quickly.  I didn't realize that so much of what my job would be in this setting would be not just educating patients and families, but being strong in my convictions despite their pain and agony of feeling like their loved one is suffering by not being able to drink thin liquids (for example). No matter how many times you educate them about the risks of the thin liquid causing aspiration, they will sneak it in. Their loved ones will get sick, and you will constantly be fighting an uphill battle. Families don't want to deny their loved ones pleasure, but they do so at the risk of causing serious harm - aspiration pneumonia and even death.  It's tough sometimes.

Now onto the craziest part of my day today. First a caveat: When I enter a room, I am generally very cautious about where I sit - if I sit at all. There is a reason for that. I work in a facility that accepts clients with all kinds of conditions, and I really have no desire to bring any bugs home to my kiddos.

That being said, today I entered the my last patient for the day's room. He was a very nice gentleman, who was soft-spoken and VERY hard of hearing. This is not out of the ordinary in my field either. (PUBLIC SERVICE ANNOUNCEMENT: IF YOUR LOVED ONE NEEDS HEARING AIDES - PLEASE GET THEM!!) Anyway, I had gone in to evaluate his cognition/speech and language to determine whether he was appropriate for services. As I stood at the foot of the bed, he seemed to be really struggling to understand what I was saying, despite my yelling.  So, I moved over the his head side and leaned in to speak loudly and clearly to him. This stooped position was both awkward and uncomfortable, so I looked over and repositioned a large upholstered club chair, so that I could sit near him at bedside. After pulling the chair over I was so focused on him that I was not paying much attention to my environment. I moved my foot slightly and noticed that it sort of slipped on the tile. When I looked down, I noticed a small puddle. When I inquired to the gentleman about said puddle, he looked puzzled, then stated, " I must have spilled some water." Then he motioned to the rolling table and asked if his pitcher was still full of water. It was.....I knew by this point what I was dealing with...the next question was how....I lifted the sheets to find that he had recently soiled his bed. Alarmed, I stood up to notify nursing and to get some alcohol wipes to clean the floor. Except, when I stood up....I noticed that suddenly my pants and rear end felt oddly wet as well. I gasped in horror as I realized that the club chair I had been sitting in was also saturated. I went green as I looked down in disbelief, and asked the patient if the chair was wet. He looked at it and said, "Yeah, well I guess the water must have spilled in that chair too." Yes....I sat in what I believe was urine.   Yes it was disgusting. I told my patient that I had to go and would return later to complete my questions.  Then,  I quickly rushed down the hall in disbelief.  I was unsure whether to cry or throw up.  I made my way to the therapy room, where I stood, shocked and disgusted by my state.  My rehab team just laughed, noting similar things that had happened to themselves and others in the past. My wonderful manager jumped in her car and ran to the nearest store (Dollar General) for a change of pants and disinfectant wipes for me. Needless to say, the evaluation will have to wait until Monday. I took a scalding hot shower and know that there may or may not be an ice cream cone in my near future.

On that note, Netflix is obviously agrees about the nursing home humor and tragedy - as they are putting out a new series soon called "Derek" about the exploits of a nursing home aide. If it resembles real life at all -it might be hilarious. There's a link to the preview below. Ricky Gervais is starring. Hope it's funny! Will you watch with me?

Anyway, what a day! The adventures in clinical fellowship are going strong.