Thursday, November 17, 2011

We dodged another Bullet-Part Two

     When I returned to the hospital the next morning, Richard was awake. He said he slept well. No one was around so I could ask "What's up" His heart rhythm looks regular and around 56. That is awesome. BP is 156/65. A bit high but I knew they had held his meds. Soon into the room comes Richard's nurse and the doctor's PA.
     The PA was discussing Richard with the nurse (and ignoring us). One of my biggest pet peeves, as a nurse, is when the doctor does not include the patient and the family in the conversation they are having right in front of them.....about them. She (the PA) told the nurse..".the plan is to keep him NPO (no food) and arrange for a colonoscopy and an upper endo so that we can find out where he is bleeding. We can move him upstairs until these can be arranged" So being the person that I am....."Excuse me," I say, "but this will be up to us to decide what we are going to do, won't it?" She turns to look at me with that facial expression that says "who do you think you are to interrupt me?" So being the person that I am...."Are these tests going to take place today?" I say. She says that they probably won't. So I say, 'then we want to go home and we will schedule them as an outpatient." She proceeds to tell me that will be up to his primary doctor that she only represents the cardiologist (really, I thought I just heard you talking about scheduling these tests/)  A few more words and she leaves the room.
     Richard's nurse Renee (great, by the way) said I will call his doctor for you and see if we can get them scheduled as an out-patient and see if he can be dismissed. I had already by this time asked about the hemoglobin and potassium results and was told they had returned to normal and his heart was now doing what it is supposed to be doing. There was really no further need to remain in the hospital.
     Then in came a NEW doctor. He introduced himself and said he was a kidney specialist and the cardiologist had asked him to come see Richard about how bad his lab looked and make some suggestions. He said that his potassium was way too low and his calcium was too low and the albumin was low. He wanted to know how Richard was eating. I said, 'he eats great, not as much as he used to but has a good appetite." So his suggestions are to start him on oral potassium 3X daily and to give him calcium 3 times daily and he would like to see him again in 2 weeks with some follow up labs. Okay! Add another doctor to the already too many who see us.
     Then this guy leaves the room and is sitting at the desk with Richard's chart. Pretty soon he comes back into the room and pulls a chair over closer to me. He says, "Something is wrong! But Not with Richard" What the heck! He then goes on to tell me that he just reviewed the labs that were drawn this very morning and compared them to the admission labs. His very low hemoglobin was now normal. Impossible with just two units of blood. And his potassium was now at the top side of normal. Again, probably not possible. And his calcium was normal and his albumin was normal. In fact, he didn't have any abnormal values at all!
     So forget about the meds he just told me to give. But come see him in two weeks just to make sure all is still okay. I heard him on the phone call the lab. I heard him tell them to find that blood and rerun all the labs using the same blood.
     Next time, Renee, the nurse was in the room she received a call on her portable phone from the lab. It was about Richard. When she hung up she said that they had done a finger stick blood draw and there was no blood left to run another test on WHAT????  They did not do a finger stick. I was in the room. The drew the blood from his left arm vein just before the IV was started. They did NOT do a finger stick. I examined his finger tips to see if there were any puncture wounds and there were not. What is going on here?????
      Now we are preparing for discharge. The snooty PA has returned twice to talk with me. She has explained that we would still like to do an occult blood check on Richard's BM (that tests for bleeding) We did it and it was NEGATIVE!  No blood! And he could be discharged from the hospital. A low dose of potassium ONCE a day would be started so that he would stay in the normal range. This woman couldn't have been nicer. HMMMMM!
     So we are now home and all is okay. He feels good and his heart is beating normal. He takes a new pill to make sure it stays in the normal rhythm. But he received 2 units of blood that he probably didn't need in the first place. That is probably not a big deal. He received a BIG dose of potassium that didn't cause him any harm cause now he is in the high normal. But potassium is deadly. And it could have caused harm.And it scared the holy crap out of his family again, thinking he was really, really sick! But he's not!   If you want my take on what I think: one, somewhere in that hospital someone needs a blood transfusion and some potassium. Or, two, with all the prayers we were receiving while there, the Good Lord above healed Richard over night. Thank you Lord. And please, please, please to all lab personnel make sure you know what you are doing. A person's life depends on you knowing what you are doing!


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