The ugly got uglier

ANd I thought metofromin type 1 diabetic was ugly, this next patient is even uglier.
Long story short - implanted nerve stimulator, COPD, mild dementia CABG X 5 and hyperlipidemia patient the other day having CP a day or two after their visit for chronic care clinic - reports it's not like their typical angina pain "doesn't feel right" and it's been going on since arrival to the facility (erroneous - denied CP adn SOb at office visit, but oh well)

ECG a couple days ago - NSR, ECG when having CP NSR with PVCs

NTG X 1 drops BP to 107/something, so I start an IV, start some fluids he's got some O2, I'm hesitant to give more NTG incase they are really is having an MI and if it's a right sided MI, well, I'm certainly not helping them with the NTG. After the second one, BP down to 94/something, hmmm, now SOB and really not feeling well and perhaps a little irregularity in the HR. I finally decided to call 911. It's weird calling 911, it's weird to be on the other end of the call and even stranger them going thru the checklist with me, depsite having answered all those questions in my initial report.

EMS arrives (and much to my happiness they know I am ShawnZ's wife - it gives me some credibility), slaps on their 12 lead, now in Afib with a rate between 30 and 79, still SOB, feeling worse. They take the patient to the hospital - and the patient's not back yet.

I have officially set a new CCJ record for the number of patient shipped out not just in a week but in a day as well. I wonder if I get a bonus for that - I'm guessing not.

The Good, The Bad, The Ugly

The good: Doc told me "good catch on the galactorrhea secondary to ablify, good call getting the US, impresive catch"
The bad: patient detoxing from EtOH, was in ER sent to us w/ severe tremor, hx of Afib, last detox in October was and seoncd stay in ICU for this. Today - Afib with RVR while detoxing = out of my comfort arena past the 2 more mg of ativan.
The ugly: trying to start using metformin as adjunctive insulin therapy with a Type 1 diabetic while arm wrestling nutrition to get a different diabetes diet and combatting sugars ranging from 55-405. All because I was dumb enough to say I would give it a try (it worked for the patient 3 yrs ago, hoping it works again)

Survival

I survived my first weekend of call with one more day to go. it feels good that I only had one phone call and it was regarding an antibiotic for a tooth abscess and some motrin - woot. I interview tomorrow to keep my new job. I'm thinking good thoughts. I also gave in to Shawn's wishes for more electronic toys. But we have 30days to change our mind.... I'm sure it won't be the first or last thing I give in for Shawn. We shall see.

So the other day my CNA and I were discussing what we like to cook or bake. Well apparently she doesn't bake (much to her teenagers and husbands dismay) and I guess I spoke so highly of my banana bread that she actually brought me a bag of banana-bread ready bananas, nuts, applesauce, sugar, salt and flour to work - how she got all that in past security I'm not sure. She politely asked if I would mind making her a loaf to try. How could I say no when she brought me all the ingredients? Plus she busts her butt daily for me to keep things running smoothly for me and the rest of the clinic.

Shawn's birthday is Wednesday, he's working I'm on call so I guess Friday will have to work instead.

For the die hard fan

In searching fro some last minute holiday/birthday gifts for Shawn I stumbled upon two gifts for the truely die hard fan (I mean seriously what do you get the Cubs fan that has everything?)I found a Chicago Cubs urn and a Chicago Cubs casket with satin pillow. Call me crazy but a gift like that might send the wrong message.

I survived the week. Thanks for the encouraging words everyone - they are greatly appreciated. It's my first weekend on call - first of many. I'm a little nervous I don't even want to go to sleep for fear of msising a call or being so groggy I can't answer a question.

The new company is in town as they prepare for take over on Feb 1, I meet the Chief Medical Officer and founder on Monday for 2 meetings. I'm crossing my fingers, I think it will go well. kinda weird I just started my job and am re-intervieweing and reapplying fro my job after3 weeks of actually working, but at least I could update my CV to show I now have experience as a PA... a whole 12 days worth. woot!
Upside of corrections- if you don't have time to see them or the problem can be addressed thru a written letter or prescription then back to their cell they go, downside, they have nothing to do but think of things that are wrong with them and they send more kytes (what the medical request forms are called) truth be told there are some real pain in the neck types - not like I can fire them from the clinic and I may see the same person several days in a row.