4
March
2010
I know I have spent a great deal of time in the past complaining about the nurses we’ve received.
It makes me sad, because the vast majority of nurses we had in the NICU (and especially Dorrie’s primaries and honorary primaries) were fabulous. Competant, reliable and trustworthy. I did not like having to leave her with them, but with only a very few exceptions, I did trust them (and the RTs and the NNPs and the doctors). Part of that was because I had to, but mostly it was because they had their act together. It was clear that they knew what they were doing.
Our first nurse when we came home post-trach, DramaNurse, was also pretty competant. All of her problems stemmed from her insane personal life; I didn’t have any fears about her ability to react and handle an emergency should it have arisen. Our original night nurse was wonderful — a combination of competant and responsible and not-insane that made me comfortable to be around her.
After DramaNurse left, we had a couple of very temporary nurses, one of whom we dismissed ourselves because we didn’t need her and one who came to orient and then fell off the face of the earth. Finally we got a more stable situation, AnnoyingNurse, who drove me absolutely bonkers but who obviously enjoyed playing with Dorrie and who Bob found tolerable. And so she stayed. After a while we rearranged my work schedule so I had to spend as little time with her as possible which improved things a good deal.
But she was still annoying. I decided that I would try not to write about her on the blog because I didn’t have anything nice to say, but she seemed like a very nice person — just one who grated on me. And she still did not project the air of ease and comfort that would have made me (both of us) feel able to leave Dorrie alone with her without Bob or I supervising. Since both our workplaces have been so accomodating, this wasn’t necessary, and so she remained.
Until last week. I am still not sure what exactly happened; the explanation we were given was entirely inadequate and did not fit the actual events. She came to work acting oddly, but not so oddly that I couldn’t pass it off as her usual irritating qualities. Then things got very very weird. The OT came and the nurse said she needed coffee, so I let her leave to go get some. Except she came back without any coffee. Puzzling. She said a few strange things and was acting bizarrely enough that the OT this week told me she had been very uncomfortable with the behavior she witnessed. Enough that she had considered calling the nursing agency and had spoken to someone at her work about it.
The OT left and the nurse began to make Dorrie’s lunch. It looked unmixed in the bottle when she brought it out and then she spilled a great deal of it trying to pour it into the bag for the pump. She wandered (and I do mean wandered) off to wash her hands off while I cleaned up the mess and actually got the feed started. I found that a lot of the food was still in the bottle and still more of it was left in the jars in the kitchen, as she had done a very poor job of getting the baby food out in the first place.
She returned and sat down on the mat next to Dorrie, saying nothing (unusual — she is a chatterbox). She sat there sort of patting Dorrie for a while while I watched getting more and more weirded out by her behavior. Eventually she decided to change Dorrie’s diaper. And here’s where the weird took a turn into freaky. She seemed to have lost the ability to control her hands. She pulled at the diaper tabs ineffectually for minutes, unable to figure out how to get them to close. Eventually, with the diaper still unfastened, she began to try and pull Dorrie’s pants back on. At that point I jumped in and fixed things, then asked Bob to come home. I didn’t know what to think. I asked her if she was okay and she was able to answer — she said she was fine. (Obviously untrue!). I thought she might have been having a stroke, but her speech was clear.
She began to try and read Dorrie a book and was stumbling through that when Bob came home. He had trouble getting her attention. At that point I was too freaked out and went upstairs for a couple minutes. Eventually, Bob and she decided that she would go home because she was worried about the ‘power being out’ (power had been lost in some neighboring towns). She managed to exit the house and make it to her car. It took her a while to get into the car, but once inside she didn’t seem to have trouble driving away. We were nervous about letting her drive and discussed if we should alert the police. In the end we didn’t, we just called the nursing agency.
In any case, after much discussion and the aforementioned inadequate explanation, she is no longer on our case. I’m pretty concerned that she’s still apparently working. There is absolutely no doubt in my mind that in the state she was in, she could never have replaced a trach and might not even have been able to fix a more minor problem like the circuit coming apart.
So now we will see what sort of new nurse we get.
Posted: nurse or no nurse, wtf, people
26
October
2009
No, none of us are sick — thankfully. However, both of our nurses are sick all of a sudden, which means that our normally well-organized weekly schedule is going to be thrown for a loop. The night nurse is only scheduled for Monday and Tuesday, so we are not really expecting to see her at all until next week. The day nurse is scheduled for Monday and Wednesday, as well as Thursday night, but we have had no word yet on what she thinks she has or when to expect her back. She was out today, and suffice it to say, if she has anything that might be contagious, we probably will not see her Wednesday either — and even if she thought she were healthy enough to come in, we would probably prefer she take an extra day anyway, just to be sure. So, the overall list of activities that this development will disrupt:
- Shopping Monday night
- Mom’s schoolwork Monday and Tuesday nights
- Our ability to get more than five hours of sleep Monday, Tuesday and Thursday nights
The only silver lining is that I have a major project I am trying to finish for work, and Dorrie usually behaves well enough for me during the night that I’ll be able to work on it while she sleeps. (Mom is the opposite way — she would prefer it if Dorrie were awake, since once it is late enough, Dorrie can usually entertain herself and let Mom do her work, whereas once Dorrie decides to go to sleep, she usually requires Mom’s constant attention.)
Posted: nurse or no nurse, our little witch
5
October
2009
So, week or so ago, we suddenly noticed that Dorrie had a little bruise on her chin. It was quite a dark one and looked painful, but we couldn’t think when it had happened.
It was starting to fade when the following conversation occurred.
Nurse: I’ve figured out how she got that bruise on her chin!
Me: Oh, really?
Nurse: I was looking at it and it just came to me.
Me: Oh?
Nurse: I had been trying to figure it out for a while, I know the two of you have been watching it, too.
Me: We have. It seems a little lighter today.
Nurse: I think it does look like it’s getting better. It’s nice to know how she did it, though.
Me: Yes, how?
Nurse: When she was lifting her head up and putting it down, she must have banged her chin on something!
Me: *stares*
Posted: medical morons, nurse or no nurse, our little witch, tales of interest
15
August
2009
Almost nothing at all happened the week before last. I’m not sure if I even got many new pictures to add. There was no word on the stroller, there was no advance on the trach collar, there wasn’t even any PT, since she was on vacation.
This week we finally got the ball rolling on several fronts.
Stroller
This has been an endless source of frustration for us. The stander was delivered to the equipment company in May and we got it in June. It’s now been 2 months since we got that. 2 months since we heard the stroller was approved. So this week we started harassing everyone: we called the equipment company, we called the PT, and finally we’re told it’ll be delivered on Monday. I’ll believe it when I see it, but at least we have a promise of action. I hope it’s as nice as I remember!
Trach Collar
After the fiasco a couple of weeks ago, the head RT came to our house and brought some additional materials and showed me how to set up the mask in a more reasonable fashion. Finally, last Wed, he and Dr. Optimist’s nurse came to the house and we were able to try it out. Dorrie was much calmer this time without the Moron Twins messing around with her ventilator and she handled it very well. She sat in my lap and kept an eye on the people in her living room while we had the mask on her. After we’d had that on for about 30 minutes, we switched her to a simple HME with oxygen attachment, and we were finally at the point where I wanted to be. Oh, it was lovely to have her attached to just a tank with a nice light tube.
We also got a chance to see how she would do just on room air — switching to the trach mask entails a near complete disassembly of the ventilator circuit, because we use the same humidifier. So we tried just pulling her off and letting her sit while the RT put it all together. She did great! I was nervous because the only other time she’s off oxygen during the week is for her trach change and she always drops like a stone. But apparently that has much more to do with the fact that she hates trach change and screams bloody murder when she realizes that’s what’s about to happen than it has to do with being disconnected from the oxygen source.
Our biggest problem with the collar (either way to do it) is suctioning. I don’t know what other babies are like, but when Dorrie is awake and active, she can need suctioning as often as every 5 minutes. This is generally fine because we have suction in line with our vent circuit — it’s never detached from her and remains as ‘clean’ as the rest of the circuit’s interior. The trach mask just has a hole where you can thread a catheter in and suction directly. The HME has a little flippy door where you can do the same. The question is what to do with that catheter when you’re not using it. If she only needed it every 30 minutes or so it’d be one thing, but it seemed like we were always pulling it out, and I get more and more tense because it just feels so dirty. Plus it is a huge pain in the butt!
So I think what we’re going to do is leave the inline suction on and attach the HME to the elbow of that. Hopefully it’ll work, because otherwise I think mummy is going to have a breakdown over the suctioning. We’ll have to figure out what to do with the suction when she’s on trach mask at another time. For now we don’t intend to use that much — disassembling the vent circuit while we’re by ourselves and trying to keep track of her is really not a great option.
It’s probably an even worse idea when we’re not alone and there with the nurse. I’m not going to get into too many details but suffice it to say she got very flustered on Wed and when the RT told her to reassemble the vent circuit after we finished with the trach mask it almost proved too much. She spent the rest of the day in a fog.
Dorrie with one of her preemie outfits.
She loves her tennis boys.
Posted: little fat fairy, moving forward... or not, nurse or no nurse, our little witch
23
May
2009
I am not sure that people fully understand how tightly scheduled our days are. Basically, our nursing agency has a real shortage of vent/trach certified RNs who are willing to do overnights. Probably because they do not pay as much as a hospital would nor do they offer benefits, but that is another discussion. All other nights we have to watch Dorrie ourselves. Over time her sleeping has improved, but she is still not a sound sleeper and she often needs suctioning during the night, not to mention food and medicine. So whoever is watching her does not get the opportunity for good sleep. Sometimes not any sleep.
A typical day looks like this:
7AM – morning meds
8AM – set up pump with some water
9AM – Dorrie wakes up, water finishes, switch oxygen monitor to other foot, clean her up, give inhalers
9AM-12PM – play with Dorrie, do leg and arm stretches, have her sit in her chair, work on hand and head control. If therapy is coming it’s usually during this time.
12PM – hook Dorrie up to pump for lunch
12:30PM – lunch finishes, disconnect pump
2PM – hook Dorrie up to pump for mid-afternoon snack
2:30PM – snack finishes, disconnect pump, throw away bag, hopefully time for a nap (Dorrie’s)
3:30PM – med
4:30PM – more food
5:00PM – more food done, clean bag
5:15PM – dad gets home from work
5:30PM – dad takes over watching/playing with Dorrie while mom makes dinner
6:00PM – start pushing 2oz water
6:30PM – mom and dad eat dinner while keeping Dorrie entertained
7:00PM – start getting everyone ready for bed. Dorrie’s bath, clothing changed, trach ties changed + neck washed, med due, get Dorrie’s bed out and set up
8:00PM – more food, dad goes to bed
8:00PM – 11:00PM – depending on her nap and mood, Dorrie goes to sleep at some point in here.
11:00PM – meds, wash food bag
12:00AM – start overnight feed
2:15AM – dad gets up, mom and dad change over
2:30AM – mom goes to bed
3:00AM – add med to feed
Add in there suctions on average every 15m during the day and once an hour at night, plus intermittant gas attacks once she’s gone to sleep. She finds farts amusing during the day but at night it’s the end of the world.
Basically, the choice was: we can both sleep in the same room with her and both be up and down all night, or we can split the night up and both of us get possibly less sleep, but uninterrupted. We went for the latter. However, as a result any little thing can throw our schedule off.
Last weekend was super busy. Not for Dorrie, but for mom and dad. Mostly mom. The end result of dashing around, getting 4 hours of sleep on Sunday and then working for 9 hours was that on Tuesday I got sick. A cold that had been nibbling at the edges of my stamina for quite a while finally got a foothold and that was it.
One of us being sick is no picnic, because we try to isolate Dorrie from the ill person. Since our day nurse had taken Wednesday off, that meant dad had to take the day off from work. He would have had to anyway, I think, because I was in no shape to look after her. But he did this after already having had to spend the whole night looking after her, which is an impressive feat of stamina. Grammy was nice enough to come over on Wednesday night and stay all day Thursday so dad could go to work and mom didn’t have to contaminate Miss D. She came back on Friday to do the same during the day there.
So I have been sick and miserable and guilty for being sick and miserable. Dad has been harried and worried about missing work. And any time something like this happens I wonder how much longer we can keep this up. It’s wearing. I’ve spent less than 200 minutes alone with my husband since January 2008 and the longest stretch of that was about 100 minutes on New Year’s 2009 when we went in the basement and watched a movie together while we had a night nurse.
The problem is that the nurses we have had recently are just not that great. Our current night nurse is an older woman and she moves very slowly. She knows what to do, but I have no confidence that she is actually capable of taking physical action quickly in an emergency. So dad will continue to sleep on the sofa on nights when she is here, just in case. And our day nurse, who I have complained about before, is just not a calm person. I do not trust her not to lose her head. She is too easily flustered in non-emergency situations for me to feel comfortable without having seen her deal with something important.
On top of that, it’s just so discouraging that Dorrie hasn’t made more progress. She is still not sitting up, and worse, she still has not really gotten the whole head control thing mastered. Tests have been done and there is so far nothing anyone can really point to to say that this is why she’s so far behind, and why she hasn’t made any strides at all toward catching up. As we move further away from the month she spent in the sedative coma, it’s harder to think that is the root cause.
Posted: moving forward... or not, nurse or no nurse, our little witch, trying to stay healthy
13
April
2009
In news I’m sure everyone is tired of hearing about, the nursing problem continues unabated. After managing to show up for two whole nights in a row, the latest superreliable nurse dispatched from the agency called in both nights last week. I expect that means she’s gone for good, but we shall see if they continue to string us along with promises of her return.
The rest of the week has been pretty calm, and Easter was nice. Dorrie was in the mood to perform, and spent quite a while lifting up her head to look at the mutant singing ducken brought by Grammy. Then I went out to lunch with mom and my brothers while Bob stayed at home to watch her. We brought back food for him and Dorrie decided to scoot around on her back to investigate what was going on at the sofa. She discovered that the sofa is surrounded by evil ceramic tile which does not feel nice to someone pushing herself around on her back.
The biggest negative to the day was Dorrie’s failure to take an adequate nap, which led to a meltdown, a pukey and finally a so sleepy baby who couldn’t stay awake until bedtime and instead slept from 6-9:30pm and then woke up again.
We also had a fun adventure with the ventilator! Since Dorrie was asleep at the usual time we get her ready for bed, I wasn’t able to change the vent circuit. As she was still up around 11:30pm, I decided to do it then and just get it over with. Bob had already gone to sleep, but we do it by ourselves often enough, so I didn’t figure it would be a big deal. (I bet you think you know where I’m going with this, and perhaps you do, but bear with me anyway.)
The change itself went off without a hitch. I fired up the vent again to run a leak test before reattaching Dorrie to it. FAIL! The worst failure I have seen yet, accompanied by a sort of sucking straw noise I was sure meant one of the hoses had a hole in it. But I could not see one or feel air coming out, so I ran the test again and this time it passed. This time I noticed that the bag of inhalation water that runs to the humidifier was not only empty, but that the leak test had caused the bag to inflate like a balloon. Ha ha, I thought, how amusing. I changed the water bag and got Dorrie hooked up.
Then the ventilator began to alarm. HW FAULT it said. WTF I said.
The vent manual, which had been hanging around the living room getting in everyone’s way for nearly a year, was suddenly nowhere to be found. The vent seemed to be working fine. Dorrie’s sats were 100. WTF I said again. HW FAULT said the vent, then beeped some more.
So I went upstairs and woke up Bob and made him come down and see it. Neither of us could guess exactly what the HW FAULT meant, so I got out the computer and started trying to find the manual online. I found it quite easily TODAY, but for some reason last night Google was being obtuse. We called our vendor, who paged the on call person, who paged the on call RT. By that point the vent had changed its mind about alarming and was quiet again. The RT was at least able to assist us in figuring out that HW FAULT meant that probably one of the sensor leads had gotten moisture in it and was helpfully letting us know in the most confusing and panic-inducing way possible. Our best guess is it happened when the vent decided to inflate the saline bag with air.
Finally a picture of Dorrie in her Easter finery. I’ll try to upload a more extensive picture post some time this week.
Posted: nurse or no nurse, our little witch, tales of interest
31
March
2009
Height: 30.5″
Weight: 10.285kg
Had our last synagis shot for the season, much to Dorrie’s dismay. She also decided to pee everywhere to express her displeasure at being put on the scale.
Down to a PEEP of 7. Don’t anticipate -too- much of a difference with that; the CPAP valve is not exactly digital, so it’s all sort of an estimate anyway.
Also, the new night nurse showed up last night!! I was highly skeptical after her failure to show up for orientation, then her 2h late arrival for the rescheduled orientation. Hopefully she’ll also show up tonight.
Posted: little fat fairy, nurse or no nurse, our little witch
14
March
2009
…not.
I believe I mentioned that our reliable night time nurse who I liked recently had to disappear for a while due to some kind of family emergency. She is still not back, but the nursing agency called at the beginning of the week to say that they had someone else who could do some nights, and she would be coming to orient on Thursday morning.
I’m sure you can all see where I’m going with this.
That’s right. She never showed up.
The agency claims they were notified, but if they were, why the hell didn’t they bother to call us?! We have had this discussion with them mutiple times in the past. We are not psychic. Perhaps we are also too trusting. When we’re told someone will be showing up to work, we are surprised when they fail to appear. This seems to be a less universal attitude than I would have expected…
Compounding the lack of nursing has been Dorrie’s horrid sleeping this past week. After a really good run of 4 or 5 days in a row week before last where she had a good nap during the day and was asleep by 9:30pm at night, from Sunday she has been refusing to nap more than about 20 minutes during the day. The problem? She’s still a baby who needs a nap. By the time we hit 6 or 7pm, she’s got so many bags under her eyes that it makes you yawn to just look at her. And quite a few times she just poops out on us. We’d be fine with that — if she stayed asleep for the rest of the night. Instead, she treats that as her nap, wakes up a little after 8 and is ready to party until dawn. Sunday night she went to sleep at 1:30am. Monday was midnight. Tuesday was 1am. And so on through the week until we hit tonight’s record of 1:45am. Bob thought it was the time change, but I don’t think that could have affected her nearly this much. I don’t see how one hour change could screw up her sleeping schedule to the tune of 4-5 hours.
Posted: nurse or no nurse, our little witch, wtf, people
4
March
2009
I swear, we can never have a schedule that’s nice for more than a couple of weeks before it’s all thrown to heck.
Until last week, we had it worked out that we had a nurse 3 nights a week, and 2 days a week, plus one half day every other week (the night nurse who wanted to come and get some playtime in while her kid was at school). But the night nurse, who I like very much and has been really reliable, has had to take a leave of absence and the nursing agency has no idea when she might be back. :( I’m really hoping that it’s soon… most nights we can get by ok, but it leaves Bob and I with essentially no free time at all if we both hope to get 6 hours of sleep apiece.
The less said about our other nurse the better. She seems to like Dorrie and is a nice person, but she drives me absolutely mad with her lack of focus and disorganization.
Posted: nurse or no nurse
13
November
2008
Just to mention that the new night nurse I mentioned a little while ago has yet to start working, and the nursing agency has no idea when or if this is ever going to happen.
Right now our only remaining nurse is doing some nights and some days for us. We had her for 2 nights this week which was a huge relief, and I feel much more refreshed for having had that break.
Posted: medical morons, nurse or no nurse