So we went to the baseball game today. D-Backs Vs Dodgers and as usual it was attended heavily by wanna-be gangbangers. We sit on the concourse level in the handicapped area so we don't have to get up and down all the time as people come and go. There is a medical reason we sit where we sit. Our actual seats are just below where we sat today. Each week we trade our tickets for seats in the handicapped area. We have half season tickets for our seats which is roughly 40 games.

There is a big push at the park to renew season tickets so I went to discuss with the guy at the season ticket booth renewing our seats, but this time in the handicapped area. Ticket guy gets on the computer and fiddles around for about five minutes and then tells me he cannot sell me the seats/tickets. I'm naturally puzzled over this as most businesses are more than willing to make a $4K plus sale. 

We talk further and he explains that state and federal laws require them to provide X-percentage of seats for handicapped individuals and they are under that requirment already so I can't have the seats. He will contact the Diversity Coordinator and have her contact me to discuss how they will be allowed to sell me season tickets in the section of my choice. Keep in mind we have been sitting in this handicapped section all year already. Anyway we will await the call from the Diversity Coordinator and maybe, just maybe I can buy some damn seats without the government stepping in and stopping the sale. I go back to our seats and explain this to the wife and she like I just scratchs her head about it.

Because we are on the concourse level people frequently congregate behind us to watch the game. This is fine when they are D-Backs fans but gets annoying when it is obnoxious dodgers fans. We learned a way to cope with this however. When there are non-obnoxious D-Backs fans behind us we stay seated. When dodger fans stand behind us we stand up to block their view. Me being six foot three and the SO being Six feet tall makes a pretty effective barrier and usually the dodgers fans leave pretty quickly.

          Some of these patients are always nearing the end of life as was the patient I am writing about. He was a very frail 96 year old white male with dementia, psychosis, and in a state of failing to thrive. His dementia had advanced to the point that he had almost forgotten how to eat. This is normal for a diagnosis of end stage dementia.  The patient also had a long-standing history of needing antipsychotic medication to control his psychotic episodes, though he currently was not on any antipsychotic medication because we had been able to control his condition without them.

The POA fed up with the state interference moved him to an inpatient hospice where he died much sooner than he probably would have if the state had not interfered with his treatment. The nursing home had been his home for 13 years and the POA was heartbroken that she had to move him from his home.

Ok, I'm starting to work on my blog again. The legal problems are over with. I have stories I want to write and other things I want to blog about. I also have to learn this new to me blog admin.

Change of Shift is up at Kims place. Plese go visit and enjoy.

 

It started innocently enough. A slight feeling of fullness in the right side of my upper lip. There was no tingling, burning, or pain so I didn't think much of it. It was about 1600 and I was at work with four more hours on the clock to go. The patients were coming in steadily and they kept me somewhat distracted from what was happening to me. At about 1900 we had a lull in patients and the other nurse practitioner gasp a little and asked me what was up with my lip.

I felt my lips and could tell the right side of my lip and face was beginning to swell even more. I had a suspicion as to what the problem was and discussed it with my partner. She agreed and ordered decadron 5 mg orally. I called my boss and told her I needed to leave work early as I had an urgent medical condition developing.

I filled the prescription of decadron and took 2.5 mg before leaving for home. By the time I arrived home the entire right side of my face was swollen and I could feel it working its way down and back to my throat. Damn, I thought, this can't be happening to me. I took the other half of the 5 mg of decadron and 50 mg of benadryl.

I sat in the dark waiting for the wife to get home and then decide how to proceed. Tick, tick, tick, seemed to take forever for her to get home and I continued to worsen. I could feel my throat tightening and it was becoming difficult to swallow on the right side. Though the swelling does not look that bad from the outside, inside my mouth my cheeks were swelling far more than the outside.

She arrived shortly and changed into her evening wear. She then began to question me and examined me as a nurse practitioner spouse is want to do. She asked if I wanted to go to the hospital. At first I said no, then thought about it for about 30 seconds. Well yes, take me to the ER. Those were shocking words to me. I am the last person who would ever go to the ER for anything. I once lacerated my finger bad enough to need stitches. I set up a suture station at the kitchen table and taught my wife how to suture on the spot. No lidocaine necessary. Another time I broke my 5^th metatarsal and dislocated it. It was sticking straight up almost poking through the skin. I simply reached down with my thumb and pushed it back in place without any lidocaine. Yes it hurt, but there was no way I was going to go to the ER and have someone else do it. I hate going to the ER but here I was admitting defeat and having my wife drive me to the ER. On the way the swelling continued to worsen.

She dropped me off at the ER entrance and I went inside and stood by the triage RN and waited for him to finish with his current patient. It seemed like he was taking forever when it was probably only 45 seconds in real time. As soon as he finished and before he could call for another patient I interrupted him. Yes he asked? I pointed at my face and said one word, angioedema.

Stand right there and don't go anywhere he responded. He grabbed the triage tech and told her to take my vitals and information while he finished with his next patient. As soon as she was finished with taking my vitals and other medical information I was back with the triage RN.

He was very thorough in his assessment and questioning and assured us I was a top priority to be taken back and treated. He finished with his questions and we retired to wait in the lobby until a bed was available. In the mean time a nurse popped in repeatedly to make sure I was still ok. I had a tight feeling in my throat and a little difficulty swallowing but was still able to breath without difficulty.

It took about 45 minutes for them to take me to a room. Even though I knew I had a life threatening problem I was not angry or demanding about the wait. I would have called myself stable and felt the triage nurse assessed the problem appropriately. Emergency rooms have their beds assigned to different tasks. Some of the beds are for broken bones (ortho beds) some areas are for non-life threatening medical conditions like abdominal pain, urinary tract infections and such. Then there is usually a small number of beds for life threatening medical conditions and trauma. I was in need of one of those small number of beds. I knew they would have to do the ER shuffle to make room for me and from what I saw that was exactly what they were doing. I was brought back to a room and told to take off all my cloths except my underwear. I have done the same routine with tens of thousands of patients when I worked the ER so I did not argue, I stripped down as I was instructed. I knew that if I went south the ER crew did not want to have to be distracted to take the time to cut my cloths off instead of intubating and bagging.

And there I lay on the bed waiting. And waiting. An hour went by. The nurses kept checking in on me, taking vitals and assessing my condition. The swelling seemed to be stalled and my tight throat was not getting worse. I don't want to die like this, I thought. I didn't hear about it until the next afternoon but I was told the ER doctor went ballistic on the nurses when he picked up the chart and read "angioedema" as the chief complaint 1 ½ hours after the chart was placed in the chart rack. By this time it was about 0030.

The doctor introduced himself and did a thorough medical evaluation. I knew exactly what he was going to say. He asked me about the decadron. I told him yes, I was a NP and thought I was having an episode of angioedema. He actually said I had probably done the right thing and that I may have prevented more severe symptoms by my earlier actions. But from everything I have ever read about angioedema I didn't think so, but I said nothing.

The doctor left and the nurse soon appeared and explained that she would need to start an IV. I expected it along with the steroids and antihistamines to follow. She prepped a vein and blew right through the first try. I told her that was ok nobody bats 1000. She got the IV on the second try and secured it with less tape than I thought would keep it in place. I added much more tape later, and I was glad I did.

She pushed the pepcid, solumedrol, and benadryl. It took about 2 minutes for the benadryl to hit me. I am very sensitive to benadryl. I have been known to hallucinate on as little as 50 mg orally and I had just had 50 mg IV. I told her before she started the IV I needed to pee. She said I could do so after she pushed the drugs. By the time she finished cleaning up all the wrappers and trash my head was lolled back and my eyes were a-glaze. She asked me if I wanted to walk to the bathroom. I was not going to be macho, I told her no way I was too wobbly. There is a lesson to be learned here. I could have played the macho man, walked half way to the bathroom and fallen down and broken something but I didn't think the nurse or my body would appreciate that. Yes it can be embarrassing peeing into a urinal but its better than breaking open your head or breaking a hip trying to be macho. I asked my wife if she would help me with a urinal and she agreed. One was produced and the nurse left me to my business.

My wife let the bedrail down and I scooted to the edge of the gurney thankful to be able to take some pressure off my sore bottom. Those ER gurneys are anything but comfortable. I wheeled around and used the gurney to steady myself and pull up the gown and pull down my underwear. Then I learned something. Urinals are difficult to use. I had marveled all these years why so many men have trouble using the thing and I found out for myself. I put the urinal to my dick and realized I had to bend my dick 90 degrees to get it into position to pee. Hmm, I never realized that before. I urinated as best I could with a kinked urethra and tried to finish up. As I removed the urinal and unkinked my dick a shot of urine spilled out on the floor. Scowls from the wife as it landed just at her feet almost landing on her. She put me back on the gurney and cleaned up the urine on the floor with the antiseptic that was on the counter. I tucked this new piece of information away and would use it later for a more successful trial with the next urinal.

And now we had to play the waiting game. An hour went by, then another 30 minutes. The nurses constantly checking on me making sure I was comfortable, safe, still able to breath. Then the ER doctor came back to re-examine me. He took one look at me and made a straightforward statement. We need to admit you to the ICU. I just nodded my head in agreement and eked out a weak who is the Hospitalist? He told me his name and that he was next door admitting another patient and would be with me shortly. Another hour and a half went by but it really didn't matter as it made no difference to me if I was in the ICU or the critical care area of the ER. The benadryl did its number on me and I began to have uncontrollable twitching. Well at least this time I was not hallucinating. By the time the Hospitalist arrived both my upper and lower lips and right lower cheek were severely swollen. He completed his exam and reaffirmed that I needed an ICU bed and left to confirm the admission. At this point I asked my wife if she wanted to go home as we had both been up almost 23 hours. She said no at first then as time went by I asked her again and she decided she had had enough for one night. She kissed me goodnight and left telling the ER nurse to take good care of her Homer while she was gone. The ER nurse responded "DoH." You can take the ER nurse out of the ER, but you can't take the ER humor out of the ER nurse.

They transported me to one of the ICU's and settled me in a bed in a corner room. Once in bed I got the usual bundle of wires attached to various parts of my body. I tried to lay on my side to get some rest but everytime I rolled to either side I would set off the alarm on the cardiac monitor. I was wound up from the drugs and at this point I was just too tired to sleep. When the nurse came to check on me shortly I pointed and asked her which cameras were working? She said none of them. I took note of that but one of them had a little green led lit so I suspected it was the working camera.

My right cheek began to swell. It looked at one point as if someone had cut a baseball in half and glued it to my cheek and painted it flesh tones. The pressure in my lips and cheeks was tremendous to the point of stretching the nerve endings past the point of feeling. I was worried but the throat pressure I had felt the night before was still gone and my breathing seemed unimpeded.

Time went by and I was beginning to become increasingly thirsty. It was now 0600 and I had not had anything to drink since the small sip of water I had had at 1900 the night before. The last food I had had was at 1300 the previous day. At 0700 I asked for a glass of water. The nurse examined me, my lips in a rictus and horribly swollen now. She brought in a cup with some ice chips and a spoon. She figured that I would have been unable to drink from a straw or cup and that all I would end up doing is spilling ice water all over myself. Later, after a little of the swelling went down I tried to drink from a straw. She had been correct, there was no way I could have done anything other than make a huge mess had I had a cup of water.

At 0730 the day nurse arrived and introduced herself. She had two students in tow and asked if they could help care for me. Sure I said, it would be a good experience for them as this condition is not seen very often. I spoke with the students and explained that I had gotten little rest in the past 24 hours but to come back later and I would give them a tool to help them remember the cranial nerves. They laughed and I told them I was faculty at their schools and was not kidding about the tool I could teach them.  

Between 0700 and 0730 I actually slept a little. This was after being up 25 hours. Around 0800 the nurse brought me breakfast. She had ordered a single pancake with juice and a skim milk. She knew that because of the swelling I would only succeed in chewing my cheeks to bits if I really had to chew a hard food. The pancake could be massaged by my tongue and washed down fairly easily. I normally detest pancakes but that one seemed the best I had ever had.

Whether through time or drugs the swelling was finally starting to go down. Hour by hour it improved and the drugs kept coming. Large doses of steroids and antihistamines.

After eating I had to urinate again. I scooted to the side of the bed moving the tangle of wires with me, not an easy feat. I slid over the edge of the bed and used it to steady myself. This time instead of using the urinal as intended I turned it around so the handle was between my legs instead of pointing away from me. Urination went off with no problems and I did not have to bend my dick into that awkward 90 degree angle. I had discovered that male urinals when used standing up have the handle on backwards.

As I crawled and shimmied back into bed I felt something akin to a dog tethered to a pole. I could sit on one side of the bed only and movement in the bed was limited because of the harness of wires attached to many points on my body. It was also very uncomfortable for me to urinate with someone watching me from a closed circuit camera. All in all though I would prefer to be in a room that is monitored as it gives an extra little bit of comfort knowing they are keeping a close eye on you.

The swelling continued to subside and by lunch time I was able to take in some soup. To keep from being bored to tears I questioned the students about the drugs the nurse was giving me. I quizzed them on class, route of administration, pharmacodynamics and pharmacokinetics. The ICU nurse seemed to get a kick out of her patient torturing her students about the drugs I was getting.

About 1500 the ICU nurse called the Hospitalist and reported the majority of my facial swelling was resolved and he may want to come and either transfer me or discharge me home.  He was there within 30 minutes and re-examined me. He asked me if I wanted to go home and I responded with a firm yes. Discharge instructions and scripts were written and I was free of the tether once again.

Looking back on the discharge it might have been better if they had kept me another 24 hours because I had not slept for 36 hours by the time we got home. I don't remember anything past about 1930 hours. The large doses of steroids caught up with me and my wife tells me I babbled incoherently throughout the night. She being a seasoned ER Nurse and Nurse Practitioner was able to handle me without having to call the paramedics to haul me back to the hospital. Its 2 days later now and I'm still on high dose steroids. Put a container of cream in my hands and in short order you will have butter I'm shaking so much. I know this too will pass and things will get back to normal. One thing I know, I will never take an ACE or ARB again the rest of my life.

*Update- ACE= Angiotensin Converting Enzyme Inhibitor, ARB= Angiotensin Receptor Blocker. Two classes of blood pressure medication that can cause angioedema. In my case Lisinopril a medication in the ACE class.

 Juan Rodriguez Cabrillo. Who, you say? Though he died on January 3, 1543 he does figure into this narrative. Jump forward to 1999. That is the year my father in law died. Sitting at the breakfast table his heart stopped and that was that. We had the funeral and we never really thought about what to do with his remains as his wife still had them.

Jump forward again to 2001. That is the year my mother in law died. It was rather an unsettling death and necessitated my wife to act as executor of the estate. During the process of cleaning out her home my wife found her dads remains in the closet. We brought them home and placed them on the shelf next to each other. But what to do with them? We had no clear directive from either of what to do with the cremains after they passed so we were stuck. Add to that a rough and rocky relationship with the remaining family and we became paralyzed with grief.

Yes, even those of us who deal with death on a daily basis can have problems with the subject when it affects us personally.  So for 6 years my wife walked by her parents on the shelf in the study unsure of what we were to do with them. Recently though we had another of those what to do talks and I mentioned that her dad had been in the Army and surely had Veterans benefits related to burial at a Veterans Cemetery.

I did a little research and found a Military/Veterans Cemetery we could check out in the San Diego area. Shortly thereafter we set out to check out the place first hand. The moment we drove onto the grounds we were certain we had found the right spot for her parents remains. The journey would soon be over.

Through many phone calls, faxes, letters for official records my wife battled through the government system until she had all the correct paperwork and a date set for internment of the cremains. One last piece of paperwork we had to complete the day before and that was to obtain burial permits through a County office. This really ticked me off having to pay the County to bury a Veteran and his wife on Federal Government property.

The next morning we set off early to do some sight seeing prior to the service. We stopped at Cabrillo National Monument and sat transfixed watching the Naval Vessels enter the harbor. Throughout the time we were at Cabrillo we were serenaded by the sweet sound of Military jets and helicopters. There is no more pleasant sound to me than the roar of a fighter jet as it banks directly over my head and takes off out over the beautiful blue Pacific Ocean.

Looking at Fort Rosecrans from Cabrillo National Monument. 

Entrance to Fort Rosecrans

After sitting watching the jets and ships for several hours we headed to the Cemetery to set up for the service. One small problem ensued though. When we retrieved the in-laws from the trunk mom-in-law was leaking. In fact just as I picked up the box a gust of wind carried some of the ashes into my mouth. Let me tell you human remains don't taste good at all. So here I stand with people milling around in the middle of a sacred Veterans Cemetery with a mouth full of ash. I started to spit but realized that others not having seen the ingestion of the ash might not realize I'm not spitting out something but spitting on someone.

I looked around trying to come up with an idea how to handle the situation. Finally after a short time I dug around in the car and came up with a bottle of water. I took a big swig and rinsed my mouth and swallowed. I repeated this several times until I could no longer feel the grit, but the horrible taste lingered on for long after.

We went into the office and explained we needed some packing tape because mom was leaking. The girl behind the counter looked a little distressed but handed over the tape and we fixed the problem.

The rest of the family arrived and we proceeded to the ceremonial area where three Army Soldiers were standing at attention with an American Flag. We sat as the Army Officer directed the ceremony presenting the colors and honoring an old Veteran. It was very moving and I pray God blesses those soldiers mightily. We all stood while Taps was played and I gave a final salute in slow respectful silence with the three Army soldiers. After display of the colors the soldiers refolded the flag and presented it to my brother-in-law who was visibly moved by the presentation.

The Father spoke some comforting words and led us in prayer and we headed to the columbarium to place the cremains. My wife placed her mom in the tomb and my brother-in-law placed his father in the tomb.  We then watched as the cover was placed as a temporary measure. The final cover will arrive in about a month. We will visit after it is placed.

Below are some pictures I took while there. This is Fort Rosecrans National Memorial Cemetery on Point Loma in San Diego. On the west one overlooks the Pacific Ocean. Without taking a step one may turn around and see San Diego Bay and Naval Air Station North Island in the other direction. I have traveled the length and breadth of California and seen many wonderful places but nothing as moving as standing in the center of Fort Rosecrans and seeing thousands of white headstones in neat rows. Currently there are over 70,000 remains at Fort Rosecrans.

It was a busy place. Currently they are processing about 350-500 families a month.

And as a reminder that flag in the upper right (as you face the screen) is a picture of the flag that flies over the National Memorial Cemetery in Phoenix.

One last image. Us sitting on the beach at Oceanside after the service. What a way to end a great day.

Change of Shift is up at madness: tales of an emergency room nurse.

Please take the time to visit.

          I would like to relate a recent story about a 96 Y/0 gentleman living in a nursing home and the battle that ensued over his care. For those of you out there wishing for Universal Health Care you might want to view this as a warning. Just to be clear this was a real patient and this happened within the past six months.I am a Nurse Practitioner and was working in Long Term Care (a euphemism for Nursing Home) and caring for about 100 patients.

          Some of these patients are always nearing the end of life as was the patient I am writing about. He was a very frail 96 year old white male with dementia, psychosis, and in a state of failing to thrive. His dementia had advanced to the point that he had almost forgotten how to eat. This is normal for a diagnosis of end stage dementia.  The patient also had a long-standing history of needing antipsychotic medication to control his psychotic episodes, though he currently was not on any antipsychotic medication because we had been able to control his condition without them.

          His psychotic episodes differed from other patients I have had with a history of psychosis. His psychotic episodes consisted of him believing he was on fire. He would scream “I’m burning” over and over and beat on his body trying to put out the flames.  His psychosis was terrifying to his state of mind so much so that he was hindered from eating or participating in daily activities. He became increasingly psychotic to the point that the usual means of redirecting him was no longer working.        

   He also no longer recognized the person who was his Power of Attorney (POA The person who was making medical decisions for him).It was late on a Friday afternoon when I decided it was time to discuss with the POA starting him on an antipsychotic medication as his condition had deteriorated severely over the  previous week. He was already on a Hospice service as we expected him to die soon and the POA wanted him as comfortable as possible. After a long discussion with the POA we agreed that Haldol, an old but potent antipsychotic that he had been on before, would be an acceptable treatment regimen.        

  As the patient was in a state of acute psychosis it was necessary to start at a low dose and rapidly increase it to get ahead of the psychosis. So I started him at 1 mg haldol every 6 hours to no effect. After close evaluation I increased it to 2 mg haldol every 6 hours, to no effect.  After further evaluation I increased his haldol to 4 mg every 6 hours. At this dosage the patient suddenly started eating 100% of his meals and was able to recognize his POA. He began participating in daily activities and the psychosis seemed to be resolved. Before he was unable to communicate his needs or eat even 20% of his meals, now he was capable of carrying on a conversation without difficulty. It was truly an amazing resurgence of his intellect and the POA was ecstatic with the change.        

  To be sure I was not over-treating him I reduced the haldol to 2 mg every 6 hours and his psychosis returned. I again increased the dose to 4 mg every 6 hours and all was fine. The maximum dose recommended in the government guidelines (Keep the word GUIDELINES in mind please) is 3 mg of haldol per day for a person this age however I have had patients taking 90 mg haldol three times a day with no ill effects so I felt we were safe in treating him with 4 mg four times daily.It was that time of year for the state department of health to do their yearly survey and so they came. About 10 AM I was called and told to see the administrator immediately. I met with him and was informed the building was to be shut down by the state inspector because this patient was on 4 mg haldol every 6 hours and the guidelines were that a maximum of 3 mg per day could be used.        

  Lets review- 96 year old psychotic male beating himself to put out the flames. Starts taking an antipsychotic and now is participating in eating and social events that he was not participating in before. I’m told if I don’t stop the medication immediately the building will be shut down. This is an 8.4 million dollar a year business, the owners are not happy with me. I sit down with the director of nursing and the administrator and arrange for a psychiatric nurse practitioner to see the patient later that day. The state inspector accepts this and backs off his threat to close the building. Keep in mind the state inspector is a licensed Registered Nurse.        

  The psychiatric nurse practitioner sees the patient that evening and stops the haldol and later tells me she stopped it because of threats and intimidation by the state. I arrive at the building at 6 AM to check on my patients. I check on this one and he can be heard screaming from a unit away.  When I get in the room he is pounding his fists on the wall and screaming “I’m on fire, put out the fire.” His left hand is severely swollen and black and blue. I order an X-ray of his hand and write a long note detailing what has occurred including charting the name of the state inspector making the threats and intimidating statements.         

  I write in the chart that the patient is experiencing harm psychologically and physically because the state inspector is practicing medicine without a license and perhaps I should call the board of nursing and report him to them (This was basically me threatening the inspector).Later in the morning the inspector reads my note, more threats to close the building were issued by the inspector. The inspector is also mad at me because I put his name in the chart which makes him legally responsible for practicing medicine without a license. I also gave his name and phone number to the POA who called and called him on the carpet for interfering with a patient’s treatment.        

  The patient was harmed because bureaucratic morons strictly adhered to guidelines they did not understand. I don’t treat guidelines I treat people, and that is the fundamental problem with bureaucrats. They follow the guidelines to the letter even when it is clear and apparent that one needs to step outside the guidelines.  If we allow universal non-health care to be enacted this is the type of treatment we can all expect to encounter. This poor old man was tortured at the demands of the state.

The POA fed up with the state interference moved him to an inpatient hospice where he died much sooner than he probably would have if the state had not interfered with his treatment. The nursing home had been his home for 13 years and the POA was heartbroken that she had to move him from his home. 

 One of my patients died today. That in itself is not an unusual event as my patients live an average of 2.8 years from the time I start seeing them. They are living in a nursing home after all. I was not on call  today but felt compelled to check my voice messages this evening. I had seven messages waiting for me, number four was the hard one to listen too. It had happened Paul had died.

Of course Paul is not his real name but I chose it because this patient suffered the torments of the damned while in the flesh and never once complained to me or anyone else. Paul was an Multiple Sclerosis patient. He was first afflicted when he was 29 years old. He was a happy healthy young man full of promise and life and MS came crashing into his universe.

He had been attending Electrician school and was due to graduate in about three weeks when he had his first episode. It would come to pass that he would never return to school. His loving sister informed me that once the MS had him by the throat it would never let go. He rapidly deteriorated and found he could not take care of himself.  He went from fully functional to living in a nursing home in less than 2 ½ years but the highlight lowlight of his disease was that MS robbed him of his memory. Though perhaps it was a blessing in disguise.

I once asked him if his sister had come to visit and his reply implied that there was maybe a higher mental functioning than we all assumed. He told me "I would not remember if she had visited."

As time passed Paul became worse. The disease seemed to stop advancing when he was able to move only his left arm. When staff entered the room he would wave his left arm in a greeting and state "I love you with all my heart." This became his catch phrase. He never complained, he never said he was unhappy or in pain. He could answer simple questions and tell you how he felt but never once did he complain.

He had a suprapubic cath from the Neurogenic Bladder caused by the MS. Eventually his penis was split like an over-ripe tomato but his only answer to the pain was "ouch."

Several years passed and one night the aids left him lay on his catheter tube. By morning he had a stage 4 tunneling ulcer eating at his hip. We instituted a wound vacuum to help with the healing but he continued to breakdown. It was not long before his other hip and coccyx broke open and I began to get very concerned. As long as he was on the wound vacuum infection seemed to be held at bay. I sent him to the wound clinic where they promptly admitted him and stopped the wound vacuum therapy. Ten days later he returned to the facility with orders for two horribly expensive antibiotics. I spoke with the PCP who set stop dates for the medications. I spoke to Paul's sister and told her it did not look good and that this illness may be the one that kills him.

Through all this Paul would continue to state "I love you with all my heart" when asked how he felt and he never once complained. The antibiotics finished and about ten days later Paul became septic and I sent him back to the hospital for the last time.

Paul had a seizure disorder and was on medication for it. The hospitalist in his wisdom did not think that Paul needed to take his seizure medication so he did not order it to be given. As one might predict Paul began to have seizures after about a week without his medication. The seizures were relentless and not easily controlled with his usual medication. He continued to have seizures for the next seven days.

On about day seven I received a call from his sister. She was in tears and told me the doctors were pressuring her to have a g-tube placed because Paul had lost the ability to swallow. She did not want him to have a g-tube because the only pleasure Paul had left in life was to eat and now that he was unable to eat she felt obligated to allow him to die peacefully.

She wanted Paul to come back to my building and be enrolled on Hospice. I asked her if she wanted me to intervene with the doctors and have Paul returned, she tearfully begged me to help her and Paul.

Knowing I was stepping on the toes of the Hospitalist I called him anyway. Within one hour and forty-five minutes Paul was back in the facility. The Hospice Nurse, Pastor, and myself met Paul's sister at the facility. The facility nurses were in tears and hovered about his bed providing ice chips to his parched lips and tongue. He mouthed to the LPN "I love you with all my heart" as she wet his tongue with the ice.

I got a voice message a couple hours ago that Paul has died. How fitting, a man who suffered the torments of the damned and never complained once, died on Easter.  

 

Recently at work I took a break to go sit out in the garden and relax. While I was relaxing and finally enjoying the cooler (84 degrees) weather I spotted a black and white kitty sitting in the bushes. After staring at me for a while and after me making some attempts at getting the kitty to come closer it came over and started rubbing my legs.

I reached down to pet it and aside from some fur and dirt there was nothing but loose skin and bones. The poor thing was starving to death. I didn't have any cat food with me so I sent one of the ladies who works there to the store to get food. While she was running this errand I went back inside and went back to work. Later in the day I went to check on the kitty and again took a seat in the garden. As soon as I was seated the kitty came out of the bushes and jumped up on my lap. He curled up in a ball and purred and rubbed against me. I stroked his fur for a few minutes and when I stopped he stood up on his back legs, placed his front paws around my neck and gave me a kiss on the cheek. He then jumped down and ran back into the bushes.

While he was stretched out I felt his front paws and determined that he had been declawed. When people abandon declawed cats, furious does not even come close to the emotion I feel. I knew right then he was going to have to be caught and taken home by someone, probably me. I called my wife on the cell phone and though she was across town at work she immediately left, went home and got the carrier and came to the kitties rescue. By the time she arrived the cat was sitting comfortably in my lap.

As she walked through the gate she did not hear me yell to take the carrier inside and I would bring the cat to it. The cat saw the carrier and took off into the bushes. Over the course of the following week this scenario was repeated several times. Not being cat people they had little understanding of how to catch this kitty.

Finally one of the cat people in the building teamed up with another cat person and they corralled the cat into the carrier and called me. I called our vet and within the hour the kitty was on the exam table ready for his screening physical and lab tests. I was not about to endanger my other animals by bringing a sick cat into the house.

Before the vet was to see the kitty the tech scanned him for a chip. She ran the scanner all over his body and nothing showed up. I felt much relieved. She then performed a second scan and an ID number popped onto the screen. Crap, I thought. Anyone putting a chip in their animal would surely want them back. I was upset because I was pretty sure the cat had been dumped and giving him back to the same people would just produce the same result. He would be dumped again, or worse.

Under Arizona law the vet has three days to actively pursue finding an owner. The tech came back with the address of where the cat was supposed to live and it was a long way from where we found it.  I said good-bye to the kitty and thought that I would never see him again.

The next morning I called and found out the owner had given the cat away to someone else and did not want it back. The vet was waiting to hear back from the second party. I called again the next day and the second owner said they had given the cat away to someone else and didn't want the cat.  The third day I called about noon and the third owner had not called or contacted them. At that point the vets office said he was going to be mine and I could pick him up later in the day.

I ran very late that day and found myself in a massive traffic jam way across town. I called my wife and asked her to pick up the kitty at the vets. When she picked him up we found out the vet paid out of his pocket to have the cat groomed at the groomers next to his office. This is the same vet who donated money in our cats name to a pet shelter after our kitty died. He has saved the lives of several of our kitties many times and I can't think of a better example of caring for the helpless and homeless. He has also saved us thousands of dollars in vet fees by caring for our homeless brood.

Here is the new member of our household. The post below is of a different Tux kitty in our home. Also a rescued cat.