VNA Hospice Nurses… The Best Advisors

Debbi had a good night last night. She did wake up and was a bit agitated between 2am and 4am but having the drug regimen suggested by the team and having been educated, the restlessness was easier to handle. In addition, I was awake at the time that it started so it did not get the best of me. Debbi was still shifting from lying down to sitting up to lying down. Cycle after cycle. Drinking became difficult at times because Debbi herself was tired and had some trouble using the plastic tubing we are using in place of a straw. After settling Debbi at 4am, I pulled a pillow next to her left side, and laid down with my left hand on her stomach. I became the vital signs machine that we always saw in the hospital rooms. I could at once sense her her heart rate, respiration rate, temperature, and her agitation. I kept the monitoring going till about 5:30 and when I woke to the sun in my eyes at 6:30, my left hand was still performing the monitoring function.

At 6:30, Debbi’s breathing consisted of four rapid deep breaths followed by about 15 seconds of shallow breathing. I do not believe that this shallow breathing was the sleep apnea described on the Hospice web pages concerning “Active Death” as her chest expanded somewhat and her nostrils flared with each breath. Overall Debbi was comfortable thanks to the proper balance of medications suggested by Debbie A., Margot, and Lyn.

Around 10am, Debbi again started a bit of restlessness. This time however, Debbi, in the midst of a tremor, asked for the kids. In short order, everyone was around her for a 45 minute visit. Debbi’s needs were attended to. A brush was run through her hair that has now grown to over 3 inches. I came across a picture of Debbi with two of her young pupils from school. In the snapshot, Debbi’s hair is as long as I ever remember it. She looks very healthy wearing a white peasant dress and shoes that have ribbons that tie above her ankles. She is simply gorgeous. Her smile is stunning and her brilliant green eyes are dramatic. How different the picture looks compared to the patient lying less than 10 feet away. It is the same Debbi but the physical body is surely different.

I was thinking, this morning, that the answer to the United States health care system might be visiting nurses. I think the government should use a good chunk of the bailout money to recruit, educate, and train a crop of graduating high school seniors. Teach them to be nurses. Spare no expense in making sure that they are thorough in their knowledge. Make their program a work study program that features hands on periods beginning with the simple tasks like diapering (I need to go back to school for this) cleaning a patient, etc. Besides anatomy and physiology, educate them in drugs and their side effects. Differentiate the nurses based on their interests and when they have finished their practicals a few years down the line, let them work in the field at full pay for 5 years before they can move on to the private sector free of school loans.

These trained nurse practitioners could treat many patients that otherwise would have gone to the hospital by expanding the VNA system. The bills that I get from Sloan Kettering are staggering and yet during an 11 day stay in March, Sloan was not able to rid Debbi of her infection. Moving Debbi to Cape Cod, a visit to her physician here, and follow-up at the Cape House by the VNA nurses knocked it right out. You might recall that they used remote services to administer and monitor the Vancomycin IV. Just because the nurses were primarily responsible does not mean that the consulting services of the doctor and pharmacist and the labs were not at the ready… they were only a phone call away. Compared to the bills for the 11 days at Sloan, the charges for the home care are a fraction of the hospital charges. In fact, I think I am about to get a letter saying that the insurance may not cover the charges for the last day of the hospital stay because they maintain that better care could have been given less expensively. I will fire back that Sloan did not do what they set out to and that home care provided a better solution at a less expensive rate. It seems reasonable to me that the insurance company should shield us from those specific charges and make Sloan eat the charges for the last day of treatment.

We can not say enough about our team. Debbie A. walked right in today and instead of popping in to see Debbi, she headed right to see my kids and see how they were doing. Only after attending to them did she find me to take the report on Debbi’s status. How caring, and how considerate, and how fortunate we are to find ourselves with such wonderful resources. I can’t imagine having the where-with-all and the stamina to be prepared to offer the best service I can potentially deliver without having Debbie A., Margot, Lyn, and Mary and don’t forget our talented health care aide Ann whom we expect to arrive any minute. Ann is hands on and bathes Debbi and makes her sparkle. Ann is an equally important part of the team and her radiant smile after being praised for a job well done with Debbi is truly genuine.

Lets stop wasting money on health care and start building an effective system that is many times more efficient than the current system. That it costs less is only a part of the true savings.

One thought on “VNA Hospice Nurses… The Best Advisors”

  1. I wish I could make it all go away. I truly feel mortal and humbled. As I sit here I can feel tears in my eyes. How can anyone express their sorrow with words? I look to the higher authority of god for the answer. As raindrops fall, the sky is crying. Just know it is my pleasure and honor to know you. With love your, “Officer” Tim

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