Please note: I will be frank with the issues surrounding my medical care at St. Barnabas Medical Center (SBMC) and it may seem at times that the negatives outweigh the positives, but they do not. I choose SBMC as my hospital because I get superior care there. I discuss the problems to assist in making this an even better place for patients, and to give other patients an example of actively participating in one's own care. If a patient cannot actively participate by her or himself then I strongly suggest that the patient have a personal patient advocate to assist them in dealing with the issues that arise in the hospitalization of the patient.
Here I am in full gear a little before 6 AM in my room in St. Barnabas Medical Center (SBMC). Taken in low light with my cellphone.
I woke up at 3 AM to urinate. I still pee a little over a liter a day.
Woke up for good around 4:30 AM. The nurse came and took my blood pressure (BP) at 4:45. It was 13?/80 Pulse 49.
At 4:55 AM there was a Code Blue.
There was a 2nd Code Blue at 5:20 AM, then a nurse said, "We've now had three." I was walking morning laps.
A cardiologist from my cardiology group came by around 6:30 AM and did a brief examination. It was the same doctor who saw me in the ER shortly after I got there Friday evening. He had also come by yesterday—Saturday—but before I was so heavily engaged in taking notes. I told him that since getting the nitro, I haven't had any pain in my chest. He said he was going to talk with the lead surgeon in the group tomorrow—Monday—about what can be done.
And I forgot to record the time they took my temperature ... it was normal, but I didn't write it down and now I have forgotten what it was. ... the vagaries of growing old.
"They" did an EKG around 8 AM.
Here I am in full gear around 8:15 AM in my room in St. Barnabas Medical Center (SBMC). Taken in better light with my cellphone. That's my IV dispenser on the pole.
In the next 15 minutes, my breakfast tray came, "they" drew blood for labs, and my day nurse came around.
My day nurse left a little before 8:30 AM saying she would bring back my meds. 8:35 and she is back with them. She is one of my favorites from my previous stay, so all should go well today.
By the way, one of my favorite night nurses from the previous stay was working our section last night. It was good to see her and talk with her a little.
OK, the story of my morning meds. I take a phosphorus binder which can also affect my other medicines, limiting their getting into my body from my digestive system if the binder is present. So the rule is, I have to wait one hour to take the binder after I have taken other medicines, and I have to wait three hours after taking the binder to take other meds. This makes for a relatively complex schedule that I have learned that I must monitor because no one else does. It is a constant hassle until it straightens out ... which usually happens when a nurse works with me for more than one day.
So my breakfast is here and my morning meds have not been straightened out. When I explained to my day nurse ... well, as I am writing this she came back with the news that I can take my morning meds (which affect my blood pressure and heart rate, and because my heart rate is hovering around 50, I wanted her to check with the cardiologist, who then approved it). I took the medicine a couple of minutes before 9 AM. I will be able to eat and take my phosphorous binder a little before 10. The important point—for me— is that I had to be actively participating in this discussion to get the sequence right.
Between 10:30 & 11:00 AM my primary nephrologist came by. We talked about my case and he affirmed that the cardiologists are in charge. I mentioned to him that my cardiologist had referred me to a lung doctor, and he immediately referred me to another specialist who was in fact in the hospital at the time.
The lung doctor came by and briefly interviewed me. He said he would check out my xrays. I now have a lung doctor whom I will have to see once I am discharged.
A little after 11 AM the cleaning person came by to do a "thorough" cleanup including dry and then wet mopping our floor. She apologized for not being able to come by yesterday because "it was so busy." I hadn't noticed.
It's 11:30 AM and I am going to get cleaned up.
My IV dispenser started beeping as I was finishing cleaning up in the bathroom. It was due to a low battery. I had left it unplugged too long. I didn't figure it out, when I should have, but my day nurse did and we plugged it back in. I unplug it to take it with me when I walk away from my bed because I need a continuous IV of Heparin solution.
Lunch and my midday meds came a little before 12:30 PM. My pulse was 55 so I took the medicine to help control my heart beat and ate part of my meal. I will finish my meal and take my phosphorous binder a little after 1 PM. Planning and monitoring some kind of consistency in taking my meds is primary to my health care.
I finished my lunch and took my phosphorous binder at 1:20 PM.
My day nurse came in and informed that I would going to nuclear medicine for imaging of my lungs that afternoon.
Around 2:40 PM the transport person came and got me and took me on a transport "stretcher" to nuclear medicine. I was there until approximately 3:45 PM when another transport person brought me back to my room.
While in nuclear medicine I had two scans, ventilation and perfusion. The first image scanning process—ventilation— involved breathing a radioactive "gas" into my lungs for approximately 5 minutes, and then having them imaged over 20 minutes. The second image scanning process—perfusion—involved having a liquid radioactive solution injected in me through my IV in my right arm, and then having my lungs imaged for 10 minutes. (See Radionuclide lung imaging.)
Dinner went well and I had eaten and taken my phosphorous binder by 6:45 PM.
Around 8:30 PM my night nurse came in and she was that favorite of mine that was working in the section the night before. (See above) That was a most pleasant surprise, and we bantered a bit about my care. She took my vitals: blood pressure, pulse,temperature, and oxygen level. All were normal ... for me.
Then around 9 PM a technician came in and said she was there to give me a breathing treatment with an inhaler. This was a surprise for me because I had not discussed it with my new lung specialist. I asked her what drugs she would be administering and she told me there were two, and one of them was albuterol, the drug which I think was the most likely cause of my heart racing and my second trip to the ER from dialysis on Saturday, October 31, my birthday.
Here's what Drugs.com says in part about albuterol:
Before using albuterolNeedless to say I refused the inhaler treatment until I had a chance to discuss it with my doctors.
You should not use this medication if you are allergic to albuterol.
If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication.
Before using albuterol, tell your doctor if you have:
* heart disease, high blood pressure, or congestive heart failure;
* a heart rhythm disorder;
My Note as I write: This is the first time I have read this level of detail about albuterol, and it really, really makes me wonder what is going on! I need to find out why they prescribed albuterol to me in the first place without testing me—when I am obvioulsy a heart patient—and THEN why my new lung specialist repeated the mistake. Now, they might have a rational reason, but I have yet to hear it, and this series of events clearly demonstrates the need for us patients to be active participants in our medical care.
My night nurse came in and agreed that I should not be taking the treatment in this situation. She then tucked me in and said she would be back at 2 AM.
