Saturday, June 17, 2017

A poem about spousal caregivers

What they ate @ Costco March, 2015

When shopping was
errand and respite,

I watched
their intimate scene.

Both frail,
but still mobile.

He used a walker,
she probably drove.

I ate a hot dog,
sitting at a red table.

She opened a lunch bag
and removed each item:

fresh whole red pepper, sliced;
rice crackers;

sliced cheese;
whole wheat bread (thick slice);

diced and whole fresh fruit -
apples, grapes, nuts;

broccoli florets,
steamed and chilled.

The list is reliable.
I noted each item right there, on my phone.

They were still enjoying their picnic
when I left the store with my load of goods.

Wednesday, June 14, 2017

Just putting this out here for now...

"There, I've said it."

I've been working on a set of training materials about caring for patients and families with advanced dementia at end of life, making steady but slow progress.

The current topic is pain, which means we talk about opioids, which means we talk about morphinophobia and adverse effects, which brings us to constipation, which led me to this little gem from the prominent 19th-20th century cutter, Albert O.

Yes, I managed to work in a fart joke.

The funny thing is, I actually made and used flax-seed poultices in my first Boston nursing gig at the old New England Baptist Hospital in the late 70's.

At that time, Kenneth Warren specialized in fixing up operations that others had botched, specifically the kind of "routine" gall bladder surgery that can go very bad, say when someone damages the intricate duct work that brings bile from the liver and digestive enzymes from the pancreas to the small intestine.

That's very bad news. You want to keep those juices moving. You don't want to kill the liver with backed-up bile, or digest the pancreas in its own enzymes.

Warren's patients had scars criss-crossing their abdomens like railroad tracks, from various attempts to straighten out the mess. By the time they arrived at the Baptist, things were often pretty grim.

One risk of gastrointestinal surgery is a condition called paralytic ileus, where the intestines stop moving in response to being manipulated during the operation. That's more bad news. You want to keep that peristalsis going.

Though Warren wasn't a contemporary of Albert O., his practice was still influenced by him and other  pioneers. One influence was Warren's use of flaxseed poultices. 

It was a lot like making oatmeal, except the hot mush got poured into a linen bag and placed on the belly, like a hot water bottle. The moist heat (and maybe some of the components of the flax seed?) helped get the intestine moving.

Moving intestines = flatus.

The notion of "success" in health care has many meanings short of a cure. It's comforting to know that "success" can include a few choice rippers, or even an SBD.