Day Four - Wednesday - Part Two

November 24, 2010:  KASSI gets discharged TODAY!  She is so anxious to see Brandon that she pushed through it all and climbed up and down six stairs, used crutches, took a shower and was able to eat some of that great hospital food and better yet, she was able to keep it in her stomach.  She is counting the hours until she gets to be with Brandon. 

For those of you who say, "What's the big deal?" "Six stairs, crutches, hospital food, I can do that." Remember she is doing it a day after surgery with a brand new 18" metal rod, associated hardware, remnants of a pneumothorax, two broken ribs and a newly discovered broken collar bone.

Her plan is to go home, gather some photos, family reminders, some favorite music, clothes, eat an early Thanksgiving dinner, pray for dry roads and head to SLC Thursday afternoon.  I don't know if is so much that she is more eager to get there to see Brandon or eat another Thanksgiving Dinner.  Pete's son Tony has kindly agreed to smoke a turkey for us.  There is no telling what some people will do for a smoked turkey. (With all the support and love, everyday for the last three days has been Thanksgiving day.)

It appears that the transport team had it right.  Brad, one of the team members is also a PA at Shock Trauma, read the films in Cedar and felt Brandon had aspirated.  Based on the fever and today's chest x-ray, Brad had it right, aspiration, not contusions.  I will avoid the description, out of respect for the holiday cooks, of the fluid they are taking from Brandon's lungs.  The antibiotics were started this morning. Hopefully their battle with the bugs will be short lived.

We are currently weaning him off the sedation.  He has not shown any signs of cranial pressure.  So they are lowering the Propofol slowly while increasing the pain meds.  I have volunteered to monitor him for tube security in an effort to increase the duration of his sedation vacation.  I am hoping we can keep him off the sedation for several hours.  He could use the break from the med and we can use the exercise.

His nurse is a very compassionate total care giver.  That may stem from her history of being a paramedic before becoming a nurse.  You all know how compassionate those paramedics can be.  Speaking of which, I was on my phone this morning outside the unit. The doors opened and Josh Forsythe walked out in his scrubs looking for another patients family.  Josh is one of those great Provo Fire paramedics who became a nurse and now works for IMC and Provo.   I received more compliments on his patient relationship skills than any other employee I have had the privilege to supervise.  It's not unusual to receive a card, letter or email expressing general thanks for a fire crew.  One thing that made my experience with the comments about Josh unique is they were not done by a card, letter, or email, they were either by phone or in person.  It was not unusual to have someone find out I was the Provo Fire Deputy Chief and start telling how much they appreciated Josh and his compassion. 

I need to take a few moments to share my philosophy on medical treatment.  In one of my posts I talked about a caregiver who gives Brandon high levels of sedation when he moves and are a little more abrupt focusing on using the skills of nursing rather than applying nursing skill.  Medicine is an art which uses science.  There are standards of care, not one absolute, scientifically proven method.  Just as with photography which combines art with chemistry, there are countless individuals who can take and develop wonderful pictures, few can produce a masterpiece. 

Because medicine is an art, there is room for choice of method and interpretation of predicted outcomes.  The nurse we had the first night was exceptional and set the tone for our stay.  All of them are skillful at the art of nursing.  I need to keep better track and write down his caregivers names, my memory is not what it used to be.  They are all worth remembering.  All the nurses here have great nursing skills.  The way they apply those skills creates the art of nursing or the masterpiece.  Some choose one path, others a different path.  Just because someone prefers blonds, doesn't diminish the value of the Mona Lisa. Most artists can paint well, few are masters. IMC Shock Trauma has many, many masters. That's what makes them good at what they do.  And that is why when given a choice of flying North or South of Cedar, North was the ONLY choice. While I may have preferred Mona Lisa as a blond, she is still quite the masterpiece as a brunette.

I really have grown to appreciate those who are masters.  Their focus and approach makes a world of difference.