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Wednesday, 21 August 2013


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Organize, organize! Learn the cycle times of your machines, start the washer, then the dishwasher, then the cooking. How long does the kettle take to come to the boil? I would not have survived forty years of marriage to a lovely but not necessarily energetic lady, without applying a certain amount of organizational technique. I can get everything accomplished before she is finished complaining about how much needs to be done.

As to the church yard, you are using a Weed Eater, right? Y'all call them 'strimmers', I believe. They were invented in Houston, a hundred and fifty mile to the East of me, and twenty inches more annual rainfall. They know from grass growth. Get the petrol powered one. They are definitely the procrastinator's friend. (Never mind how I know.:)

Whipper Snipper in Australia - no home should be without one.
In Cairns we have 10 ft. of rain a year! Beat that, Tex!
David, where's the little Scandahoovian maid?

Pardon me for being my usual opinionated self but "she will be 'excused boots' for another - six weeks" is, pardon my Mandarin, bulldoody.

Ok, since I don't know the original condition I can't be specific but making assumptions on age and, more importantly gender, I can guess.

I'm guessing some form of Valgus deformation. Keeping the foot elevated for a week, until the swelling declines enough to wear 'normal' shoes is standard. That does not mean enforced bed-rest, in fact that is counter-productive in that other side-effects of not mobilising (exacerbated by age, I know) will occur. The swelling 'may' not entirely disperse for six weeks (and bone healing will take that long to 'complete'), but six weeks doing nothing and she'll be bed-ridden (think joint, GI, Respiratory and even CV problems).

As to excused boots? Well, excused the very footwear type that probably caused the problem in the first place (fashion!!!) yes. Get her a pair of Andras favourites - Uggs.

If I ever have a daughter, I'd encourage her into being a tomboy or a grunge type - so as not to wear anything other than wide fitting boots.

Waffling (inconsequential and probably wrong) rant over - my best to your lady wife (and get her mobilising soon)

Able dear,
I have never owned a pair of Ugg boots in my life. I live in the bloody Tropics.
Ugg boots are de rigeur in Melbourne but definitely not in Cairns. We get about in sarongs and bikinis!!
Thongs are the preferred footwear.

Yes, yes, Michael, I'm aware of the need for organisation but the fact is that I am by nature a disorganised slob, as a quick glance around this garret in the roof where I do my blogging will tell you. I really can't get myself to concentrate on what we will have to eat tomorrow night, pathetic, I know, but there it is.

Able, thanks for the advice but the Quacks were quite specific, foot up for 50 mins out of every 60 mins! She has one of these huge 'boot/sandle thingies' intended, I believe to ensure that she walks on her heel - although as of yesterday they said she could take it off whilst in bed - but she must keep the foot high.

Andra, I think I speak for all the gentlemen on this blog in saying that we would pay good money to see you in a thong and Ugg boots!


Sarongs and bikinis? I'm booking a flight right now, look out for the pale (as in 'oh my god it's a vampire') Brit leeringx I mean admiring the 'native dress'

Oh, and since when has 'fashion' had anything whatsoever to do with common sense things like the weather?

Able - "Valgus deformation" - I'll have you know, Sir, there is nothing wrong with my wife's valgus, it's very pretty, actually, er, in a dim light, you understand!

"If I ever have a daughter, I'd encourage her into being a tomboy or a grunge type": there speaks a man who has no idea how hard it is to persuade a daughter into anything that runs against her natural inclination.

Ah DM - I'd encourage it by banning it altogether, thus making it a certainty.

Censure will not be by any form of traditional punishment, but by the threat of my singing and dancing in front of her friends - no daughter would be able to live it down. She'd be marked/scarred for life. I don't foresee any disciplinary problems as a consequence.

"my singing and dancing in front of her friends"

"The horror . . . oh, the horror!"

"but by the threat of my singing and dancing in front of her friends"

Novel idea on how to get fledglings to leave the nest.

Up2L8 -but by the threat of my singing and dancing in front of her friends" Novel idea on how to get fledglings to leave the nest.
Doesn't work, I tried this. She just stopped inviting friends over!

Dear Duffers, such trials you endure. My heart bleeds.

And gentlemen, there are such things as stylish comfortable shoes. Ugliness need not apply in this household. Of course hunting for them becomes a full time endeavour.

My son left for University the summer after he turned eighteen, and came home a few months later with his future wife. I felt like an empty husk. The microwave oven hummed the first two notes of "Lord's My Shepherd",* and I sang along and dropped tears in the oatmeal, for months. Getting him to leave home was never a goal. Our daughter? I have sung in front of her friends. Didn't work. However, now she's learning to cook, taking some weight off me, so, OK, she stays.

I must admit to a bit of perplexity about the spousal foot. The internal bleeding/swelling should surely stop in forty eight hours, probably less. Why the week of elevation? Yes, yes, I sound like I am prying, but I do have a scientific curiosity. My own BSU took a fall in a Walmart, in 2011, breaking her fibula. If you ever wondered why we even still have those, I can assure you, they are very necessary for something, even though I am not sure what. She was in a boot that sounds like Memsahib's for twelve weeks, and could not drive. Never the most useful person in the best of times, I had to drive her everywhere she needed to go, and Julia and I did all the grocery shopping, and any other errands that could not be postponed. She was in pain. Doing another ten percent of chores was also a pain. So, bless your heart!

As for work: I realize that I am signing away all my whining rights, but, what the Hell! I take care of a chronically disabled boy in his home. Part of his genetic disorder causes central hypoventilation, not breathing deeply enough, so he has a Tracheostomy and a ventilator, an LTV 950. On Wednesdays, I shampoo his hair, change his trach cannula and tubing circuit, adding in the bits and bobs which, in this household we call "tiliches". Yes, his family is from Mexico, and I have the case in part because I speak Spanish. Since his care is paid for by Medicaid, there is a huge amount of charting, five pages every day, and the usual turn, wipe, meds per stomach tube, nebs into the vent. I actually work about three hours a day, but they pay me for eight or twelve, depending on the day. Today, Thursday, I 'work' twelve hours, but no harder than I would at home.

Slobs? Bubba, you do not know sloberry! My Beloved Spousal Unit would be delighted to give you chapter and verse on that. However, I bring a bit of art to it. I make the tea and coffee in the morning
and boil water to put in m'lady's Thermos, to keep her coffee hot longer, and boil more water so that, as it cools, some of the calcium and magnesium precipitate, filtered out with a paper coffee filter, and then, when it is boiled again for tea, it won't have those odd looking little crescent-shaped crystals in the tea, which bother the Queen and the Princess. However, this morning I also wrote a comment about weed eaters, and flossed, while I did it. Sure, the garage looks like a bomb went off in it, and some damned government agency was in charge of the clean up, but, I cover the essentials, and loafing, it would soon become apparent, is essential.

OK, there's that four-letter word again, 'work'. time to give some meds.We'll see what the day brings.

*I think the tune is the one in the Scottish Psalter. It is definitely NOT the one in the opening credits of The Vicar of Dibley.

Michael, the damage to her big toe was deliberately inflicted by the surgeon. She had been experiencing increasing pain from this toe for some considerable time and it *may* have been a contributory factor in her hip wearing out and being replaced. Anyway, the 'sawbones' said the bones in that toe were mis-aligned and that
it was necessary to open up that end of her foot, twist the bones into the proper direction, fuse them and hold them together with screws and wires. Anyway, she's had the stitches out but she was warned to keep her leg up and when walking to put all her weight on the heel. So I suppose it will be another six weeks or so before we know if it has all been a success.

As for your 'work' - quite incredible! I know you medics quickly acquire thick skins but sometimes the mental stress must reach you. Good luck and send my 'mejores deseos' to the lad - I hope Google Translate got that right!

Dear Miss Red, that's what I'm after, simply oodles and oodles of sympathy!

OK, mark this on your calendars, sound the trumpets. Today, I am going to say something nice about the NHS, and other, similar abominations. Medicine is not good for you. Government medicine has the effect of rationing its availability. People can argue all day about whether this is the original intent, but it is, beyond doubt, the result. Less medicine is good, better than more. e.g.My mother's appendix was removed in 1948ish, by a young surgeon recently returned from WWII. His wounded-soldier patients were patched up and directed to the buses to be transferred to wherever they would convalesce. They got better much faster, fewer adhesions and other complications. The British Army learned similar hard but useful lessons, in WWI and WWII. So, Mama was required to stand up from the operating table and take a couple of steps to the wheel chair, and from the chair to her bed. Sure, she was assisted, not allowed to fall, but, she moved. She was in a semi-private room, and her poor room mate, about the same age, was just getting up, in agony, the day Mama was discharged from the hospital, one week post-op.

So, limits to procedures being what they are, I am venturing a guess that Mrs Duff was treated with what we call 'conservative measures,' cortisone shots in the toe, that sort of thing, for months before the guy charged in to break her bones and make them right. Yep, a lot of pain while s/he piddled around, but, if it had worked, and it often does, Memsahib would have been spared all the crap she has endured since then. Those of us who still sort of remember, um, back when, know that toes are very sensitive. Yes, she hurts, and thus has my sincere sympathy.

If I may offer a couple of nursely hints, with apologies if you already are doing all these and more, give the pain pills exactly on schedule. Do not wait, or try to expand the time between them. She is very unlikely to develop tolerance, (AKA addiction) in a couple of weeks, and can be gently weaned at the right time. It's complicated, and the hypotheses may not prove out, anyway, but we use a concept known as 'cycle of pain' to explain how pain brings pain. Never leave the pills in reach of the bed, lest she take one in the night that turns out to be one too many. That would not be fatal, except to you, when you can't wake her up and think she has O.D'd. Still, not good technique. If you want her to self medicate during the night and let you sleep, leave a pill and a glass of water in reach.

Get to the store and buy a nice stack of something like Tupperware, which is not sold in the store, but the substitutes are. When a friend brings something to eat, divide whatever it into serving sizes in those tuppies. We can hope the friends get the message, and start bringing their love offerings in appropriate containers. They really do want to help, and yet we often can't bring ourselves to direct them in utilitarian ways. Clearly, the tuppies division gambit also applies to whatever you might cook ahead, and refrigerate or freeze, so y'all aren't eating the same damned thing for three consecutive days. Pot roast, shepherds' pie, chicken pie, all come to mind as good make-ahead dishes. Oh, and cassoulet, e-mail me for the recipe, people have wept tears of joy over mine. The fish in fish and chips freeze well. The potatoes, not so much.

Investigate a bedside commode, if you don't already have one. This will allow her to go, while maintaining a modicum of dignity.

Both of you are in my prayers.


"but sometimes the mental stress must reach you"

I can't speak for Michael but for myself stress was always caused by colleagues, management and environment (think supplies, equipment, etc. or lack of due to money being spent on pet projects or junkets). Patients, not so much (well except for the whingeing/demanding ninnies in A&E with cut fingers whilst old ladies with 16 cm prolapses lie quietly and uncomplainingly or you're busy mopping blood off the walls from some major trauma).

Patients tend to put minor irrelevant stresses in perspective. Michael mentioned Tracheostomy care, I remember an individual who despite major illness, pain, immobility and imminent death (aged 24) would joke with us, his favourite 'trick' was to remove his silver (long term) tube and 'huff' a sputum ball sufficient to bounce off the bed curtains and onto a target he'd stuck on his window - regular bullseyes (gross but funny, you'd have to be there - nurese humour tends towards the gross, dark or malicious).

I worked at Lane Fox unit at St. Thomas' - the last of the old Polio units, doing negative pressure ventilation on patients who had been there since the last big outbreak (and Salks legacy) in 1965. You would never here a word of complaint. How can you complain about stress in such situations?

I don't know about you, but my impression is that those who complain the most about stress are usually those with the least reason to do so. Just my opinion.

Interesting stuff, Gentlemen, it's always good to hear what the view is like from the business end of the ward. Nursing is very much what the 'cousins' call 'a people business' and as, by and large, I find people piss me off fairly quickly I don't think I would do very well at it. But then, as you point out, amongst the moaners and groaners you find the occasional example of quiet stoicism and heroism which, in a way, must help you get through things.

I should stress that the 'Memsahib's' op was at what I call the 'oh what a bloody nuisance' end of things. I'm only making such a song and dance about it because it is forcing me to do things which hitherto I have taken for granted. Anyway, can't hang around, I've got to do the shopping for the weekend . . .

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