A day in the life of a palliative care nurse practitioner

This guy is in big trouble

I learned from one of my patients that there is an active manhunt going on in a neighboring county. The guy's name is Kirby Wallace and he's been on the lam for several days and he's guilty of rape and murder. It's a big deal. There's a whole section of Tennessee that's on some kind of lock down. Two counties of cops are there. The Tennessee Bureau of Investigation (aka the TN FBI) is involved. My patient was avidly following it on t.v. because she's stuck in her house for the rest of her life and her excitement was catching.  There's a 7,500  20,000 reward and he's wanted dead or alive!  So after the visit I called my best friend who lives in the county where this guy is on the run. She didn't answer so I left a message. "Hey, there's this rapist murderer on the run in your county. There's a 7,500 reward. If you want to go after him on Sunday I'll borrow some shotguns. Let me know. Bye."

The guy is pretty puny looking. And I could use the extra money. Then tonight as I checked the internet to see if he got caught yet I found an article entitled :

Wallace offered Ferry worker a sausage biscuit while on the run

This biscuit offering was after he paid for the ferry ride and tipped the worker. And even though the ferry worker alerted the authorities, for some reason they let him off the ferry. Now you know the power of sausage biscuits in Tennessee. 

After setting up a manhunt for the weekend I moved on to my next patient, a farmer with dementia who I've never seen in anything but overalls. His son tends the farm now but when my patient feels well enough he hops on his golf cart with his wife and tour around their farm visiting their horses and donkeys. This patient doesn't really like to talk about himself but I quickly learned that talking about donkeys and cows was a way to establish rapport. I told him on the first day I met him that I might like a donkey someday and now ever visit he tries to set me up with a donkey. Today we talked about his donkeys a bit, sat in silence for a moment and then he said "everybody needs a donkey". 

"That's true" I responded. 

And then I was on to visit my patient who is fascinated with food and diets. He finds me pretty interesting because I told him I'm a vegetarian. I'm pretty sure I'm the only herbivore he's ever met. Today we got on the subject of marriage and when I asked him how long he's been married he told me "42 years, been with her longer than I been with my momma". That statement made me think. If the average person lives with their momma for 18 years, then a 19th wedding anniversary is the anniversary where time spent with your partner is greater than time spent with your momma. That seems like a pretty big milestone in a marriage. You could sum up any marriage as pre-momma or post-momma. For example, say you were chatting with a friend and you were talking about a couple and you get to asking the friend "how long have they been married". Your friend responds "I'm not sure". Then you might say, "well are they pre-momma or post-momma?" And then your friend could respond, "oh, they are definitely post-momma" and now you've got a better idea of how long that couple has been together. 

Another patient I visited today is a woman in her 90's who lives alone in a small farm house with her dog. She's got some dementia as well. Going to visit her is like visiting Socrates. I think the nurse practitioner who saw her regularly before I took over thought she was more demented than she is but I think she's always been a little weird and her eccentricity throws people off. She's also smart and has some pretty slick work arounds to direct questions meant to assess her mental status. For example when I asked her the name of her neighbor she told me "I'm not handy with names". When I asked her for more information about the nurse who visits her she tells me "I don't know, she comes in a car and leaves in a car". Who can argue with that? And then she'll launch into a philosophical exploration of age. "What's age? I've never felt old. I have days I don't do as well but don't we all so I just chock it up to normal." I usually leave her house feeling like I've just done acid with Buddha. 

My next patient has severe lung disease and can always be found outside on her deck smoking and painting little figurines. She's a straight shooter and I like her a lot. Being able to do our visit outside is a bonus. Today she laughed as she pointed out a blemish on a female figurine she was painting which she described as "an affliction on her titty". She declined to be weighed today while lamenting her skinnier days as she told me that while she used to be more petite she was never my size stating "you ain't as big as a Friday fart". I'm going to need to research that pearl with Mike. What on earth is a Friday fart? And this patient has no dementia what so ever so I'm inclined to believe that is a real saying. What confuses me is that I would think a Friday fart is big because it's the end of the week. Or did I misunderstand her? Did she say a "fly fart"? That would make more sense but I swear I heard three syllables. Or maybe "Friday fart" is a line from an old song.

My last patient decided to go missing which satiated some of my need for a manhunt. But since I was in a manhunt state of mind I'm happy to report that due to my sleuthing skills I located her. It wasn't as dramatic as hunting a murderer with a shotgun but I did have to call the police to track her down. At one point due to some miscommunication with a hospital I thought she was dead but I found her alive and tucked neatly into her hospital bed where I facilitated a successful transition to hospice which in my field is what we call #success.