Archive for category Life at Home

Those Nortriptyline Blehs

Nortriptyline, according to Wikipedia,

is a second-generation tricyclic antidepressant (TCA) marketed as the hydrochloride salt under the trade names SensovalAventyl,PamelorNorpressAllegronNoritren and Nortrilen. It is used in the treatment of major depression and childhood nocturnal enuresis (bedwetting). In addition, it is sometimes used for chronic illnesses such as chronic fatigue syndromechronic pain and migraine, and labile affect in some neurological conditions.

A few weeks ago I had a fall (when it comes to falling down, I’m a Viking) which exacerbated an old injury from another fall — bottom line, was in a considerable amount of pain, and what was worse I couldn’t sleep becuase of the pain. So after about a week of sleeplessness and overdosing on AC & C, I finally gave up and went to  my GP. She prescribed some wicked bad-ass anti-inflammatories, and she also suggested I try nortriptyline. Besides being a rather dated anti-depressant, nortriptyline has some pretty nifty pain-control properties as well as the ability of  inducing sweet, restful sleep.

And, I must report, it worked amazingly well for the last couple of weeks. I’ve been sleeping like the dead, the pain is far, far better now, and I can function normally — sort of. Aside from a dry mouth, I’ve had no physical side effects at all.

Take two of these, and your ability to snark will vanish

But there’s this: nortriptyline, as I mentioned, is an antidepressant and mood stabilizer, and I guess I would describe my mood over the last week or so as tranquil, sedate, calm, unstressed, cool, placid, and serene to the point of having to check my pulse for a heart rate. Part of this new found attitude of repose is being completely demotivated to do anything creative at all, including any writing. For the last two weeks I have opened up the blog utility, fooled around a little, and after a half-hour, said, “Meh,” and went back to playing Words with Friends.

It’s plainly obvious, at least for me, having some emotional friction and turbulence feeds the creative daemon. It prods me to write, and I would guess this is true for most people who think of themselves as creative. So an interesting question: at what point would you sacrifice creativity for pain control — or relief of any condition, especially if it’s central to who you are as a human being? And on a larger scale, if everyone is medicated (it seems) for everything, what is it doing to culture as a whole?

Fortunately for me, I’ve finished the nortriptyline. It was a temporary thing. We now, as they say, return to our regularly scheduled moodiness. But here’s the thing: when I was on the drug, not only was I completely uninterested in writing, I didn’t care whether I was writing or not. The fact I could throw over something which I’ve done daily (in one way or another, even if I have written a couple of lines) for nearly three years is remarkable.

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Saved by Words for Friends

Ok, we’ve both been out of commission for a couple of weeks.  Our Miss Jean Hill, bright future of the nursing profession and co-blogger extraordinaire,  has a computer which has suffered last week the CPU equivalent of a massive cerebral bleed and maybe ethanol withdrawal too; the computer has since recovered, but Jean Hill’s nerves have been so shattered by the experience that it has left her tongue-tied, even catatonic. Which if you know Jean Hill, is a somewhat singular experience. At any rate, once she collects herself, she will be back. As for me, the schedule from hell and a lack of prewritten posts is my excuse. . . don’t you hate it when life gets in the way of what’s really important?

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The other day I was touring home from one of those interminable staff meetings about nothing at all, and I decided to stop in at an interesting-looking shop near Acme Regional. Since I live a little distance from my employment, my usual pattern is to race to the TorontoEmerg Lair and NurseCave on the nearest 400-series highway so I might more speedily savour the delights of Stately Doe Manor.

So I was innocently perusing the merchandise — mostly crap, alas — when someone tapped me on the shoulder. I looked around.

“Do you live around here?” a woman asked. She looked vaguely familiar.

“Uh, no.”

I need more vowels to spell crazy.

“You work at the hospital, don’t you.”

Goddamnit all to hell, I thought, except I inserted the f-bomb at least twice. Caught.

“Um, yes.”

And then she looked at me expectantly.She had the sort of blotchy complexion and body shape that suggested cholecystitis before 40. She seemed a little crazed, which made me a little, well, anxious. She clearly wanted me to comment on her mother’s/child’s/lover’s/nephew’s (or her) condition/prognosis/diagnosis/lab results/medications. Which, equally clearly, I couldn’t have done, even if I did remember her.

Then my phone buzzed.

“Excuse me,” I said. I stared intently at the phone and pretended the message was of such urgency and import as to leave me befuddled. I tapped the screen viciously.

She went away. I let out my breath.

There was no emergency. Of course it was nothing of the sort. It was my turn to play Words with Friends. Thank God for time-wasting aps.

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So I went to a second interview for a managerial position which in fact involves little actual management but is more administrative and actually fairly bomb-proof in an era of flat-lined hospital budgets. I actually really really want this position. I would feel fairly positive except the manager interviewing made what I have come to think of as the kiss of death statement: “It has been a real pleasure having the opportunity to get to know you.” Translation: Buh-bye, we will see you no more. Or am I parsing too much?

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Just Because I Don’t Remember You Doesn’t Mean I Didn’t Care

In the Emergency Department where I work, the number of patients we see pushes 200 some days. We assess and treat a lot of people, mostly for lumps and bumps, breaks and bruises, but also for major, cataclysmic, life-altering events — MIs, trauma, stroke, what-have-you.

I have a problem. The moment to the patient leaves the department I tend to forget them. Completely. If you are a run of the mill STEMI, I swear I will not remember you the next day. I may not remember you in an hour. A little while ago, my manager asked me about a case receiving some, um, legal attention. It was only after a good deal of prodding that I vaguely remembered — and this was a Code Blue! (Fortunately the legal formalities were about treatment received on previous visits, so I wasn’t directly involved. My charting was good, anyway.)

I do remember some cases which for one reason or another have stuck in my mind. (For example, like here. Or here. Or here, among others.) But mostly, nah. Maybe it’s because of the sheer volume. Maybe because my head will explode if I remembered the details on each and every patient. Maybe it’s just coping skills. Who knows. Anyone else have this problem?

Anyway, I was triaging the other day, and a patient told me how much she appreciated the care I gave her husband. (He was a Triple A, and survived.) I goggled at her for a second — we don’t frequently receive compliments in the ED — and said, “Yes, of course, I remember him.” She beamed. I made her happy. But I didn’t remember him at all. The patient’s husband was all in a day’s work for me — and a hugely important day in her life. We tend to forget what impact we have on patients and families. So a small lie for a good cause, I guess, a tiny bit of therapeutic communication.

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Some stupid to ponder, or how a local employer treats their nurses like idiots. Our local CCAC — the provincial agency which arranges for Home Care and related services — hath decreed that case managers are no longer permitted to use hospital-provided educational materials because 1) they haven’t been vetted by CCAC and 2) because the case managers haven’t been in-serviced on them.

Really.

CCAC evidently thinks their case managers — all RNs, by the way — are complete idiots in that they can’t tell patients using a hospital provided form when to come back the ED because (for example) their saline lock is infected. And CCAC believes that hospital put out bogus and misleading educational materials.

Sometimes you just have to shake your head. And mutter. Who comes up with these bonehead rules, anyway? Do managers lie awake at night thinking them up?

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On a personal note, thanks to all who emailed or tweeted or otherwise left messages of support regarding the family medical emergency a couple of weeks ago. All is well again, but I was a little frightened for a while. Your concern was really appreciated, and made me realize that I — we — have a great little community around this blog. Thanks!

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9 Comments

What I Found in my Garden

A turtle.

I remember as a child reading about turtles (or tortoises) in England, where all proper gardens seemed to have one — and being rather charmed by the idea. So I’m pretty pleased this gentleman (or lady) is residing in mine, even if temporarily. Every garden needs a turtle, in my opinion. (Under this crusty exterior, you see, lurks a sentimental fool.)

I have no idea of the species, but I’m guessing it’s a painted turtle. You can get an idea of the size by the paving bricks.

Also, a purely gratuitous cat picture, since I haven’t posted one of the wee moggie in a while. She looks so, well, innocent, doesn’t she?

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In Case You were Wondering

I saw the respirologist and the Something is not the Big Bad Something, or even a life-threatening Something, but nevertheless a Something which will require further investigations. So breathing is possible again, so to speak.

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Persistent Infiltrate R Lung

This is what the diagnosis said on the emergency facesheet, after I got my post-pneumonia chest film taken at work.

The atelectasis in the left lower lobe has resolved. The right, not so much. There’s a bit of fluff there, a dab of whatnot, a smudge, a blot, an unknowable Something or Other.  There is no good reason for this fragment of whatever. It’s enough, though, for a referral to a respirologist (my respirologist, in fact) for a bronchoscopy, which is where the good physician put a cable of fibre optics and tiny little collection instruments down my gaw to visualize the various tube and tubules in the lungs, and it is exactly as pleasant as I describe it.

I’m not scared, exactly. Foolishly or not I don’t know enough to be frightened. How can it be otherwise? It’s still ill-defined Thing. It could be nothing or it could be Hell. But suddenly, issues of vast import seem trivial. Federal election, who cares? Taxes return — next week, if I get to it.

Maybe I will have a little Moment later, with tissues.  But not right now.

Important: spouse, friends, cats, dogs, garden, family, writing. Today the rest can rot.

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On the other hand, I was able to help a close friend successfully navigate a particular dangerous place in his health in relation to the health care system today.  Which leads me to a Profound, Trite, Reflection, that bad things tend to happen to people without cause or justice, but we each author what good things can happen to others.

And no, I’m not Pollyanna.

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Pee-new-moe-knee-a

That’s right. Bilateral even.

I was having this funky back pain radiating around to my chest for a couple of weeks and a really strange shortness of breath that left me inexplicably gasping, so I went to my local ED to get it checked out. Got the full cardiac work-up, blood work, chest x-ray, ECG. Nil acute, nothing wrong, rien, diagnosed with musculoskeletal pain, patted me on the hand, and sent on my way. That was two weeks ago.

Last Thursday a colleague told me I looked “haggard” after a twelve-hour day.

Friday my GP left me a message on my voicemail asking me to follow-up because the radiologist’s report showed “an abnormality” on the chest x-ray. Here we go, I thought. I’m a reformed smoker.

After having a small meltdown, and making many phone calls trying to figure what exactly the radiologists report said, it was determined I only have pneumonia. Undiagnosed for a couple of weeks or more. The term of art for this is “missed finding”: the ED doc literally missed it on the x-ray — or forgot to look.

I haven’t felt exactly unwell: just sort of run-down, which I attributed to the weather and the season. Ibuprofen took care of the back and chest pain. I only started feeling really sick on Friday before I got the call. Since then it’s been hit or miss. Saturday I felt fine, Sunday I was intermittently febrile, and yesterday and this morning— just general malaise. Thankfully, I have a few off to lounge around the house.

Needless to say, all of this is far better than the alternative. It’s funny, though, how a phone call can transform you from “well” to “sick” in a matter of seconds. One moment I was perfectly okay, if a little under the weather; the next I was afflicted with a semi-serious illness, and thinking I needed all the prerogatives and privileges of the sick: warm blankets, ginger ale, chicken soup and general pampering. None of that has happened this far: no one quite believes me! For this, oddly enough, I’m grateful.

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The Best Moment in Nursing

We drank wine, too much wine, after dinner, laughed too loud, made music with the rims of the glasses and watched the candles splash light on the wall with gold fingers. I vented, just a little, and she listened. Why the hell am I a nurse? This was the general theme. She listened carefully and said nothing. After a while, the music became low and somber, and we switched to coffee and Cointreau. She played with her hair, twisting the bangs, and she asked me, suddenly —

“What was your best moment in nursing?”

I stopped and thought. I could see my reflection in the dining room mirror, dimly, and even I could see bone-tired in my face. But I thought about codes and trauma. I thought about why I was once made Employee of the Month. I thought of smaller moments of giving care— warm blankets, a back rub, a cup of ice chips, repositioning. I thought about missed findings. I thought about the time a patient an ambulance gurney went VSA while I was triaging her, and walked out of hospital ten days later. I thought about innumerable STEMIs caught and thrombolysed (and later sent for rescue cathetherization) within minutes of arrival. I thought about the times when I pushed for some extra intervention which made a real difference in the patient’s life.

I smiled. “There are too many.”

“Really,” she said. “No, really — what’s your best moment as a nurse?”

I thought again. I thought about speaking to the thirty-something husband of a woman dying  from ovarian cancer, who didn’t know what to expect. I thought about the unexpected joy of assisting the delivery of a child in the Emergency. I thought about arranging for a patient to spend his last hours at home, and the gratitude of the family as they walked out of the department.

I had a revelation. Not a huge, life-changing one, not comfort really, but still.

“Maybe,” I said, “maybe, I hope, the best moment is yet to come.”

“I think so too,” she said.

And the candles burned and we watched their dancing light and the shadows the made on the wall, and drank coffee and Cointreau.

 

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The Geography of My Bed

So we bought this fabulous new queen-sized bed and frame, eurotop and all, and all I’m left with is the fringe on the right side, so that my bum is suspended, cold and draught-prone, over the edge. This will not do, as my very important charge nurse clinical care leader duties require excellent sleep hygiene on my part.

Thus I created this diagram to help in my analysis of the siutation (and yes, the etc. in the middle worries me just a little):

After due consideration, my conclusion: clearly, the husband must go.

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Hello, TorontoEmerg, This is You Brain Calling

How I spent the last few days and how this relates to my plans for the coming week.

I spent the better part of Friday preparing to get drunk, and then, in fact, getting drunk. Far, far too drunk. This is funny, because I never drink, being the soul of moderation.

Saturday was the day after the night before.

Sunday I nearly went to church, but didn’t because I procrastinated till it was too late to go (I was writing a blog post, actually), and then I went shopping. I know I’ve said I’m a Christian and so on, and Christians are not supposed to drink to excess and even Sunday shopping is a little frowned upon — but I never said I was a good Christian. I’m hardly even a mediocre Christian. Too mouthy. Anyway, I also went to my new favourite all-you-can-eat sushi restaurant, perhaps to soothe the guilt of not doing my religious duty. I am a little embarrassed to relate I’m eating there so frequently the owner has given me a little card making me a “V.I.P customer” which entitles me to 10% off lunch and dinner. Last time I went he gave me a plate of delicious steamed mussels though they aren’t on the all-you-can-eat menu. This worried me, a little. When a man gives you a plate of steamed mussels in front of your husband, I think there is something going on. I was quite anxious about this. Would he repeat his free mussel performance? I glanced nervously toward the kitchen every few moments. I felt as though God was punishing me by wrecking my lunch. However, there were no further mussels.

Monday, I took  friend and her diabetic cat to the vet, then ended up shopping some more, which is very surprising, because I loathe shopping the same way some people loathe Justin Bieber. Incidentally, I saw his doll at 50% off. We intended just to run into the mall “for just a minute” at 1115 and stayed so long our planned lunch metamorphosed into supper.

Filed under the category of It Seemed Like a Good Idea at the Time is the fact that I’m working four day shifts in a row beginning today.

All of which is to say, posting may be light and insubstantial over the next few days. I don’t even have any ideas for light and insubstantial posts. I have no blog posts written in advance. I used up my emergency reserve post a couple of weeks ago.  My brain has gone on vacation.

I am a bad blogger.

I hang my head. In shame.

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