24 September 2022
Every month the RN visits to do the dressing change and qualify Joyce for continued home treatment three times a week. It's never been an issue with an open wound as large as Joyce's. Yesterday was the qualifying visit for October.
So Dana the RN arrived with RJ, a new RN, to change the dressing.
I bring Dana up to date on medications and symptoms that may have changed over the weeks she was last here and we discuss the state of the wound.
Not much change in medications (no opioids now, just Tylenol for pain), a little more pain in the evenings and the Santyl seems to be reducing the yellow slough slowly. There are actually places in the wound where some pink tissue is poking through.
So there's some slow progress.
RJ took Joyce's vitals. Joyce is always cold so she wears a jacket in the house and RJ tried to take her blood pressure over her jacket. Sometimes this does work but not yesterday. His reading was 155/100 or so.
Later he tried again without the jacket and got her normal reading. She's consistently within a few digits of 120/80 without medication. And that's what he got.
The company has been constantly hiring since Covid hit. They really can't get enough nurses.
They can never get her oxygen level because she has Raynaud's syndrome, which restricts blood supply to the fingers. Her fingers, on cold days, are blue.
He removed the old dressing and applied the new one according to Dana's instructions.
The company has been constantly hiring since Covid hit. They really can't get enough nurses.
One reason is that Kaiser offloaded a lot of care to home nursing to avoid exposing its care providers to Covid. But it seems like there are just more people who need home nursing now than ever before.
Both Dana and Kristine the LVN have brought trainees here. And when they do, I make a lot of precise suggestions with brief explanations, although more so when Dana brings someone because, coming once a month, she isn't as familiar with the techniques as they evolve.
Dana, who is married with two boys, used to work seven days a week to cover her patients. She and Kristine both work six days a week now. "I love my job," Kristine says, "but I like my days off."
In the just over two years of this adventure, we've seen a lot of RNs and LVNs attend to Joyce at home. Tyler, Salwa, Laura, Sarah, Ben, Vic, Kevin, Barbara, Dana, Quoia, Claire, Sami, Loraine, Twinkle, Kristine. Not to mention the hyperbaric oxygen crew, the Kaiser hospital staff or the plastic surgery clinic nurses.
The LVNs, like Salwa, Sami and Kristine, are all going to nursing school as well, trying to become RNs. It's ridiculously expensive. And on top of working six days a week (and some of them raising kids), we can't imagine how they pull it off.
We always ask how classes are going. And they all do well, even when they are not particularly happy with their teachers. They've learned not to let that get in their way.
They are determined to get where they are going. Before we close the door behind them as they hurry off to the next patient, we wish them well one way or another. Every time.