A "Carolyn moment" at Rex

Well, I think you all knew that I couldn't make it through the summer without one glorious moment of unparalleled klutziness. That moment came today. It seems like they refinish the floor of one unit each week at Rex - they strip off the shiny coating with a horribly chemical-smelling liquid, lay down a new coat and buff it until you can see your face in it. They try to be unobtrusive by only doing small sections of half of the hallway at a time, but they still block doors for quite a while. It can change your plans for the morning if they're working right outside the patient rooms you need to visit. Well, today I decided not to be deterred. I had to get into the supply room to pick up some formula for a patient. They had put up the caution ropes but hadn't started waxing yet, so I brazenly walked into the supply room. I delivered the formula with no problems. Then, on my way back, I noticed another RD with an arm-load of formula cans (a pt had rejected all of the Vivonex we sent her to drink PO...can't blame her). So instead of making her hop the caution ropes with all of those cans, I decided to do the hopping for her so that she could just hand me the cans. I took just one step over the rope, and I was on the floor. Totally on the floor. My pager and calculator went clattering across the newly waxed linoleum. There was a collective gasp and then silence at the nurse's station. I assured everyone that I was OK and assured the wide-eyed maintenance men that it was entirely my fault. As I got up and carefully made my way back to ground with coefficient of friction >0, a nurse seized my lab jacket by the collar so that I wouldn't fall again. (She later told me that she was worried I would take her down with her if I fell again, and then she might break a bone because she has to take Boniva.) Everyone asked if I was injured about ten times, and the manager of Environmental Services had to come talk to me. Then I had to go to Employee Health and fill out a variance report. The nurse asked, among other questions, "do you know why this incident occurred?" to which I replied, "Is 'stupidity' one of the options?"

Getting back to actual dietetics...end-of-life issues continue to fascinate me. The cat man made it out of ICU with an alb hovering ~1.6. I had an opportunity to speak with the surgeon, staff nurse and palliative care nurse about him yesterday. Apparently, his wildly metastatic gastric cancer had caused such an extreme bowel obstruction that he was vomiting large amounts of stool. The surgeon thought that even though the prognosis was poor, that was no way to die, so he operated on him, forming a fistula between two remaining viable portions of his intestines. Now, after his good long stay in ICU, the pt is back on the floor and actually eating. However, he still "has cancer like someone spray painted his insides with it," in the words of the surgeon, and he still can't eat much. The pt maintains that he wants to be a full code and have everything done, but he doesn't seem to grasp the severity of his condition or the complexity of his care. (His thinks that his neighbors could look after him just fine.) His daughter stands by what her father wants. This leaves us in an awkward position because he can't eat enough PO to meet his needs, but the surgeon doesn't want to put a feeding tube in such a diseased GI tract, but a nursing home won't take him on TPN, but the pt doesn't want to die, which is what would happen if we stopped TPN, but the pt thinks he's getting better and wants to go. The saga will continue through the weekend with a calorie count...