A Rough Morning with a Better Evening

This morning, when I arrived to the room, I could tell Amanda was in terrible pain, and the night didn’t go well. The nurse was giving meds, and I began to question the pain meds given overnight. IV pain meds previously available to Amanda were scaled back and were taken on the PRN, or as-needed schedule, but not anymore. Now the nurse would have to page the NP to get approval, and the amount given varied as well as the response time of the NP. My questions for the nurse were to garner ammo for when he team came by to have the IV put back on an as-needed basis. What we needed was the pain management team to come by. 

As the morning went on, the housekeeping lady asked me for help. This wasn’t the normal one, who calls us her good apples amongst a lot of bad apples, but a fill-in. She had two large rolling crash cans stuck together and needed help separating them. She had gloves ready for me to throw in an assist. I joked and asked, was this why I had just received a $100 citation from the Vandy parking police for being an ’employee’ in visitor parking! They’d caught me on a bad day, leaving me the ticket when we found out about the knee infection; I left a not-so-nice voicemail at the parking office! Number one, we have Texas tags, though maybe the N3W-HRT plates may give off cardiothoracic vibes, and not New-Heart transplant patient vibes! Number two, what employee is here every single day of the week? The Yukon has been parked here every day since the end of May.

As I was in the hall for rounds, I could tell Dr. McChicken was thinking things were rough. In hallway rounds, he doesn’t hide his feelings, speaking softly so that Amanda can’t hear him, though. Things aren’t looking good with the infection, with white count and whatnot. He let out a big “JC”, hung his head, and sighed, as he walked toward the room. He had a smile and a dad joke for Amanda, though. I like being in the hall rounds because I get the real feel of things; he doesn’t mince words or hide his facial expressions there. I made eye contact with him a couple of times during the rounds, and I could tell things didn’t seem good.

He could tell without Amanda saying a word that she was in pain. This is the good thing about having the same doctor; at least he’d seen her long enough to know. The carido meds were set, not much changes there, his top priority was pain control, so was mine. They got an IV dose of pain medication ordered right then and there. The NP didn’t want to give as much as he did, but either way, we were working in the right direction. The pain team was consulted along with ortho. 

PT came by, and Amanda was almost in tears thinking of getting up. I had to be the devil’s advocate, echoing PT, telling her she needed to do what she could. They’d talked with the nurse and knew she was about to get the IV dose, and said they would be back. In the interim, we had a horde come by. ID led the pack; her attitude was the same as yesterday, somber; I wasn’t going to let it bring me down. They swap services tomorrow, I’d like to get a feel of things from another doctor who’s not a Debbie Downer. Today’s blood cultures will be the tell if things get better, but we won’t know about those until tomorrow afternoon. The ortho surgeon came in while she was still there. He didn’t have much else to say than yesterday, the fluid looked good and not pus-like, but that could be swayed by her odd immune response being on immune suppression meds. The kidney team came in while he was still there. Nothing new from them, the biggest question was whether she could have pain meds while she was down for dialysis, since some meds get washed out by the dialysis. The pain med was ok to take while she was there, at least.

Pain management followed them, with PT hovering like buzzards in the hall. The pain NP was in forever, and talked way too much, I didn’t care about her thought process, we just needed something for Amanda and quick, while they figured things out. A nerve block was considered, as I had requested, along with McChick. Pain needed to come up with an action plan, and all the other teams needed to approve. So in the meantime, I told the NP, how about adding some as-needed IV pain meds so we can at least stay on top of things. She concurred and added it shortly after she left. 

PT showed up, but the IV meds had worn down a bit, and ortho had mentioned that PT wasn’t vital today. I was worried Amanda would shoo them off, but she was a trooper and went through with it. She’s been down so much, I wanted her to get up, even knowing how much pain she was in. They took it easy and were just going to go as far as she could handle, with getting into the chair as a goal. She made it like a champ, but not without a lot of pain. Even walking a few steps and putting weight on the now braced and straight leg. Her knee pain after was a 10 out of 10, though. She nearly cried as I mentioned to the nurse I’d forgotten that she would just have to get back in bed for them to take her to dialysis soon after. Saying Oh no, I can’t in a soft, squeaky voice. 

After I helped get her back in bed and situated for the nurse to take her to dialysis, I left to run some errands. I noticed a spot on a couple of the Yukon’s tires, so I ran to the Discount Tire close by the apartment. We have the certificates, so with 50K miles on them, put on over the last 16 months, I was secretly hoping they were bad, and I was going to come away with new tires. No luck with that. They were fine, and what I saw wasn’t a safety concern. It was just an issue with the trend, not a structural issue. 

I went back to the apartment for a bit and worked on a couple of things. Then I headed back to the med center and grabbed some jeans I had at the cleaners. I ran over to hop for a bit. Brett was back from vacation and hating his life for coming right back to the day after his 11 pm arrival. I talked with him, his relief, and Jack for a bit, then went back to the hospital. I was sure Amadna would have just been back from dialysis, but she was still gone. I waited about an hour before she arrived. I was getting slightly concerned. They had issues with her BP and had to delay the start. After getting the BP up, they started and were able to pull over 2 liters off, so that was good.

She wasn’t in as much pain either and looked better. They had done a nerve block while she was in dialysis. She didn’t think it helped too much, saying the incision still hurt, but I could tell the pain was way more under control. They swapped her to the IV pain med only; it just wasn’t scheduled, and she has to ask for it every 4 hours. She felt like eating a little, finally, so I warmed up some soup we had in our cooler. I’ve been on her case about eating and told her I wouldn’t push it too much today, but she had to drink a couple of protein shakes at a minimum. She’d backed off of them since we’ve been in step down. I’m not giving her the choice now. She has nutritionist Barkley, who’s going to make sure she’s back to drinking them! She is sleepy with the IV pain meds, so I’m going to head to the apartment at a responsible hour tonight. Maybe I can get there and put my feet up in the recliner and watch a show for a second before bed, like a normal person.