After Western States, I jumped straight into my Long Term Care (LTC) rotation with Pharmerica. It has now been 7 days of working, and I have already spent 2 days in Kula Hospital, 4 days staffing, and one day at Hale Makua, which included both chart review and the Quarterly Infection Control meeting.
People told me Kula Hospital was creepy, but it’s absolutely beautiful! I have been spending more time in Kula lately, both at the hospital and cycling, and I love the view, the temperature, and the jacaranda trees.
I have seen some pretty amazing (and somewhat heartbreaking) cases at Kula Hospital. So many complications, so many drugs. Wherever you go, there is that “problem child” patient that you adopt because they are complicated and need extra help, and you want to help make their life better, some how, some way. I came across one of those today at Hale Makua. She was an ornery old lady, lashing out at staff and endangering herself and others. She sat across the room as her nurse, my preceptor and I discussed her case. She seemed content enough, noshing on her lunch and reading her book. I couldn’t help but notice her stern face and brightly painted red nails. She didn’t seem like a large lady, but then I noticed the swollen legs. Nothing was being done for that, but I would guess it was 3+ pitting edema on both legs. Now, that’s not exactly normal, and can’t be comfortable.
Turns out she has multiple issues that are more likely causing her problems. Without going into much detail, I felt that she could take off 2 of her anti-hypertensives, while upping the dose on one. She is on a CCB that is likely contributing to her swelling, on propranolol that can cause severe depression, and her blood pressure was too low anyway. They wanted to put her on Remeron, but she needed to lose weight, and her depression could be handled most likely by getting rid of the propranolol. Hey, making things simpler while cutting costs! Splendid!
As ornery as they said she was, I said, “I like her already!” and I think she must have heard, because she commented very sweetly shortly thereafter about how beautiful my hair was. She is a charmer, and I truly hope that the recommendations help.