Sorry for the Hiatus and Surely They Didn't.....Wait Oh Yes They Did

*I apologize for the blogging hiatus and promise to get up at least a post a week from here on out. Sometimes life just gets in the way of a good story.*

I go into many neighborhoods from very wealthy ones to the inner city. One thing has remained constant throughout all of them, people on all ends of the income spectrum plant fake flowers. I find this practice quite annoying, although I am not quite sure why I harbor such unnatural resentment for plastic flowers.
I was going to see a patient one day, in a fairly nice neighborhood, whom I had been seeing for quite some time. Off to the side of the path leading up to their door was a evergreen tree. Every time I walked by this tree something bugged me about it. It just looked off to me for some reason. I began to have suspicions that the tree was not what it seemed and it started to annoy me more and more. So one day I decided to veer off the path under the guise of dropping something so I could feel the tree. Well my suspicions were correct. My patient decided to plant a fake Christmas tree. In. her. yard. Now I have come to tolerate fake flowers but seriously people? A fake evergreen? No just No.

You just never know.....

One day I was out doing home care visits in anonymous urban area and had a patient on a street in a very questionable area. So I was heading out on major interstate and exited onto very questionable area exit. When I heard the unmistakable sound of the air leaving my tire. So at the end of the exit in the middle of unquestionable area, I pulled my car over to confirm my suspicions and hope against hope I was wrong. I got out of the car and my tire was as flat as a pancake. This was before everybody and their brother had a cell phone so I was stuck because I have no friggen clue how to change a tire. So I immediately did the only thing I knew that would help. I sobbed like a little bitch. So 2 gentlemen happened to be walking down the street and they looked very questionable. They were probably all of 19 and they were drinking 40 oz. beers out of brown paper bags. They stopped when they heard me sobbing and said they would help me change the tire. The only thing they wanted from me was for me to watch their beer. Now I have many reasons to be leery as I have been robbed, harassed, and assaulted while doing home care however I did not have much choice since there was no way I was fixing my tire. They promptly got to work until the one kid said he needed to get a lug wrench or something from his cousins house on the corner. So I am waiting for them to come back and a crowd is forming but I took my beer watching job very seriously and not one drop of beer escaped. The guys came back and promptly changed my tire. I tried to pay them but they would not take it. I argued with them to take it and they still wouldn't. They told me to get going that I had no business being in this neighborhood.
This story is why I love and continue to do home health care. I have had many bad things happen to me while caring for patients in urban areas but it has also affirmed my belief that people are generally good. I made it to my patients house who promptly starting bitching that I was late. She did not care about my flat tire, I made her late for her hair appointment.

Damn Baby.....

So I had been doing home care 10 years when I got pregnant with my 2nd child. You can imagine how difficult it was doing home care in the neighborhoods I was sometimes sent into. I had to climb rickety steps, was attacked by 2 dogs, and dealt with every smell imaginable in that 9 months.
One day I was going into a less desirable neighborhood to see a patient. I was 8 months pregnant and as big as a house. Well this patient had a gate that was broken. So to be able to get inside the fence and up the the house to see my patient I had to somehow scale this fence. I am not the most graceful person even on my best days so adding another 30+ pounds from the pregnancy and you can just imagine me trying to get over the fence. I struggled mightily for about 10 minutes before finally getting over the fence. The whole time the patients' nephew is sitting on the porch drinking a 40 ounce watching my struggle without comment. At this point I am sweaty and bitchy and really just want to go home. The patients nephew walks off the porch and proceeds to hop right over the gate. He then turns to me and says "Damn baby, I bet you look gooood when you aren't pregnant." I just looked at him, gathered up my remaining shred of dignity and waddled in to see his uncle.

Clara; Nurse & crisis negotiator extraordinaire

Nothing makes me more nervous, than getting a call from a patient after hours. Usually, there is some type of medical issue they are seeking advice about. However, one hot, August Saturday afternoon, I received a call from the wife of my patient. She was frantic, and I started to think the worst. I finally calmed her down, and she told me her husband wasn't acting right. I reassured her, I was on my way. Stroke? Heart Attack? Infection? What could be wrong. As I raced to the front door, she greeted me with a tear stained face. "Where is he?" I asked. She pointed to the garage. The knot in my stomach just got bigger. I moved as fast as I could through the house into the garage. And there he was. Sitting in the drivers side of his new Buick. Now, I am confused. I looked at his wife, and asked what was going on. She then preceded to explain to me, they had a big argument. He wanted fish for dinner, and she already had pork chops in the oven. Really????? He became so upset, he stormed outside to the garage, and locked himself in the car. He had been there for an hour before she called me, refusing to get out of the car. So, when she told me he wasn't acting right, she simply meant misbehaving? not getting along with others?? Apparently so. I knocked on the window. He ignored me, and looked away. It was 90 degrees outside. He could really get in trouble. I yelled through the window to open the door, and he shook his head no. After 15 minutes of attempting to get him out, he still refused. Now what? Well, no other choice.. 911 can I help you?? Yes, you can, I'm a home care nurse, and my patient is upset and locked himself in his car, and has been there over an hour. After a few minutes, police and EMS arrived. He continued to refuse to get out. I stood there in disbelief. As the police finally told him get out, or they would break his window, he slowly opened the door. As he got out of the car, he looked at the officer and said, " If you would've broke my window, I wouldn't be able to go buy my fish dinner..." I saw this patient for several months after this, but this incident was never discussed.

Yeah Ummm No Thanks

As we have established in previous posts we see patients from all walks of life, ages, and areas. Sometimes we get patients that are very young and through major abuses of their bodies are dealing with health problems that people 3 times their age deal with.
The patient I will talk about today was a gentleman in his early adulthood who looked to be in his early 50's. He was a chronic drug abuser(cocaine), alcoholic, and had a history of tracheal cancer. Due to the cancer he had a tracheostomy(hole in the neck through which he breathed) and a g-tube(a tube that goes directly into the stomach since he could no longer eat by mouth). I had actually caught him many times smoking cigarettes through his trach. I went to visit him one day and he was pouring beer down his g-tube. I proceeded to give him a long lecture about why he should not be putting alcohol down his g-tube due to the large amounts of medications he was on and the dangers of mixing those medications with alcohol. He listened intently for a few minutes, then calmly said "Well I was going to ask you if you wanted to get high with me, I guess that is out of the question?".

Have You Seen Her?????

One crazy, hectic, Friday afternoon I was planning to see my husband/wife patients at the end of the day. Their visits were typically uneventful, and I really enjoyed taking care of them. With his hearing loss, and her confusion, we often wondered if they were ok at home alone. But they complimented one another, and did just fine. As I walked up to the door, I checked my watch- just enough time to do my visits, and be on my way. I loudly knocked(so he could hear), and announced myself through the door, (so she wouldnt be afraid). I heard her come to the door, after I guided her through the process of turning the lock, then turning the handle(yes, I had to instruct her to turn the knob), she let me in. "Oh" she said, "You're here, let me go get my husband from the bedroom". I took my coat off, sat down on the couch, and started filling out my paperwork. After a few minutes, I still continued to sit there.. what was she doing??? By this point, frustration was setting in. I was now going to be completely off schedule. Waiting. Waiting. More waiting. Fifteen minutes had passed. Now I didnt know what to do.. go look for them or just leave. Well, I couldnt just leave. I slowly walked to the bedroom door, and called through the door "yoo hoo". Nothing. Now, I was starting to panic. I had to go in. I had to make sure they were ok. I slowly opened the door, as I peaked in, the lights were off. I became more nervous. I flipped on the lights to find the two of them in bed- SLEEPING!! She went in to get him, he was napping, saw him sleeping- and got in bed too! They both quickly sat up in bed looking more startled than I was, and she looked at me and said, "Who let you in????" After 30 minutes in the home, I never did get to do my visits. I told them I would be back tomorrow because they were napping now.

Hmmm that is one way to look at it.....

I went to see a patient one time that was status post a breast mastectomy. I was there that day to remove her staples from the incision and empty her JP drains. We got to talking about Cancer and the treatments for Cancer. She was concerned about the chemotherapy that she was going to have to go through. I was talking her through her fears and it turned out most of them were based on the fact that her relative had colon cancer.
We had the following conversation:
Patient: You know they took his butthole off and put a butthole on his stomach
Me: (stifling a smile) Well what he had was removal of his colon and then they attach the remaining colon to his abdominal wall and attach a bag to it so he can still eliminate waste from his bowels
Patient: Yeah they put a butthole on his stomach
Me: Indeed they did.....

911 Fire Police or Medic?

The block party I stumbled upon, arriving to my patients house one Saturday, concerned me at first. However, in true home care nursing fashion, I grabbed my nursing bag, pinned on my name badge, and confidently walked up to the house. After refusing a bottle of beer the nice gentleman on the porch offered me, I proceeded to ring the bell. A woman, pushed her way through the crowded living room, and opened the door. I explained I was there to see my patient, and she showed me up the narrow staircase. As I walked into the tiny bedroom, I found my patient sitting on the edge of the bed. I introduced myself, and the very obvious intoxicated lady politely shut the door, and went downstairs. My patient looked at me and said, "Who was that"? I didn't know, and neither did she. Trying to stay on task, I started my nursing visit. The music was very loud, and I struggled communicate with my little lady. After some time, I finished up, thanked my patient, and told her I would be back Tuesday. Picking up my bag, I walked to the door. As I turned the knob, it appeared to be stuck. Jiggling the door, I began to break a sweat. My patient kept saying, "just turn it".. REALLY? Thanks, for the help. She then got up, slowly made her way over to the door, and failed as well. Hmmm.. what now? I tried it again, and again. After what seemed like forever, I tried to yell out the door, but the music was too loud. I put on my "survivor" face, and got a bright idea to open the window, and yell to the crowd that I saw on the front lawn. Much to my dismay, the window was painted shut. Awesome. It was at this moment I questioned my profession. Sitting there, looking my patient in the eye, I wondered if I was on Candid Camera. Was somebody going to jump out of the closet, and yell..:"GOTCHA" . No such luck. I had no other option.. I grabbed my cell phone, and YES I did it. 911, fire, police, or medical? The operator said. Well, fire would help get a ladder to this second floor window that's painted shut, police could break down the door and free me-and safely get me out of here, and definitely the medic for the panic attack I was having, and 10 pound of fluid Ive lost from sweating. Take your pick, I told her. Moments later, I heard them.. the sirens prompted the music to quickly get turned down, and random people scattered(yes, I was watching out the window.) Pretty soon, I heard a voice, "Are you in here"? Yep, I proudly replied, and the police officer opened the door. Apparently, the delightful mystery guest locked the door from the outside. I grabbed my stuff, let the kind police officer escort me to my car, NEVER to return again. (BTW, the patient was subsequently removed from that home, and now happily resides with her other son across town- -not a good idea to lock someone in their room) Moral of the story.. always carry your cell phone (or a crowbar)

Elderly Pimpin'

So I had an elderly African-American patient a couple of years ago that we were seeing for antibiotic injections for pneumonia. Part of my responsibilities as a home care nurse is to educate patients on their disease processes and also their medications. So as I was teaching this gentleman about his medications and quizzing him on what each one was, we got to his Viagra. Now this patient happened to be on twice the normal dose then is indicated for erectile dysfunction. When I inquired as to why he was taking it, thinking maybe there was another reason he set me straight:
Flo: Do you know why you are on this medication
Him: Yeah that is so I can get it up for the ladies
Flo: That is an extremely high dose
Him: Yeah Dr Blank says that us black men need twice as much since we are twice as big
Flo: I have never heard that before
Him: Want to see how it works?
Flo: I'll see you next week
Sometimes it is just better to keep your mouth shut. When will I ever learn?

There She Blows!

I believe I have mentioned before what a glamorous career that nursing is. We deal with body fluids of all kinds, poop, vomit, pee, mucous, and the good old mystery fluids that you really do not want to know what they are. Well today was no exception.

I have a patient who is a monthly foley catheter change. This is a tube that goes directly into the bladder for people who retain urine or their bladders just do not drain correctly anymore.

So this lady happens to be obese and it is very difficult to get to where I need to be from the front. So I have her roll to her side so I can insert the catheter. So everything is going normally until I hear "OMG, OMG, OMG!" from my patient. Before I had time to react the most unholy inhumane fart sounding as if it originated from the depth of Hell. Meh, farts are easy it has happened to me many times and I barely miss a beat. However this time the fart from hell was followed by the hugest smelliest shit I have ever had the misfortune of of seeing/smelling. Not to mention the fact it landed all over my arm. Some days I wish the uniform wasn't scrubs but full body armor!

Would you like to buy a vowel???

Sitting in the rocking chair, my patient turns and looks at me at says, "I don't feel well today". After pressing the issue, trying to identify what exactly was wrong, and what I could do for him, he continued to repeat over and over, "the doctor said its my pirates, they're abnormal" "Pirates??" I asked. "Yes, pirates...p-i-r-a-t-e-s". Well, since he took the time to spell it, I knew that's what he was saying. Now, I have been a nurse for awhile, and never heard of abnormal pirates. He then asked me, what will happen to him if his pirates do not improve. I wanted to say, "well, you may encounter some trouble the next time you take over a ship", but I didn't. I simply picked up the phone and called his doctor. The doctor was less than pleased to get on the phone, and more agitated when I asked him whats wrong with my patients pirates. He said a few choice words.... then said...ohhhhh, he just had blood work, and his PLATELETS were abnormal...I tried not to laugh, but couldn't help myself. I told my patient he would be fine.. his pirates will be checked again next month.. nothing to worry about.

When In Rome.....

Having a job that pays you a salary is a wonderful thing. However, in home care, that doesn't always work in your favor. Being a salaried nurse, you don't always have the ability to pick and choose the patients you see. I received a call from the office one day, telling me I had another patient to add to my schedule. After getting all of the demographics, the scheduler-quietly said, " Oh, he gets a little combative and agitated at times, and sometimes refuses to let the nurse in, but you have to make him let you in.. he is a brittle diabetic, but I know you can handle it". Great. I reviewed his diagnosis list..diabetes-fine, hypertension-no problem, coronary artery disease-piece of cake.. schizophrenia-hmmm, we'll see.
After parking my car in the parking lot, I began to walk down the grassy hill to the low-income apartments. It was at that point I noticed, the homeless man fast asleep in the side yard, the little kids running around in diapers, the young men gathered around an old car with the radio blasting, and smoke in the air. As I identified my patients apartment , I noticed the blinds were twisted, broken, and a face was looking out the window. Taking a deep breath, and reminding myself that I love my job(over and over), I slowly approached, and knocked. A loud voice yelled through the metal door, "Who is it?" I explained I was the nurse, and was here to check his blood sugar, and give him his insulin. After what seemed like hours, he replied louder, "You're lying, I'm not letting you in"..Wow. Now what? I told him again, I was here to help him. He continued to peer out the window, as I stood there.. confused, and slightly irritated that he was now putting me behind schedule. "I'm not letting you in, until you tell me your gang affiliation" he announced. What??, there I stood, nursing bag over my shoulder, scrubs on my body, name badge on my shirt, and he wants to know my gang affiliation??
I stood there for a few more seconds, trying to decide: run as fast as I can back to my car, or answer the man. I pressed my face close to the door, and said, in a low voice "I'm with the West Side Nurses". Long awkward pause. Slowly, the door opened. There stood a pleasant man, smiling from ear to ear, and exclaimed, "Why didn't you say that from the beginning.. come on in honey".
I took care of this man every day for almost a year. The director of nursing asked me on several occasions, "How did you get him to agree to your visits.. I just told her, don't worry about it. One day, I was running late to see him, and he called the office- he didn't give my name, yet told the director, "My nurse isn't here yet- ya know her- the one in the West Side Nurses Gang, can you call her?"
I won employee of the year that year

Why didn't I become an accountant?

Some stories are so out there only time makes them humorous in hindsight. This story has been a favorite of my coworkers and friends for years.

The first homecare agency I worked for had a policy for what to do in case a person lost a digit to necrosis(side note: sometimes people with severe vascular disease and diabetes will have toes or fingers get necrotic and the doctors will allow the diseased digits to just die and fall off instead of risking the patient going through surgery, this is way more common with toes). The policy was that we would have to collect the toe and put it in a biohazard bag to be sent to pathology at the hospital. I know it is a glamorous job try not to be jealous.

Fast forward about 2 months and I have a patient John Doe who was a very brittle diabetic and we were seeing him for wound care on 3 of his toes. Basically we were just wrapping his foot with gauze and checking to make sure the skin on his foot was not becoming necrotic or dead like his toes.

The toes were becoming very black and brittle and I held my breath every visit just hoping those toes stayed where they were supposed to be. Well that idea was shot to shit one visit and I have been traumatized every since. I unwrapped his foot as usual and 2 of the toes had come off in the dressing. So I was getting in my nursing bag to get out a biohazard bag and THE PATIENTS DOG GRABBED ONE OF THE TOES RIGHT OFF THE BANDAGE! So here I am totally freaked out chasing this little dog all over the house while the patient is laughing at me telling me not to worry about it because he could not use the toes anyway. The dog totally ate one of his toes!!! I called my office to let them know I would only be bringing in one specimen and after they picked themselves up off the floor from laughing at me they told me I had to let the doctor know. That was one of the most awkward calls I have ever made. The doctor thought I was just messing with him but ended up being very amused by the whole situation. The patient teased me about the incident until the day we discharged him. I still shudder when I see necrotic toes to this day.
*because I like you all I will spare you images of necrosis of the toes but for anyone wondering how a toe just falls off, please feel free to google it, although I must warn you it is not for the faint of heart*

I NEED YOU TO CHECK SOMETHING FOR ME..

SCROTUM: Noun/Plural..The pouch of skin that contains the testes.

What the dictionary does not include in this definition: As men age, their scrotums become supersized and extra shiny. I did not discover this by reading an updated anatomy book, or attending a mens health expo. Unfortunately, I had the misfortune of my patient announcing, (before I could take off my coat) "I need you to check something". As homecare nurses, we are very familiar with that phrase..hearing it several times a week. Typically, the next step is our patients show us a bruise or cut, new bottle of medicine, or even the thermostat. But, this day was different. As I quickly removed my coat, (in superstar nurse -save the day fashion), and started to walk over to him, he already was standing in front of his lazyboy. Pants down around ankles. Boxers twisted at his feet. AND THERE IT WAS... the biggest, longest scrotum I had ever seen. It wasnt his scrotum he needed me to check. He had an itch in his right groin area. I didnt have a choice.. I had to go in...I adorned my medium non latex powder free gloves, attempted to visualize the groin.. Quite difficult with him standing, and myself bending at the waist with my hair nearly dragging on the ground. I asked him to go lay in his bed, and he refused.. of course. I reluctantly, kneeled down (yes, the picture in your mind is correct), grabbed hold of the fifty pound, six foot scrotum, and dug in...noting a horrible fungal infection. While assessing the entire groin, and scrotum, with his penis blowing in the wind... he had the nerve to ask me if any patients with a rash like his that need checked, get an erection....
As I helped him fold up his scrotum, and place it back down his pants into his shoe, I told him I would report this to his doctor, and politely excused myself out the door....
This would be the last time, "I need you to check something" would get me.

Oh *that* Spot? Don't worry about that...

I was working one of my 1st home care jobs when I met Jane Doe a 58 year old diabetic with a non-healing foot wound. Jane was very non-compliant and did not follow her diabetic diet nor the wound care for her foot. So I was sent out daily to do wound care on her foot wound.

I will try and describe the condition of the home. The floors had carpet on them at one time which was worn to but a few threads and the mice and cockroaches had pretty much taken over. Now I feel bad when someone is unable to care for their home due to illness and have been known to clean a patients house for them. This was not the case for this patient. She was as able to clean her house as she was to do her own wound care, she just chose not to.

I was at her house for a routine visit one day and had black jeans on. I kneeled down on the floor to do her wound care and imagine my surprise when my knee hit something mushy and wet. I stood up and said "Jane! What is on your carpet!?" Jane replied "Oh don't worry about that *nurse*, I vomited there earlier and didn't clean it up." Yeah she vomited on the floor and just left it. She was perfectly able to clean it up, yet did not. The worst part is she thought it was ok to vomit on the floor and leave it. I seriously reconsidered my profession that day. Lucky for you I didn't

Homecare Hilarity

My name is Flo* and I have been a homecare nurse for 13 years. My partner Clara* has 10 years of homecare experience. We see some of the worst non-complaint patients in neighborhoods that you see on the news. We have entertained our friends for years with our anonymous stories of patients we have seen. Now my dear internet we are bringing those stories to you.