10.23.2008

transitioning

I woke up last night in a cold sweat. Wait, this was two nights ago. Weird dreams. I was lying in a hospital bed about to get a tracheotomy. Everything seemed huge and weird and incomprehensible. There was a doctor sitting next to the bed, he told me that I felt strange because of the drugs. "What? I don't understand you!". But I did understand him. He adjusted something, and everything seemed weirder. The effects of the drugs intensified. Later, I was in some kind of auditorium. There were lots of doors off to the side that lead to small service businesses. A doctor's office, music lessons, random things like that. There were people dancing in the middle. The way they danced was awe-inspiring. Not because of the dance moves, but because as they stomped the ground with their feet they made different musical tones, which seemed to map out the outer reaches of my auditory sensorium, which was spherical. The sounds were full of stereo delay and phasing. Later, I had to drive a scooter to take home the sister of the drummer in one of the bands I'm in. She appeared as a three-year-old instead of her actual age. Her brother wanted to drive, but I insisted on driving and having him ride the scooter with us, figuring I'm the better driver but he's the tai chi master (someone was planning to ambush us on the way back). We were all able to fly by pushing off on things, as if there was no gravity. As we were getting ready to leave, I noticed I left my copy of Medical/Surgical Nursing on one of the cafeteria tables set up in the auditorium. As I went back to retrieve it, one of the bartenders from the pub I frequent killed me by spraying aerosolized lysol down my tracheostomy tube. There was more but this was yesterday and I rarely remember my dreams. It only seems to happen when my sleep schedule's disrupted or transitioning.

It was four in the morning. I'd probably slept for less than four hours, and I had four hours to go until my homecare shift started. I couldn't get back to sleep, I was totally awake. I kept myself occupied with the latest NPR podcasts. Internet Go. I made myself a bowl of steel-cut oats for the first time. They took 30 minutes on the stovetop but I had time to kill.

When I arrived at my client's home, I discovered that they were ill. They only slept for 1.5 hours. Frequent sneezing fits caused bright yellow mucous to gush out of the tracheostomy tube, necessitating frequent suctioning and resulting in vomiting episodes that threatened the airway and wasted precious calories from feedings. The parents weren't too concerned, saying the yellow mucous is a common occurance, and that they go to the doctor when the discharge is green, red, tan or brown. Since I'd never seen the kid this sick, though, I decided to be ultra thorough. I pulled out an infrequently used oximeter from the bedroom (they used to do continuous monitoring but it isn't needed anymore) and got a nice, high value. Breath sounds were just a little more rhonchorous than usual (although I'm finding it hard to tell with all the noise from the trach, on the advice of one of my paramedic buddies I'm going to get a specialized stethoscope for this client), no nasal flaring, no retractions, no lethargy or restlessness. Just sneezy.

So, off to school we went. The van ride to school always seems like it's the worst. The parents say the client isn't any worse than usual when they ride in their car, but while the client's in that van they sneeze more frequently than ever. Maybe it's the time of day and not the van, but I'm not sure.

Everything ended up going fine, and I got to see some interesting physical/occupational therapy. Watching the other children interact with my client is also interesting. Overnight the client spiked a temperature that was resolved with acetaminophen, then the next day their temperature climbed again and one of the parents gave acetaminophen again. They explained that they no longer allow home-care nurses to administer medication to their child, after an LPN gave their child a 10x overdose of acetaminophen/codeine (!!). The client's temp was back to normal within the hour.

For me it was a stressful couple of days. For the parents, it was just another day in their life of caring for their child. A good warm-up, maybe, for when things get really bad. A reminder that I'm not only the child's nurse on days when they're healthy. I'm still learning a lot from the child's parents, I'm glad they've decided to keep me around.

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