Challenges

My personal life has been a little crazy so I haven't been able to keep up with my blog the way I would like to..so sorry for those who are following me...I usually don't like to divulge into my private life but since it has to do with being on the other side of being an NP I am allowing myself this one time to do so....My parents are in their 80's and have been in good health up until a couple of years ago...my Dad was the first to have medical problems...he was diagnosed with CML a few years ago but is in remission now...However, he has other medical problems that have been making his good days of feeling well fewer and fewer...He has an array of heart, lung and renal problems..His has more days of not breathing well than good days...he can't even help my Mom with light housekeeping chores without fatiguing and getting dyspnic.....he has been to more specialist than I can count on my 2 hands and they come up with the same conclusions...Multi factorial causes to his declining quality of life...My Mom has been the rock for him during this time...making sure he takes he medications;getting him to the doctors; and providing love and emotional support....today my Mother ended up in the ER with TIA....I went to visit her at the hospital tonight and she is devastated that she can't be there for my Father and take care of him....she is his rock...with tears in my eyes I told her it will be ok..that is why you have us ...as much as my parents don't want to be a burden and face the reality that the day is here..they need us to help them...it breaks my heart I see this everyday as a Nurse Practitioner caring for my patients...families that are faced with the challenges of elder parents and providing for their elders...I am there I am one of them ...I am wearing the other shoe..I am on the other side of the fence...I am in a fog right now to tell you how I am feeling..reality hasn't set in quite yet..but I know from experience it is creeping up on me...As I sat in the hospital room listening to my Mom telling me how she is so concern for my Dad...I told my self this is my time to be the rock for my parents.....they deserve it...they have given me a good life and lots of love in their own way..right now I just want to be a daughter and not a health care provider....

The TOP memorable patients in my career

Ok I am sure Jay Leno is known to all especially with his Top 10 whatever...so this gave me an idea to post the Top most memorable patients that I have come across thus far in my career:

16 year old female who was raped by her father became pregnant and is raising the child..

20+ year old female who complained have not having her menses for 6months and claimed she never was sexually active in her life....guess what...yep she was 6 months pregnant

26 year old healthy male who came to the office thinking he had a cold...chest xray revealed empyema

80 year old women never wanted a hernia repair ....it literally hung down to her knees

Elderly female who thought she had the virus came in with nausea vomiting back pain...ekg showed inferior MI...to the hospital with you!!!

Amish male came to office with nail from a nail gun through his leg

Schizophrenic young adult male came in for his depokote shot and closed the exam room door and cornered me and was irate...then he runs out of the office building onto a busy highway

Homeless man complaining of foot pain...unwrapped the soil dressing he had covering the painful area to find and foul smelling magot infested wound

so it is only 8 but I am sure I will have many more found memories to be added to this list

Delirium and awful place to be

So I have to say my 2nd week of the year at work proved to be very eventful...The 3.0FTE provider positions are now 2.5. ..myself and attending and 0.5 PA who unfortunately was not on the floor all week because he was covering another PA who is out sick...best laid plans...and the day this went into effect our census jumped from 16 patients up to 26 patients and still going...yep...another best laid plan...so 2 days into this I found myself attempting to convince an 87 year old delirious patient to have his vitals taken and his pulse ox...He refused saying we poisoned him and we aren't doing for him...I pulled him into a very very quite room and tried to reason with him that we were helping him and not hurting him...he started to get a little agitated and I had asked the nurse to give him haldol...despite all efforts we needed to bring in more troops to get this accomplished....at this point his anger became directed at me saying I poisoned him and he didn't want me to take care of him...I also took away his dentures and broke them as well as his hearing aide....he became a little loud and started to take swings at me...we finally calmed him down and gave him his haldol...he slept for a good 1/2 hour...by lunch time he was up and eating his lunch...he was a little more cordial to me but still believed I was no good and against him...my feelings were hurt because he and I were really getting along very well prior to the earlier incident...thankfully the psychiatrist came in to help sort this out for me and we changed some of his medications...this proved to be a positive thing...he finally got a good night sleep( he had his days and nights mixed up) I went in early this morning to find him back to his old self...he was smiling and was very apologetic to me and told me he would never hate me and loved me and my smile...now that was a good moment and one to cherish...

Growing Pains...journey of a career path

I am writing this blog before I title it so hopeful once I am finished I can come up with a suitable title...I am having a writer's block on what to write anymore...this is bad news since I have only had this blog for a couple years...So I was doing some deep soul searching this morning on what I can write about...actually I was in church while I was doing this...call this my morning meditation....as I was thinking an looking around at the people surrounded me I got this overwhelming felling I have really grown into myself...I am saying this not only personnally, spiritually and also professionally....Personally I look who I have become....not the same person I would have pictured in my early 20's ...at that point all I wanted to do was be a med surg nurse, marry young and have a family...not that I didn't do that ...but I took some detours on the way...I did become a nurse(working part time), I did marry...and I did have a family...the glitch and first detour was when I was 25....the happy ever life as I knew it ended...horrified when my husband told me that he didn't want to be married anymore...and leaving me with a brand new house and an 18month old daughter...I had no idea what I was going to do...needless to say...the part time nurse idea was out the door...I had to work full time to support myself and my daughter...hopes of living in the brand new house was also out the door and I was back living in an apartment...my self esteem hit rock bottom...It took several years to pick my ego out of the basement and wipe myself off and realize it was all up to me of how the rest of my life was going to pan out...this is when I did my double challenge take on a new job as a nurse educator and go to school part time for my Masters in Nursing...still a single Mom this was a challenge. By the grace of God and the help of my parents and 5 years later I had a MSN next to my last name and to add to my credentials...during this time I met my best friend and husband...He has proven to be a rock to me ...He made my family true family and we married in 1992...I continued to work in the hospital setting as a nurse educator...but something still didn't seem right to me...I was bored...can you imagine...bored with a family and full time job...plus hospitals were re organizing and the nurse educators were the first on the chopping block...so that is when I decided to go back to school again for my NP and post masters...2 1/2 years of working full time and keeping a house and family I succeded...jobs were not plentiful or were well known at this time for NP's I literally sent out letters with my CV to all the family doctors in the area...I got that one bite and I was on my way to my current career...granted it wasn't all sweet and nice in the beginning...I actually worked a full time job as a Disease Manager in a hospital and part time in the evenings as an NP for the first 6 months...then another family practice approached me to work in their office...so I was able to quit the hospital job and work the two family practices at the same time for a full time job....the first year I worked 60 hour weeks..ugh..and the pay was lousy...after a year I quit the first job I landed and worked the second job ...was lucky to add hours to this job to make it a full time job....During my first 2years as an NP I had a lot of growing pains....fears of not knowing a lot and of possilbly making an error...I wouldn't sleep at night...was constantly reading and looking things up ...I would wake up in the night and think about a case I had during the day doubting myself...it was awful...plus office practice was not the end all and be all for me...the pay was lousy and benfits were nothing...and the docs just didn't get us...that is when I started looking for something different and even 2nd guessing if I made the right choice to be an NP....that is when I ran into a fellow NP collegue at a conference who introduced me to her boss...they were looking for a new NP at the nearby VA....I got an interview the next week and the rest is history...almost 11 years I have been there...they do get it..and I am very happy there...I can honestly say.. I don't feel bored ...I learn something everyday...the docs I work with get me and me them...and I love the patients...working for the VA gives me a sense of security with my practice and with my ohm....I doubt I will ever return to the private sector...the VA has come a long way...it works very hard to provide quality care...it is built in to every providers work day...we are constantly provided tools to provide this for our vets...I can honestly say that I am where I want to be now...I wouldn't even know where else to go nor do I have a desire to go...I do get up everyday and dread getting up only because I can't sleep in but I do look forward to going to work...it is always a new adventure and a great opportunity to help those who otherwise would not be able to get good health care in the private sectore...plus it is my way to give back to those who gave to our country...so now that I wrote this what should I call it?

Happy New Year

Well in looking back to last year I kept my promise to write more...so I am going to try to live up to it again this year...I have already promised myself to organize my closets and kitchen cabinets...done and checked off the list..trying to exercise more...shall be a challenge ..and eat healthier....OK now what should I do for my career...hmmmm...this is always a struggle...I have found myself to be in such a routine anymore...I don't want to go back to school...I have had enough of that...I don't want to change my job...I love what I do...so maybe I can promise myself to read more...educate myself more...maybe I can stick to doing a couple CME's once a week...I think I can do that.....
I always like to self reflect on how my year was in the past with caring for my patients...I have had some real challenging cases in this past year...Some of my challenges were with those patients who lost their battle with life...suffering from chronic diseases, cancer, cirrhosis...Some patients I was able to help and turn their life around...like giving them another chance in life...others remain in the cycle of no return with their poor health and addictions...these are the ones I wish I could make a difference and hope that someday the light will go off and they will get it....Hopefully 2012 will bring more challenges that I can face head on and make a difference in more lives...in a good way...I hope that you too have a very Happy New Year and may it be blessed with good health

It is a zebra

How many times did they mention the zebra to us in school...basically telling us that this a something rarely seen so keep it way back in the differential ....so you get a patient with pneumonia....treat accordingly...discharge and you are all good...you did the standard of care ...got the xray, cbc chem blood cultures sputum cultures treat with empiric antibiotic for CAP until cultures finalized...and you are good...wrong...the patient is discharged to home on oxygen and never needed it before...first clue...yeah...you send him home on his merry way....in a week...he returns to another facility more dyspnic even with the oxygen...multiple CT's bronchs...antibiotics...he is better good to go ...right...wrong...returns again in respiratory distress...multiple xrays, CT's showing pleural effusions...thoracentecisis after thoracentisis....antibiotics.... without improvement....pull out the big guns...thoracotomy wedge resection....guess what ...he has BOOP....needs steroids over long period of time...in the meantime during this last hooray...he was intubated , vented and trached and lost lots of weight and needed a PEG....wow....so now I get him...wonderful man...ready to jump right back on the horse and get better and go back to work...what an ordeal for this man....okay when in this picture do you think we should of thought of the zebra???BINGO you are right...when someone who didn't need oxygen now needs oxygen...Lesson plan and summary...we are all human God only knows I am not perfect... we get so wrapped up in day to day shmuck in trying to discharge people on a timely basis...we all need to sit back and look at the picture and remember the zebras

What I see during the day

What I see everyday is different from anyone else....working in health care is different from any other career....things I see would not be seen in other peoples' work areas..it may not be accepted or appreciated...My day starts by greeting my first patient sitting outside in his wheelchair catching the rising sun, drinking coffee and smoking a cigarette...they aren't in regular clothes because they may not have any other than the VA pj's we issue everyone when they come in....walking to the elevator I see recovering(substance abuse) vets who are now attempting to be reintroduced into society by working as an escort on my floor...they accompany me on the elevator up to the 2nd floor to start their day of work as well...please note the pay for this job is below minimal wage...but they are thankful they are provided room and board by the VA during this transitional period....I walk to my office an are greeted by the nightshift nurse...always smiling to see me ...accompanied with reports of what happened through the night and a swift good bye so they can leave and attend to their normal lives...once in my office I may occassionally get a knock on my door from an early rising patient who has questions or greets me for the day....once I complete my morning computer run...I walk to morning report to the next building...always greeted by other vets waiting for the DAV van to take them to appointments either to Philly VA or Wilmington VA....once report is completed...I head to my unit again and already have made a mental note of my priorities for the day...walking down the hall I catch a glimpse of many vets lying in bed sombering away....in one room is a wife sitting by her dying husband looking out the window...what is she thinking...does she know that today may be the day her beloved lifelong partner may leave her and this world...further down the hall I see the vet who helps recreational therapy preparing the morning coffee and snacks for the vets on our floor in the day room....I see vets who are bedbound and others who are rehabbing their injuries or recent surgeries...many vets who are on oxygen but don't want to give up cigarettes and turn the oxygen off as they go out and smoke...I see vets who are homeless,disabled and have no money and depend on us to find them a place to go....see vets who have drank themselves from a lively person to decompensated person with no one love ones to help them during their end of life...many come to us with no family support or social support and depend on us to help find them a home or give them a place to die peacefully...I have seen multiple individuals who have been riddened with psychiatric problems with no one to care for them but us...some with multiple medical problems that have no other insurance or finances but the VA to care for their complicated medical course....I have seen loved ones bring their family members to us to find answers for their medical and psychiatric problems...the list goes on...I have found that my day is bombarded with many emotional facets to the gammet of problems and issues that come from all of my patients....my beeper goes off continuously as well as my phone rings without a break..multiple interruptions from families, patients and nurses and other disciplines....but my day ends knowing I have done my best to help these vets...I always walk away knowing I have accomplished a list of tasks, answered questions and held a hand an mostly smiled and consoled my vets and their families...I never walk away dissatisfied with my job...I may be tired and frustrated but I know I have done my best....my day is fulling and I am so grateful I have chose this profession...I look back to my career path..and it only seems right that I have chosen to be an NP...I only wish I decided to do this sooner...but life has a funny way of working its way to what is best for you...this was a perfect match for me ....I cherish my days that I have helped someone being an NP