A second opinion, and life goes on

It is hard to believe it has been just a month since we discovered my boy has two heart defects that will require surgery to repair. Life continues to fly by with science fair projects, end-of-year school performances and wrap-up of our spring sports schedule. Sometimes, I can even forget we have this major event staring us in the face!

Not so, last Monday. My boy and I met with a cardiologist for a second opinion and a repeat echocardiogram. Not surprisingly, the second opinion was the same as the first. Yes, there are two large defects that need to be repaired to prevent further compromise of my son’s heart function. Knowing that I’m a nurse practitioner, this cardiologist even took the time to do the echo himself, walking me through the pictures and showing me the defects and altered blood flow. He also included me in the assessment, putting my hand on my boy’s chest so I could feel the force of his heart beating against his ribs, not a typical assessment finding!

We talked about how healthy my son seems, and the doctor explained that because my boy is always working at an increased effort, he has less reserve. Light bulb moment! That explains why he struggles more than I would expect to peddle up a mountain on his mountain bike and why I’ve twice had to carry him the last 100 yards up Mt. Evans, a 14,000-foot mountain you can drive up most of the way. I would frequently get frustrated with him during these times. Often, the biking was at his request, and then he “refused” to keep up, often throwing a fit when the rest of us peddled on ahead. Pile on the “mommy guilt!”

Although I really appreciated the second physician’s time and patience with us, I will stick with the original doctor’s office. It is more convenient and is associated with one of the best children’s hospitals in the country. So, surgery is scheduled for the third week of June with the chief of the cardiothoracic department. He comes highly recommended and he has an NP as his assistant. (He can’t be all bad!)

Years ago, I worked in an adult ICU doing open-heart recovery and was the lead on the balloon-pump program. The up side is, I am prepared for the surgery, knowing what to expect. The down side is, I keep remembering all the complications, all the times people returned to the unit still “open,” the times I rushed to the OR with the balloon pump praying for a miracle, the times I sat with families after passing along the news that “things are not going well.” I keep holding to the truth that my boy is healthy and strong, and that this is corrective and planned surgery—not an emergent response to an ailing heart with blocked blood flow.

In the meantime, life goes on with Cub Scouts and camping trips that were planned prior to surgery, together with baseball practice and building of bike ramps, using construction debris scavenged from around our cul-de-sac—typical, active boy fun.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

A REAL doctor!

I had one of those experiences last week that I know is not specific to military medicine. I am sure it happens to our civilian counterparts, to other NPs and PAs. And I know it happens on a near daily basis at military treatment facilities worldwide. As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn't allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.

Some people think we are on active duty because we can’t cut it in the “real world,” that we are somehow subpar when compared to our civilian peers. And, people do sense a lack of control, since they have to enroll with a provider at a military clinic, requirements put in place by TRICARE (basically, our military HMO/PPO/insurance provider, depending on current terminology). In reality, we are all credentialed and/or certified in our specialty and really have two specialties to maintain, our civilian requirements and our military ones. I honestly believe military medicine should be it’s own specialty, since we have to know how various military-specific careers affect disease processes. And don’t even get me started on deployment medicine—who needs malaria prophylaxis, who is more resilient and able to tolerate the stress of deployment, etc. I could go on and on!

So, what did I say to that patient that day? Basically, a toned-down version of the above. That she is actually lucky, that we are a unified practice of providers all credentialed in our fields, who “get” the difficulties of being a military family. Then I asked, “What can I do for you today?” and we progressed on with the visit. I hope it was a positive experience for her and she won’t be so opposed to military providers in the future. Time will tell.

As NPs, that is all we can do; try to show the world—a patient at a time—what we bring to the table and what we have to offer. And, to hope that, over time, the response won’t be, “I wasn’t able to see a real doctor” but that patients become more accepting and some will even prefer to see us for what we have to offer!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The speed bump that became a high spot

Friday was one of those days that will linger in my mind for quite awhile.

It was the end of a long week. Sick children, life stressors, work demands—all the typical things that pile up in the face of an approaching weeklong vacation. I thought I had the week pretty well planned in advance—a few days of “sick call” and a wide-open Friday afternoon to ensure a few quiet, patient-free hours to tie up loose ends before leaving the nurse in charge. (I hate leaving too much for my covering physician to deal with. He has his own daily demands and, as we all know, covering for another provider can destroy your week.)

Then, as only the military can do, a huge speed bump was put in the middle of my well-planned road! In response to the events occurring in Japan—the earthquake, the tsunami and, now, a nuclear threat—the military was offering voluntary evacuations to family members located in that country. The evacuees—mainly women and children—were being routed through various cities, and our location was chosen to support this mission. The request was for a provider to be on site at all times to provide acute care and address any medical concerns that might arise as the families were routed to final destinations elsewhere in the United States.

I scrambled to find someone to come to the house in the early morning hours and get the kids off to school. A few good friends have made the offer to “call anytime,” so I took one up on it, and he was quick to say yes. (Proof that the week wasn’t all that bad is that it reminded me of the wonderful friends I have made here in a short six months!)

When I arrived at the site, I was pleasantly surprised to see how organized the event was. The USO and Red Cross were there with food, hygiene items and a bank of computers and phones for the evacuees to utilize. The support staff had established play areas for the various aged children (everything from playpens to a bounce house to Wii) and staff to supervise them. They even had military members in place to walk the animals that were accompanying the families.

As the evacuees arrived, it was awesome to watch young soldiers, sailors and airmen assist the travel-weary women by carrying their baggage, pushing strollers and cleaning up after pets. The women were free to complete all the necessary paperwork and arrange their follow-on travel, knowing that everything else was covered, and the kids—and pets—were able to spend all their stored-up energy in a safe environment.

Except for treating some nausea and hypertension and handing out lots of Band-Aids, I provided very little patient care. In the course of the day, eight to 10 new moms and their babies came through—one just 6 days old—and I touched base with most of them to ensure they were doing OK and didn't need additional support. In general, I just watched and was so proud to be a part of this organization that sometimes can frustrate me to no end but, at the end of the day, can put together an operation to support our own that is second to none.

Although the evacuation initially added stress to an already stressful week, I am so glad I had the opportunity to assist in this massive undertaking, talk to these people, hear their stories and provide what little relief I could. It may have started as a road bump in my busy life, but it ended up being one of those experiences that will stick with me as a highlight of my time in the military.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

All in a day's work

As you look at these photos, I’m sure you wonder what an Air Force nurse practitioner is doing flying around Afghanistan in a Blackhawk helicopter. This is one of the best, yet little known, benefits of my current position. In addition to providing medical support to our driving missions throughout the province, we occasionally put together air-assault missions. When we do, one of us medics generally goes along, “just in case.” Our soldiers are well trained in combat lifesaver skills (see prior post) but when things go wrong, the first thing they usually yell is “Medic!” and they like to know we are there to help.

Our mission last Thursday was to the western region of a province we are in the process of handing off to a new PRT (Provincial Reconstruction Team). To do the handoff appropriately, we needed to perform quality assurance checks on these projects, but driving would take several days, and there was no guarantee we could reach all the destinations. Because of safety concerns, we have started using only MRAP (Mine Resistant Ambush Protected) trucks and there is some belief that they are too large to navigate the terrain.

I have to admit flying is much better than driving. In addition to the adrenalin rush, we were able to see the three projects in just a few hours. As the mission medic, I carried enough supplies to treat the soldiers, if needed, including intubation equipment and pain medications. I also went fully armed and was responsible for additional security at each objective (not your typical day as an NP!).

Thankfully, the mission ended up being routine and, other than a couple hard landings, we had no incidents. I managed to jump in and out of the helicopter every time, without seriously hurting myself. I did wound my pride—and bruised my ribs—when I jumped out of the Helo, threw myself forward a few steps and landed in a “defensive fighting position.” Apparently, I was supposed to land on my knees, elbows and the butt stock of my rifle rather than my abdomen/chest. Oh, well, lesson learned!

I have a few days to recover while the rest of the team conducts a series of missions. Then, it will be back to work for a few days prior to the start of my leave (two weeks alone with my spouse in Germany!!!). More to come as the adventures continue.

Lori