June 19, 2009 Don't look if you are squeamish!

looking down into pelvis


omentum

is that the diapghragm at top?

on the liver

more on liver






So here it is revealed: the dressings were removed this morning...

Last night, we changed to a larger room, Daniel reports:
"if you don't ask you don't get... This being New York, it stands to reason the big cancer hospital would have some super-nice room somewhere. Well on one of our circuits with Josh walking around the floor, Cheryl noticed a corner room with wood flooring- not linoleum- being swabbed out. Cheryl swung into action-"because we are expecting a crowd of visitors and our room is too small" (good line). And voila! Joshua gets the corner suite, easily 2 times the size of the former squeezo space. And with clean, see-through windows! Very nice for tomorrow's visitors."

Cheryl writes: The nurses here have been great. But, hospitals are different at night, and if you stay in one as a caregiver, you find the cracks in the system. Fewer, and often, less-experienced staff. Slimmer resources. They expect you to be sleeping. However, if you are in need of help, often night-time is the worst time to expect it. So this it was a rough night: not good enough pain control and long response times. Neither of us got much sleep, and Josh had lot of pain. Finally around 4 AM they got enough control to be helpful.

Here are some problem areas for all hospitals: the call system has no volume control, so Josh's very soft voice can't be heard in the nurses station. This means I talk for him...And, Even though they say they'll come if they get no response, the room is far from the nursing station, and this is not the way to communicate with people who have problems communicating.

Another systems problem is monitoring pain control. The pain team makes a recommendation, and instead of just DOING what they recommend, they order it and leave. They leave it up to the nurse to set it up--which usually takes between 1/2 hour to an hour 1/4 to set up because she's got other responsibilities, and by that time the pain has gotten worse, which means that it's harder to control and establish best dosages. Then, if it's not working they have to be called up again and we wait for them to arrive and assess. Another delay...So: Why doesn't the pain team assess, administer, AND monitor? ....They also have a strange formula for deciding how much narcotic you need: the more you hit the button, the more narcotic they think you need, and they reset the rate based on "average atttempted hits". But Josh knows that his button is set to administer not more than every 10 minutes, so he doesn't waste his energy pushing the button...too smart for his own good, but what research led the team to decide unconscious behavior is the best indicator to calculate need? Meanwhile, Josh is looking ragged: blanched and moaning, begging for ativan so he can relax, can't find the button to push, can't move without a lot of pain, and the pain person is "being conservative..." Meanwhile Joshua's muscles are cramping and he is having pain breathing... His O2 sat drops, they decide not to give him more opiates since that inhibits respiration, and instead he gets no more pain meds and just O2 until 4AM. The night passes in misery with shallow breathing...Is this backwards or what?

This morning is better, the A-team is on, the ativan came in a competent dose, a decent nap was had, and post-surgical fever is subsiding with exercise. The pain meds, revised, are working...the blood work is low but good, today's Xray shows some expected and resolving lower lung congestion on the R side, and toradol is on the way. Hooray! A lap around the floor, (shuffle, really) a sleepy stint in the chair, some deep breaths and a few painful coughs producing excellent globs, and Josh is back to bed...Able to drink some water today, hooray! and: The toradol is hooked up! Almost instant relief... And, the foley catheter is removed, one less tube to deal with! He is napping nicely now, looking like himself and taking deeper breaths...

Looking happier.