Showing posts with label DNR. Show all posts
Showing posts with label DNR. Show all posts

Thursday, January 10, 2013

"Even in this nicke of time, this very, very instant."

I'm probably the only person in the northern climes running the air conditioner.  My initial excuse was that the air needed dehumidifying.  When that got the bald eyeball, I admitted to being hot.  Now it's getting a bit cool but I'm safely ensconced in comfy bedding, hoping someone else will discover how to use the thermostat.

Life with fevers!  Hot, cold, sweaty.  I want frozen fruit, no, wait, I want hot soup, with many spices and several of TW's dried jalapeños, for good measure.  Wait, hold the soup, and gimme an ice pack!

But it's been kind of a nice day.  Pain sitting at a mere 6 out of 10 (whatever the heck that means) and Buddy has discovered all my old cashmere leg warmers.

Cashmere leg warmers, when sprinkled with catnip and then rolled into a ball, are objects of drooling adoration for Mr. Buddy.  And they're perfect for me -- I throw like a girl, so what better thing for me to be tossing about but bright red or sexy black cashmere leggings?  I am achieving amazing distances and Buddy is uprooting all the haphazardly strewn about area rugs in our chichi wing of Marlinspike Hall.

I have quarantined myself in our cozy little wing because the staff is coughing and sneezing and generally making any gross respiratory-related, gravelly noise possible.  Roughly 80% of the staff has the flu and the other 20% are apparent mimics.  I'm not letting those walking microbes across my line in the sand... not for nothing.

Every year, my MDVIP Go-To-Guy and I have the same conversation about the flu vaccine.

Oh, I probably haven't mentioned that I had the Grand Pooh-Bah of MDVIP Appointments last week, last Thursday to be exact.  I dread these annual affairs, and they always turn out... fine.
More on that later.

Back to the recurring flu vaccine conversation.  Back in 2005, I was an advocate of the vaccine, thought nothing of it, was very grateful for it, even though I'd had the flu a few times after getting it -- either getting a variant not covered by the flu-guessers or bad timing.  That year, I'd just had my right shoulder replaced by none other than our beloved ShoulderMan -- it was our first meeting, back when things seemed much more straightforward!  I had a few problems afterward, weird stuff, of course -- a necrotic lymph node right next to the surgical site, and a pretty severe anemia, despite having had a top-off at the hospital prior to discharge.

This was before Go-To-Guy went all MDVIP on everyone, back when he was one of the founding docs of a pretty large, very busy practice.  I came in because I was inexplicably getting weaker, and  blahblahblah we discovered I was just anemic.

"While you're here, why don't we give you your flu shot?  I know you're a little run down, but what could happen?"

Please pay attention to that phrase: "what could happen?"

Informed consent, wham, bam, thank you super nurse, I got my shot and we headed home.

Two hours later, I was deathly ill.  Fred, not always quick to pick up trouble, being a cheerful and positive kind of guy, went and bought the Mucinex that Go-To-Guy recommended.  And that's the last thing I remember until I woke up about five days later on a respirator, overwhelmed by the sensation that I had missed something.

Anyway, "what could happen?" became a catchphrase that reduces me and Fred to tearful hysteria.  It just cracks us up.

And Go-To-Guy wipes the story from his memory every year.  Psychic trauma does that to people.
Last Thursday, as he talked me into taking the pneumonia vaccine, he opened his mouth, which then sort of flapped around aimlessly, because you *know* what he was about to say!  It was almost the same situation as the phrase's début iteration -- we were dealing with being rundown from my stomach bleed, with a low hemoglobin (but so much better, thankyouverymuch!).

I about fell on the floor laughing.  (No, I didn't.  That would have been... rude.)

There's been nary a hint of a problem from the vaccine.  But think carefully the next time you're tempted to gloss over potential pitfalls with a blithe "what could happen?"!

So... part of these annual MDVIP "physicals" is a prompt summary letter afterward to remind you of what you just talked about the week before.

The happy experience of discovering that my desire to be on "Do Not Resuscitate" status was not going to cause me or my treating physicians a boatload of upset or the need for reinventing the wheel -- well, I had not had the chance to even run it by my MDVIP Go-To-Guy Treasure of a Physician.  We had exchanged emails, but I was always in a snit over something, over-the-top, and he's a born optimist.  So I was never sure if we were talking about the same thing.

That my last hospitalization went so well, that this potentially thorny issue proved thornless, had nothing to do with him -- turns out, he didn't even know I had stayed as long as I had.

So last week, I let him know the day before the big exam that I was hurting a lot and would appreciate it if we skipped most everything so I could get home and rest my nasty bones.  We always need to go over meds and that takes a long time -- it's very useful and helpful, and it actually serves well as a guide for what is going on in each "system." As we discuss a drug, we discuss the problem, we make adjustments, etc.  We review my blood work, which, frankly, depresses me.  There is no way to dress up those results.

I couldn't bring myself to look at this kind man, or at his super kind nurse, and even say "DNR." But I found words, and delivered them with what I hoped was good humor and appreciation.

Here's the relevant paragraph from the letter I got today:

"Unfortunately, you continue to have severe pain with your hips being the most prevalent at this time.  It is certainly possible you have an infection in one or both of your hips and it sounds like your left shoulder may have infection in it as well.  The elevated white blood cell count and the persistent low grade temperature support this fact but we really have not been able to eradicate this infection by the use of either oral of IV antibiotics.  As you said to me, I think right now the best approach is pain management and 'putting out any of the fires that we can.' Ideally, surgical resection of any hardware in your joints with heavy doses of IV antibiotics would be the only way to eradicate this ongoing infection but I am not sure you are willing to proceed with anymore surgery and frankly, I am not sure if your body could take much more than what you have been through."

He did hear me.  He always has.  I am really blessed.  Because I did not make it easy for my physician to hear me.  I flirted with the concept of "stopping," but then, when it got hard, I called for help.  Now comes the test.  At any given time, there are "fires," but which are the ones that threaten the foundation?  Which are just flare-ups, little grease fires that can be squashed with a cooking lid or stifled with a damp towel?  When do I just drop and roll -- with prayer or mute begging to the universe, or, if I am doing well, and have done my work, the hope of resolution?  And when, prayer, begging, and work done, but Death dallying, do I call for help, because it's just a straightforward blaze that a spritz or two will stop?

Were he not such a good guy, I'd ask MDVIP Go-To-Guy, but it's not his place to be asked, and it's not his place to answer.  It's not Fred's place, though it will be his to endure the results.

It's time for me to grow up -- it's the very nick of time.  I'm gonna have me a chat with Buddy.


NICK OF TIME

Origin

The English language gives us the opportunity to be 'in' many things - the doldrums, the offing, the pink; we can even be down in the dumps. With all of these expressions it is pretty easy to see what they refer to, but what or where is the 'nick of time'? It may not be immediately obvious what the nick of time is, but we do know what it means to be in it, i.e. arriving at the last propitious moment. Prior to the 16th century there was another expression used to convey that meaning - 'pudding time'. This relates to the fact that pudding was the dish served first at mediaeval mealtimes. To arrive at pudding time was to arrive at the start of the meal, just in time to eat. Pudding was then a savoury dish - a form of sausage or haggis (see also the proof is in the pudding). Pudding time is first referred to in print in John Heywood's invaluable glossary A dialogue conteinyng the nomber in effect of all the prouerbes in the Englishe tongue, 1546:
This geare comth euen in puddyng time ryghtly.
In the nick of timeThat seems a perfectly serviceable idiom, so why did the Tudors change it to 'the nick of time'? The motivation appears to be the desire to express a finer degree of timing than the vague 'around the beginning of the meal'. The nick that was being referred to was a notch or small cut and was synonymous with precision. Such notches were used on 'tally' sticks to measure or keep score. Also, during the 16th century, pudding began being used as the name of sweet dishes and they were usually served at the end of the meal. As this trend continued 'pudding time' being used to mean 'in good time' made less and less sense.
Note: the expressions 'keeping score' and 'keeping tally' derive from this and so do 'stocks' and 'shares', which refer to the splitting of such sticks (stocks) along their length and sharing the two matching halves as a record of a deal.
If someone is now said to be 'in the nick' the English would expect him to be found in prison, the Scots would picture him in the valley between two hills and Australians would imagine him to be naked. To Shakespeare and his contemporaries if someone were 'in (or at, or upon) the (very) nick' they were in the precise place at the precise time. Watches and the strings of musical instruments were adjusted to precise pre-marked nicks to keep them in proper order. Ben Jonson makes a reference to that in the play Pans Anniversary, circa 1637:
For to these, there is annexed a clock-keeper, a grave person, as Time himself, who is to see that they all keep time to a nick.
Arthur Golding gave what is likely to be the first example of the use of 'nick' in this context in his translation of Ovid's Metamorphosis, 1565:
Another thing cleane overthwart there commeth in the nicke:
The Ladie Semell great with childe by Jove as then was quicke.
The 'time' in 'the nick of time' is rather superfluous, as nick itself refers to time. The first example of the use of the phrase as we now know it comes in Arthur Day's Festivals, 1615:
Even in this nicke of time, this very, very instant.

Sunday, December 23, 2012

My Seasonal Under-Seasoned, Non-Reasoned Side Dish

This is not exactly a "vent," according to the technical requirements of venting, nor is it a pot pourri, as defined many times in this blog.  You can refresh yourself of the sad history of rotten earthenware on elle est belle la seine la seine elle est belle by fecklessly clicking HERE.

As for "venting," I'd go there in a heartbeat -- perhaps it's all I ever do -- but the thought of passing gas in the midst of a gastrointestinal bleed that cannot decide whether to resolve or seep, well, you understand.  And if you don't, well God bless your sweet little heart and maybe you should consider hanging out elsewhere, hmm?

It's an upper bleed, born of my need for anti-inflammatories.  See, Ma?  I told you it wasn't the crack and the meth and the fentanyl or the percocets that were gonna bring me down!  It's the Mobic and the ibuprofen, not to mention that fiendish aspirin protocol, those deceptively sweet little 81 mg aspirin doses meant for gurgling, chubby babies. Those fiendish back-alley drugs sold by tottering toddlers in droopy diaper drawers.

While I am blessing simpler minds and hearts, let me also praise the television and the brilliance of its offerings today.  You see, changing the channel has become difficult, much as standing, sitting, rolling over, and begging for bonita flakes have become terrible tasks.  Of course, I may be slightly confused, as my O2 sats are averaging a whopping 84.  I don't beg for bonito flakes.  Buddy begs for bonito flakes.  So where the television was when it was extinguished in the wee hours is where it stayed, mostly, today, under the terse glare of my double vision.

I watched three Dirty Harry movies in a row.  I'd never seen one before, not in its entirety (there's a clue for ya!).

Being a member of the simpler-minded set, the "dirty" in Dirty Harry began to bug me.  I started to itch.  Putting on my thinking cap, and vaguely wondering what-the-hell-is-that-musty-odor? -- I began to calculate, by counting backward through the momentous events that mark my days, when last I showered.

Hmmm, thought I, the Mathematician.  I knew The Calculus would serve me one day.  A liberal arts education is not yet bereft of all use!  And do you remember the guy who tutored me, O My Goodness.  Joe the Football Player and Math Whiz.  A cutie-pie.  A sweetie-poo.  His jeans weren't in style but they fit well, and we liked each other.  I hope Joe the Football Player and Math Whiz had a good life.  He surely deserved one.

Umm, yes, well, anyway, it turns out to have been the morning we went dashing through the rain to the Emergency Room... last Monday.  No... that's not right.  It was the Monday before THAT, 10 December.

Upon which realization, I made showering the sole goal of my day, to the relief of Fred, the Feline Triumvirate, and the Cistercian Brotherhood (apparently there has been a freakish shift in wind patterns, lo this past fortnight).

I must insist, as I have before, that I am not dirty.  I bathe daily, just not in the confines of a bathtub or shower.  Judicious use of a well-stocked half-bath, often two to three times in a day, keeps me as clean as your average person.  But we all know there's nothing like a shower, and certainly nothing feels so good as warm water streaming down an accursed bowed back.

This time, I refrained from scrubbing my feet, as that proved to be such a distraction to the medic-types in the hospital.  "Ew... your feet are bleeding." They even called in the Wound Care Team, which consisted of two timid young folk, quivering at the end of the bed, saying: "Ew... your feet are bleeding."

Moving right along, the shower is done, and the Dirty Harry marathon, as well.  I made a stab at changing the channel and hit upon, in sequence, The Sound of Music and The Return of the King, last of the trilogy.  Thank you, Peter Jackson.  Pippin just sang a plaintive tune to the finger-licking Denethor, Steward of Gondor.  That's one messed up Daddy -- though the influence of Mordor can do that to a man.

Which brings to mind a hilarious series of tweets, strung together by Todd Zwillich some time back.  I love 'em and know you will, too.  It was his moment of personal insanity over the often insanity producing topic of the bleeping "fiscal cliff."



Know who else went over the cliff to his demise? 

Know who ELSE went over the cliff to his demise?? 

Know who !ELSE! went over the cliff but survived? 



Know who ELSE went over the cliff but was stronger for it?!

[i *totaly* messed up that slick copy and paste maneuver, apologies!]

I can't go to movie theatres anymore -- that's right, I've been universally banned -- so The Hobbit being out is about killing me.  Have any of you Dear Readers seen it?  Was it wonderful?

I made it through this day, plan to do well tomorrow and actually sally-forth from behind Manor walls for some Christmas cheer and shopping.  I'm whipping up a ginger and honey carrot dish for Fred to offer the few Militant Existential Feminist Lesbians who will gather for a meal on Christmas day.  I'm planning to sneak some fresh cranberries, cooked just to the point of popping, to the dish, and think it will be beautiful as well as tasty.  

When I dropped the bomb about having been granted DNR status and offered Hospice palliative care during this last hearsepital stay, I thought there'd be an uproar.  Instead, there's been a studious refusal to discuss it.  I am in a quandry, as I don't feel much like talking about it, either, but really, really would be angry were it to be screwed up in application... so I am trying to figure out the right time to broach this oh-so-celebratory topic.  All I know is... bless one Dr. Montgomery, who helped me NOT to go to pieces but to articulate my wishes in a sane and sensible manner.

So I am thinking the best time to spring the discussion on the old Loved Ones is between the Yule Log and the popping of the 2013 cork.  And to cross every available digit in the hope that nothing happens between now and then.

As usual, not the post I set out to write.  Not a vent, not a pot pourri, not even something I'd choose to proof or edit.

It turned out like some kind of underseasoned, overthought side dish.

Needs salt.


Thursday, December 13, 2012

yes, the river really does know

Hi, all.  

The buzz around Marlinspike Hall has been all about how I have adroitly ducked out of doing any work on The Manor -- where everyone is all a-flutter due to an upcoming Haddock Corporation Inspection [We're expecting a flotilla of pink miniature submarines surfacing in the moat -- which, despite Fred's superhuman efforts, still has a kind of neon emerald algae overgrowth going on -- at any time.  "At any time" refers equally well to our  algae overgrowth chronicity as to the possibility of a herd of pink submarines popping up, full of corporate suits and a swearing Captain Haddock.]  Anyway, yeah, I ditched my usual slave labor in favor of a stay at the local hospital, the Lone Hospital West of the Lone Alp here in Tête de Hergé.

Everything these days, from internet orders to a simple request for some apple cider from the Cistercian Brothers right next door, carries an "order number." Well, at the hospital, I wore so many of those fashionable little plastic bracelets that they decided to revert to the old "case" shorthand.  I became "the case of the missing hemoglobin."

It was just an upper g.i. bleed, and without benefit of supplementary blood products, I have returned to my post here at The Manor with a hemoglobin of 9 and a solid hematocrit of 20-something.  I'm getting no sympathy from anyone, just glares for my shirking-of-duty ways.

They decided to let me go late last evening when it became clear that my pain management and general overall comfort would be better managed by getting me the heck out of a place where people are just hardwired to TOUCH the patients, God bless 'em.  Even though they were bound by their own set of internally ultra-rigid rules -- "you can have the pain medication in another 2 hours and 4 minutes!" -- they were truly understanding of the situation, and together we decided the best place to be was... home.

Which leads me to what I hope will be accepted as a quiet understatement, despite any verbal tendencies that may have led my dedicated readers to assume me incapable of quiet understatement:  Working with the admitting doctor, we were able to pretty easily have me placed on a "No Code" status and discussed possibly making use of some of hospice care's gentler gifts. This just goes to supplement the legal documents I already have in place but which, quite honestly, are often ignored.  It's much more effective to have it written as an order in the chart, and to have the secret not-so-secret orange band placed upon the wrist.

And so, of course, I came nowhere near coding and am home with my robust Hgb of 9 and a hell-hole of pain, since all anti-inflammatories are now forbidden, seeing as how they made me bleed in an unholy manner, that momentous bit of decision-making really did turn out to be a quiet one, momentous for me in that it was so easy and not fraught with emotion or argument.  I suppose it should be a bit depressing that the doctors didn't see much point in arguing with me, and that I saw a bit of "whew!" relief in their eyes, but it's not at all saddening.  The nurses were a different story -- they felt that if I had the right kind of pain relief, POOF, everything would be fine.  "Have you tried a heating pad?" asked one particularly kind, particularly inexperienced new nurse, on her very first evening shift without being "shadowed" be another nurse-mentor.

That's the sure DNR fix:  a heating pad.  It was hard to know what to say to her without bursting her first-night-working-alone bubble.  I explained that heating pads and ice were both contraindicated but "that sure is a good idea."  She was the *only* person I encountered, though, with whom I had the Usual Conversation:

ME:  Please don't touch my legs.  Thanks.
NEW NURSE:  [while touching feet]  I won't.
ME:  STOP TOUCHING ME.
NEW NURSE:  [feeling for pedal pulses] I'M NOT!
ME:  {whispering} Please, please, please don't touch my feet.
NEW NURSE:  I'm not, I'm just checking for pedal pulses.  It's part of my assessment.

Don't ask me.  I don't get it, either.  All I know is that I was BLESSED to have it happen only once.  I got the feeling that while I was under "conscious sedation" for the upper g.i. scope, my legs were pretty well checked out.  I swear I could be brought into the emergency room with an arrow through my head and my nose where my ear should be and the first area of interest would be my legs.

It borders on the absurd (o, puh-leeze, it inhabits the heart of absurdity), but they sent in the damned wound care "team"-- they travel in packs -- to investigate the patch of raw skin on one of my toes, a patch that would not have been there had I not made the mistake of scrubbing my feet with Hibiclens prior to hopping into Ruby the Honda CRV for the trip to the ER.  The bruising that has been there for over 5 years was much "ooohed-and-aaahhhhed" over, until I suggested a layer of gauze and a light application of paper tape, which my nurse and i promptly removed upon their self-satisfied departure.

We should start a pool to see what the Wound Care Consult and "treatment" charges turn out to be.  I wager somewhere in the region of $600 but that's lowballing it.

Fred was a trooper.  He did the best he's ever done and I am really, really proud of him.  The DNR discussion was hard, but we did it, and it's over. I hope.  I had to have the same discusssion with Brother-Unit Grader Boob, as he is my health care proxy in case Fred craps out or is unavailable at the necessary time.  That was harder, as silence on the phone -- I HATE PHONES -- can be difficult to interpret.

For you, TW, this is that conversation.  One-sided.  But somehow, I thought and think that you will most easily understand it for what it is:  The River knows.

The Doors; Yes, The River Knows 
Uploaded on Aug 3, 2009 by jameshippiekid
Waiting for the Sun 

Track:10

So... give me a few days to get stronger and I shall regale you with hilarious tales of funny and terrific nurses and some of the sweetest docs I've ever met.

Unless I die earlier than necessary because the Domestic Staff has me scrubbing one of the ballroom parquet floors with a soft toothbrush.





Please believe me the river told me
Very softly want you to hold me

Free fall flow, river flow on and on it goes
Breath under water till the end
Free fall flow, river flow on and on it goes
Breath under water till the end
Yes, the river knows

Please believe me if you don't need me
I'm going, but I need a little time
I promised I would drown myself
In masticated wine

Please believe me the river told me
Very softly want you to hold me

I'm going, but I need a little time
I promised I would drown myself
In masticated wine

Free fall flow, river flow on and on it goes
Breath under water till the end
Free fall flow, river flow on and on it goes
Breath under water till the end