Rubber band

"It's a small world"
OK, now, hurry and start singing something else, or you will hate me for the rest of the day!
Just got a "friend" request on Facebook from a relative that I would not have expected to be looking for me there. Made me feel good. I joined it because many of my coworkers and my daughter are on there, and after listening for a couple of years to people talking about My Space and Facebook and sites like it, I figured, what the heck, I'll check it out. As long as I don't put incriminating stuff, or personal info I don't want spread around on there, what do I have to lose?
It now occurs to me how the world is reconnecting using the internet and sites such as these. I knew that was a neat phenomena when my immediate family simplified our connection with instant messaging, but I am now reconnected with people I haven't seen in years. And I can send them messages in the middle of the night if I want. Which is very handy to those of us who crawl back in their coffins when the sun comes up.
The US postal service suffers of course, but I think they will be okay as long as Publishers Clearing House stays in business!
Families, years ago, lived within just a few miles of each other, or even sometimes in the same house. Then, when they had to move further fom home to find work, or go to school, the family constellations spread to the point where it became easier and easier to lose contact completely with people who were important to our growth and development as kids. People we really enjoyed, but forgot how much because we didn't have the stimulus to remind us. Too much other stimuli to be aware that this had happened, it now takes a "poke" or a nudge, or a surprise message for us to grab hold of these people again, and set up a network where, hopefully, that contact will remain available as long as we wish. Neat.
So, here I sit, at 0-dark-30 again, recovering in one of my "safe places to be", from a week of being in contact with way too many of those negative forces I refer to in my last blog.
We are supposed to follow our "bliss". I will have to include this connectivity in mine. My life continues to be enhanced in ways I never expected. Yippee!

Dear Mr. Obama

I had heard on a newscast that president elect Obama was looking for suggestions on how to reduce costs in the health care system. I have, what I think, is a great one. ( But of course I would think it was great....you tell me what you think).

Little 78 year old Mr Johnson is admitted to the hospital with CHF, or congestive heart failure. He has no insurance other than medicare, which reimburses hospitals per diagnosis, a fixed amount. No more, no less. Mr Johnson also has diabetes, COPD, has had strokes in the past, high blood pressure and kidney insufficiency or outright failure. He worked most of his life at jobs that you and I would cringe at the thought of having to do, to put food on the table and clothes on his kids backs. He never had health insurance, picking cotton from the third grade on, or harvesting peanuts, he sent his children to school so they would not have to do what he did. He stays in the hospital for many days past what medicare pays for, but he only calls the nurses when he really needs help, thanks them for the help he gets, and treats his caregivers with utmost respect. He follows instructions, cooperates with his medical team and often has to be encouraged to take medication that will relieve him of his pain. His family members take turns staying with him to help in his care and make sure he is safe when the nurses can't be in the room with him. He comes in and out of the hospital several times a year, often because he ran out of his medicines and couldn't afford to get more, and his condition deteriorated to a life threatening level. We bring him back to his health baseline, and send him out the door again, hugging him and telling him to take care of himself, that we hope we don't have to see him for awhile. Knowing all the while, it is only a matter of time.

Now, here comes Mr. Smith. You cringed when you heard his name and that he was coming to your floor. You apologize to the nurse he is assigned to when you tell them they will be admitting him and they say "THANKS ALOT!!". ER personnel give you report, naming him a "frequent flyer", and while that term applies to Mr. Johnson as well, it would be said in a completely different tone of voice. Mr. Smith is being admitted for a chief complaint of chest pain, has a heart history several pages long at the age of 46, so can't be ignored for fear of a lawsuit. His EKG is , so far, normal, his enzymes that determine cardiac injury are , so far, normal. But he is having "unrelieved" chest pain. He has refused a nitro drip in the ER, has listed his allergies as Toradol, Stadol, Darvocet, Ultram, and Tylenol. He is positive for cocaine, marijuana, benzodiazapines and ETOH on his drug screen. He got Dilaudid an hour ago for his chest pain, and he reported that it brought him from a "10" pain level to a "7", and the ER doc wouldn't give him any more. He had been to hospital X yesterday, and was sent home with minimal treatment, and was just discharged from our hospital 4 days ago when his heart attack was again ruled out for the sixth or seventh time in the last six months. BUT, seven months ago, he'd had a cardiac cath and had required a stent to open a blockage. He has been receiving disability checks since he was 30 for a back injury received while on the job, and hasn't worked a day since. He smokes, and has been out "AMA", or "against medical advice" to smoke twice while he was waiting for his ER evaluation and a bed assignment.
He arrives on the floor on a hospital stretcher, and before you can even get to the room, he has pulled off his heart monitor, is stuffing it in a drawer, and heading down the hall to go smoke. You stop him, ask him to return to the room so he can be admitted, and he becomes hostile and belligerent. You quickly get him to sign the "AMA to smoke " form, supposedly absolving you of responsibility, should he "code" while out to smoke, and let him go. You know this guy and his game, and you don't want to play. When he comes back, his first request is for something for chest pain, which he reports is again at a level "10" out of 10, and when you try to give him a nitro first, as is protocol, he calls you a name you wouldn't repeat, says "that sh-- doesn't work", and demands the Dilaudid. You tell him it isn't time for the Dilaudid yet and he becomes more hostile and belligerent. He knows he has about 24 hours before his free high expires, tho, so he settles down. He then asks you when he CAN have it, and sets his watch alarm for that time.
So it goes. He's nasty to everyone who cares for him, noncompliant with all instructions, demands cookies, sodas, ice cream, extra food from the cafeteria, and smokes in the room because it's cold outside, then denies that he's done it. When the tests prove he has not, in fact, had an MI, the MD's discontinue all his narcotics. The next time he asks for them and is told they have been discontinued, he yells, curses all the staff, pulls his heart monitor off and walks out of the hospital AMA.
OK, Mr. Obama, here's my suggestion......set up a database shared by local networks of hospitals. When the frequent flyer comes through the door, and you find he has walked out AMA for the same diagnosis 3 times, make a law that you can refuse care without fear of legal repercussions. The little boy cried wolf, 3 strikes you're out, too bad ,so sad!! Billions would be saved in NO TIME AT ALL!!, AND we would have time to care more diligently for Mr. Johnson, who worked hard all his life, likely fought for his country, and raised his children to do the same.

Whew!!

It's 0200 or so, one of those times when I can't seem to get my days and nights switched back around from my night shift job. I have 6 days off this stretch, which is rare for me anymore. I used to get that every 2 weeks, but events and change in units caused that to change as well. It was wonderful, and I miss it, but for other reasons, don't want to change back. I usually get 4 in a row off, max, and that is still pretty great. Age, I guess, stress of my job, and just plain " I LOVE to sleep", sometimes keeps me from switching gears back to the real rest of the world. Not fair to my husband, but he's a pretty good ol guy, and makes do. Much easier for him to do, now that we go to the resort every chance we get and he has friends here to play with while I doze.
It might also be that I think I am at the very tail end of a kootie situation going around that has been one of those that you get for 2 weeks, start to get better, then it comes around and bites you in the butt again, this time worse than the first. It started out for me like it might have been a sinus infection, mostly in my head, but throat sore and coughing because of drainage. I tried to get in to my doc, couldn't because everybody else in the area was trying to get in at the same time, so he called my in a script and told me if I didn't get better to get back with him. Suited me fine, I'm one of those who doesn't go to the doc until I'm half dead. Drives him nuts. But, if he wants to check on me, he can, just by showing up on the floor where I work. And he does. And he scowls at me. He has a pretty good scowl, but it doesn't work very well, because then he grins at me cuz he knows I'm not going to change.
So, I took my meds, started to feel some better, went back to work. Then about a week and a half later, I start coughing and coughing and coughing. This is different, so I make an appointment and go see him. Well. this concerns him, because here I am, actually IN HIS OFFICE. Must be bad. Gives me more antibiotics, then sends me to get chest Xrays to make sure I don't have p-monia. I am set to work that same night, so I pull my report off the computer, and it says there is a density in my upper left lobe that is of some concern, a spiculated area. I had to look up "spiculated", had never heard it before. One of our pulmonologists wandered through and I asked him to look at my report and tell me what it meant. I had already gotten the definition for spiculated, but didn't know a lot more than before about whether that was a bad thing or not. When this doc started patting my arm and writing down that I should have a CT scan, pulmonary function studies, a PET scan ASAP, I got scared. This was a couple of weeks before Christmas.
Rooster had an appt with our MD the next day, so I sent the report with him. I know how things work, knew this would be faster than him waiting to get the report. They started setting up all the aforementioned tests and studies that day. That night, I had another of the pulmonologists look at my report, because this was the one I would go to if it turned out I would need one. He is like nobody else! I choose him, not only because he is phenominal....to his patients, to the nurses, but also because if worse came to worst, he would let me have my Smirnoff Ice while I was in the hospital, AND ...he knows when to let go. Just for giggles, I will tell you his daughter is married to Steve Martin. I got to see wedding pics with Tom Hanks in them, etc. Cool.
He read my report, immediately went and looked at my xrays, and came back to me. He asked me what my plans were for Christmas. When I told him, he told me not to change any of them, this was not urgent enough to cancel plans, all could wait until after the holidays. He also told me that "whatever this is, it is tiny, it can wait".
I already had my CT scan scheduled, so I went ahead and had that done. And, of course, printed out my report for that as well. No mention of a MASS, just scarring and emphysema in my left upper lobe, recommendation to follow it for changes. I smoked for 34 years, so all of this was no surprise at all. I have not had a cigarette since Aug 3, 8 years ago, so I am almost halfway there to the time frame where docs consider you pretty safe after having smoked that long. I called the Rooster, read it to him and explained the big words and he hooted his relief. He was dancing on the front porch when I got home the next morning. I was still coughingcoughingcoughing, so I knew I still need to have the Pulmonary function studies, but it is not as urgent as before.
Merry Christmas. Happy New Year.
Maybe I'll ride a bull named Fu Manchu