Monthly Archives: December 2018

Treat the Child and the Parent

My first job as a physician assistant was with a pediatric practice in Maine. I began working in June, so I was well-acclimated by the time winter arrived. I’d gotten to know many of the young patients as well as their caring mothers and fathers by the time snow started flying.

Many of the mothers were experiencing motherhood for the first time, and they were as uncertain about all the pitfalls of raising a child as the child was about being manhandled by a stranger, albeit gently and kindly. My job as a PA had me treating the parent as much as the child, as it turned out. I always allowed time to answer questions asked by the parents in an effort to avoid having them go away confused and uncertain about their child’s situation and their treatment plan.

Since part of my responsibility was to be on call after regular office hours, my cell phone number was made available to all our patients. I could answer the phone in the comfort of my home and often solve the problem right then and there. If I determined that the child needed to be seen, I’d arrange to meet the mother or parent and child in the hospital emergency room, which was a twenty minute drive for me.

The winter in Maine is the time for colds, coughs, ear infections, strep throat and the dreaded croup.Croup affects young children far worse than it affects big children and adults, for the simple reason that small children have smaller, narrower airways than their older siblings and parents. Croup is usually a side effect of a cold. It is inflammation that settles in the throat, and in the case of young children it causes swelling and narrowing of the child’s airway. When it’s bad, the results are noticeable. The child struggles to draw in a breath and expel it,and it’s often accompanied by a crowing sound with each breath. You can imagine the effect it has on a young child’s parents, especially if it’s their firstchild. Panic often sets in.

When my cell phone rang and I answered it to hear a frantic parent, voice raised well above the normal decibel level, begging me to do something to save their child, my first words were, “Take a deep breath and tell me what’s going on.” That, together with my own calm voice, usually brought the panic level down a notch, maybe more. The conversation usually went something like this:

“My little Andy can’t breathe! He’s gasping and making horrible sounds with each breath!”

It sounds bad to the parent, but to me it meant Little Andy was holding his own, though he wasn’t having any fun at the time.

“It sounds like he has a touch of the croup, Mrs. Andy,” I’d begin.

“A touch of the croup! It sounds like he’s dying!”

“He’s going to be all right, Mrs. Andy. Here’s what I want you to do, okay? Go in the bathroom and turn on the shower, and when the water’s warm, have Andy stand under the shower stream and take long, slow breaths. Have him do it for a good ten minutes, and let’s see how he’s doing after that. Call me back when you’re done, and tell me how he is, okay?”

“Okay! Come on, Andy. Doctor Charlie wants you to take a shower!” Then she hung up.

I would stand by the phone and keep track of the time. If Mrs. Andy didn’t call back in ten minutes, I could be pretty sure that the simple treatment had worked. Past ten minutes, I usually got a call back from a much calmer Mrs. Andy saying that Andy was much better, thank you very much. The simple treatment of cool, moist air being breathed in almost always reversed the crowing sound and strained breathing.

Unfortunately for me, it didn’t always work out. One of the main reasons was because Mrs. Andy didn’t give Andy enough time in the shower, her own panic causing her to shorten Little Andy’s shower time and call me back with the news that it hadn’t worked and he wasn’t any better.

At times like those, action always spoke louder than words, although I could predict with 99 percent accuracy that Little Andy was going to be fine. As I said earlier, it’s important to treat the parents as well as the real patients.

“I’ll meet you and Little Andy at the Emergency Room of the hospital, Mrs. Andy. Bundle him up and head on over. It takes me twenty minutes to get there, so if you beat me there, I’ll be right along, okay?”

“Okay, Doctor Charlie. Thank you!”

I’d throw on my coat and hatand pull on my gloves, and drive to the hospital. The car was icy cold, so I’dturn on the heater to take off the chill. I’d drive into the hospital parking lot and park, then walk to the Emergency Room. If Mrs. and Little Andy were there already, I’d eyeball Andy while greeting Mrs. Andy. “How are you feeling, Champ?” I’d ask him.

“I’m feeling good, Doctor Charlie. I think the shower worked,” he’d tell me, no sign of difficulty breathing as hespoke. He was alert and his skin color was normal.

Reassured, I’d turn to checkout Mrs. Andy. She, too, was calm and under control once more, a smile sealing the deal.

I would go through the motions of examining Little Andy to make sure there wasn’t something else going on. I’d look in his ears, look in his mouth and have him say ‘aaah!’, and feel his neck for enlarged lymph nodes. Then I’d listen with my stethoscope to his breathing and his heart. In most cases, it would be a nasty cold that triggered the croup.

When I’d finished, I’dtell  Mrs. Andy that he was going to be fine, and maybe prescribe some simple anti-inflammatory medication for him to take.

Then it was Mrs. Andy’s turn.“I don’t understand how he made such a dramatic recovery. He seemed so, so seriously sick to me.”

My turn.

“You did everything right, Mrs. Andy. His time in the shower may have been a little short, but when youtook him outside into this freezing cold night, the icy air did the rest. It cooled down his irritated throat and helped open his airway.”

“Just like that?”

“Just like that.”

“Thank you so much, Doctor Charlie. You’ve taught me so much tonight.”

“That’s what I’m here for, Mrs. Andy. I hope you and Little Andy have a good night.”

Working with young children taught me the importance of the combination of treatment and education. They go hand in hand.

—o—

Charles M. Dupoy has traveled the world, seen Africa as a Peace Corp volunteer, been a saleman and a farmer, and a magazine writer and editor, and an EMT. later he studied for and became a physician assistant which took him from pediatrics to geriatrics, and from Maine to the Santa Fe, New Mexico penitentiary where he worked in the maximum security unit. Retired now, he draws on his lifetime experiences while writing suspense novels. His first published novel, EASY KILL, is the first in the series, featuring his kick ass heroine, E.Z.Kelly. The second in the series is due for release in the Spring.

From Being a Nurse to a Patient

“ You learn about those who truly care for you in your darkest of times, for they appear to be the light out of the darkness.”

At the age of twenty-eight  I was a  nurse and working on a step down unit and a nursing home setting depending on my two employers’ needs. Overall I felt like I was healthy, I was going to school for my masters degree. I never expected to have difficulty with my health at this point. In January of 2016 I hurt my back and was put out on leave for about a week. I slowly but surely recovered or so I thought. Some weeks later on March 6th 2016, a Sunday night as I was winding down my shift at my nursing home position, I kept urinating and feeling like there was an issue with my bladder.  I thought at first it was the bubble tea I had earlier that evening when some of the other nurses asked me if I wanted anything from the Thai place. After a while I stopped drinking the bubble tea. I had some cranberry pills and drank lots of water. I told one of the other nurses, “ I may have a UTI.”

I went home thinking I would  try to see my doctor the next morning and get seen. Unfortunately as the night went on I was unable to void. I kept pushing and I could barely get anything out. By 1:45am I could not urinate at all. I felt like my insides had closed up preventing me from releasing the urine from my bladder. My parents heard me rushing back and forth to the bathroom and asked me what was wrong. Close to 4am I laid on my bed curled up in fetal position admitting defeat.

I admitted then I need to go to the ER. My parents are  not in the medical field. Therefore when I got the point across that  I needed to get the urine out, and it was something that required a hospital.

We arrived in the ER after 4:30am. The doctors and nurses often left me alone after I was placed in observation. At first they assumed I had a kidney stone. It would be several hours after I convinced them I was not pregnant and a bad CT scan they realized they needed to bladder scan me. A negative pregnancy test preceded prior to the bladder scan which should have been done before they sent me to CT hours ago. After some more time and three attempts of unsuccessful straight cath, they inserted a foley which drained over 1500 cc of urine out of my body. Finally my discomfort waned. The foley remained off an on next few days before a decision was made by my urologist that would remain inside of my bladder until they figured out the cause of my inability to urinate.

Days later  they discovered I actually had a mass in the bladder. My left kidney had lost most of its function. But there was good news. The right kidney miraculously retained over eighty percent of function. Now the goal was how do we solve the problem of fluid on my kidneys which led to me not being able to pee on my own?

My urologist worked relentlessly to get me to a gynecology urology specialist  and a urology oncologist. Surgery was scheduled for March 24,2016. For the month I was out of work and school, I had to get my foley changed six times. Late March I received the news that the tumor was benign. My family and I sighed with relief.  My sister was my greatest support. I had some great friends from work that came to visit me and others  I have known for several years.

I learned who my true friends and supporters were. On April 5,2016 I returned to  the hospital I worked at to get my routine tb testing done for work. I decided to  walk up to my unit. I was foley free. I happily told my coworkers  I did not need a foley anymore. I also did not have cancer.

April 10th, 2016, I returned to work and  a month later resumed my education towards my masters degree.

Through my experiences,  I gained more compassion for my patients and management of their care. I will admit I was depressed for some days, but once I recovered , the experience remained a nightmare that I hope never returns.

 

 

Sonali Dhir is a new nurse practitioner. She worked as a registered nurse for seven years. She loves writing, her family, taking care of her parents and traveling. She lives in New Jersey.

 

On Being A Hospital Virgin

 

I’m told I was born in a hospital, though I have no memory of it.  I do, however, have a brief newspaper story identifying me upon my birth as the 100,000th registered patient at Madison General Hospital, so I guess it really happened.

For the next 63 years, I was in good health and had no reason to be hospitalized. Then, in 2015, I developed a nasty bladder infection that triggered a four-day hospitalization for IV fluids and antibiotics. I received excellent care, but it was a totally new and sometimes confounding experience for this hospital virgin.

My guide through this unfamiliar terrain was a wonderful nurse named Jane. We developed a nice rapport over numerous visits checking vital signs, drawing blood, administering medications, and chatting on a wide range of topics.  There was, however, one thing I had to learn the hard way.

I awoke in the middle of my second night with a strong urge to get to the bathroom.  With impeccable logic, I unclamped the IV line from my right arm so I could make my way across the room.

In no time, there was blood everywhere.  I pulled the emergency cord and Jane came running in.  Once she realized what had happened and remedied the situation, we had a good laugh over my mistake.  The guy who had to clean up after me, however, did not share our sense of humor.

Little did I know that the bond I formed with Jane would be rekindled a year later when I was hospitalized with acute myeloid leukemia. More on that frightening story later. For now, I’ll just say that having Jane as my nurse once again was very reassuring as she administered my first chemotherapy treatment and I lost my hospital virginity for good.

 

Steve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his forthcoming memoir from Written Dream Publishing.