shellyscorner

Yup ... Don't I feel silly! I actually saw that .. but NOT until AFTER I'd already posted my question! It's a shame too. I sounded like it had some really good information!

Hey nurseprnRN! The link you provided didn't work: "this is a really nice little site with pdf worksheets for different diagnoses..." 404 Error - Page Not Found I'm wondering if there was an error in the link or if the link is just no longer functional... I did a Google search for the link and everything came back to allnurses.com ... so I'm not sure any help? Thanks EDIT: See ... it won't even let me leave the link you gave ... I'm wondering if the site has been removed?

I don't understand HOW you can rate something that you can't OBJECTIVELY measure ... (I've never heard of rating NONpitting edema... which of course does NOT mean that it can't be or isn't done... It just means that I've never heard of it. ) Now, theoretically, if you knew the circumference of the edematous area PRIOR TO becoming edematous, then, yes... I could see how you could rate it. But otherwise? It seems to me that it would be pretty much a useless value. Am I wrong?

Yeah, my observations have been that a male nurse might be able to get away with that, but a female nurse, . . . not as likely. . .

Actually, I think it may have more to do with the "God Complex" that so many of them seem to develop!

I guess a poor excuse is better than none?

HA-HA!!! That's awesome!

Oh MAN! A pop quiz!?! Holy Cow! And not just a pop quiz, but a PUBLIC pop quiz! Okay . . . I'll try to represent . . . (What'cha bet I NEVER forget the answers!?!) I assume (bad thing to be doing!) that you'll send me corrections to my answers . . .!?! 1). What are TWO questions you MUST know answers before giving the patient 4 mg of Ativan IV? (there are more than two of them, actually, but you're just a student :) The first two that come to mind are 1)Current meds, 2)Med allergies, & then 3)Meds taken that day/last time taken, 4)Since patient's in ICU and is having difficulty breathing I'd also like to know when was the last time the patient ate (esp if I'm concerned about a potential intubation) . . . and still, I wonder what I'm missing . . . 2) Which one specific med MUST be immediately available in the unit for a nurse safely administer Ativan? Flumazenil? I admit, that one I didn't/don't know, but I looked it up, and this is what I found for treatment of adverse effects/events in the use of benzodiazepines. And I'm still not positive that that's the one you're looking for. 3). Same as 2) if order says "6 mg of morphine IVP" naloxone 4). What monitors the patient must be on for safely administering this order? telemetry, SaO2, respiratory, & blood pressure monitoring 5). You wrote that the patient had hypoxia. What test you'd like to see to determine if it is "hypoxia" or "hypoxemia"? You know you're correct. I did use the term(s) as though they were interchangeable. I stand corrected . . . She was certainly hypoxemic, as her PAO2 was below normal. She did have some altered mental status as well, as twice when asked what year it was she answered 1932, both times. When asked the second time, she didn't seem to even remember being asked and having answered wrong the first time. So would that not also suggest at least some hypoxia as well? Unfortunately, I don't remember well enough what her labs were to say for sure, so I guess I really can't be sure one way or the other. I know I want ABG's. I'd also like a lactic acid too. But, seems a metabolic panel also be useful as well? Well. Okay then. I guess I'm done. That makes it time to turn in my quiz. But before I do, I'd like to apologize for taking SO long in getting back to you with this! I wasn't ignoring you, or the questions. I knew it was going to take me a bit to to get through with it, so it did take me a few days to actually have the time available to give it it's proper due. Then, I had filled it out, and my computer crashed on me! Fortunately, I realized that the forum has an auto-save feature, and I was able to restore everything I had done . . . WHEW! Looking forward to hearing from you regarding how I did!

Oh! Ouch! That doesn't seem fair. There is a difference between specialty and super-sonic subspecialty. But hey, I'm just a student. What do I know!?!

As to the boundaries, I can't say that you might not have a point. I certainly need to give that some thought. I know I certainly FELT for her. But beyond that, I really hadn't thought through it, except my surprise with the dosage and the doctor's manner with the patient. As I mentioned to someone else, it wasn't the use of the drug in and of itself, I just wasn't familiar with the dosage in a setting like this, or truthfully, I think, just the seriousness of the situation. My other concern was my perception of the doctors response/manner, which was admittedly all my own, but again, admittedly was effected by the patients response to him. I had just never experienced a doctor respond to a patient the way he seemed to, nor a patient respond to a doctor that way. Again, I say seemed, as I don't know the doctor. I'd never met him before. Honestly, yes. It was quite a drama, at least for me. And frankly, I wasn't about to ask the patient's nurse about it AT ALL! That seemed out of line to me. And even if it didn't seem out of line, I'll admit openly, I would have been to big a chicken to ask! While I was surprised at several things, I didn't want to openly appear to be question a physician in a hospital where I don't work. Just seemed like the best plan was to keep my mouth shut. But, when I got home and started thinking about it more, it just ate at me, so I tried to research it out. I couldn't find the sufficient answers, in that I knew they wouldn't be cut and dried, or simple. Then I found this forum/site and thought perhaps I could find some food for thought from people who had already been in the field and might have some helpful thoughts for me. And, I was right. You guys have given me some really good things to think about. Not just in this situation, but in general. I'm really very grateful for everyone's sharing their thoughts. It's been a helpful and a good experience.

"THANKS!!!! I'll check it out for sure! But your right . . . I SHOULD have thought of that . . . after I hit "Post Comment" I promise I WILL check it out! Thanks much for the tip~ I REALLY do appreciate it . . . a LOT!" Weeell, I did do as I promised . . . I guess at some point, I need to get a new phone! It wouldn't let me download it! :banghead: There were several others to choose from. I'm certainly open to other suggestions. I did download a Medscape app but it's a LOT more involved than I probably need or want. I think it's really geared more to doctors. I would truly be interested in an alternative selection from you. ~ Again, thank you for the suggestion! It should have been obvious to me, but yeah, it wasn't.

Wow! Ok, good to know . . . I've just not had much experience with patients on Ativan, at all. In a previous post I commented back to someone and said: ". . . it was the amount that concerned me. It just seemed like so much. Although, when I looked it up, the max suggested dose was 8mg., but I'm not familiar with the circumstances with when that dose would be appropriate. I never dreamed you could give someone 8mg of Ativan! Four surprised me, can't imagine using 8mg, unless the patient used it on a regular basis and at higher does than what I'm familiar with (like .5 to 2mg doses)." I just wanted to clarify that I'm only familiar with patients, using .5mg-2mg. And I'd only seen one patient that occasionally used 2mg. All the other few pts that I'd been involved with used .5mg-1mg. So I guess that's why 4mg seemed to be so much. Again, thanks for sharing with me.

THANKS!!!! I'll check it out for sure! But your right . . . I SHOULD have thought of that . . . after I hit "Post Comment" I promise I WILL check it out! Thanks much for the tip~ I REALLY do appreciate it . . . a LOT!

That's a little scary. Doesn't that put the patient on a pretty slippery slope? It seems to me that in a patient that was having trouble getting diagnosed to begin with, that that could really be damaging to the patient's well being? Not to sound overly judgmental, but just as a human being that seems like an integrity/pride issues that could be really dangerous to a patient. I mean, I'm quite sure that they don't INTEND any harm, and again, I don't mean to overstep my bounds, but that really bothers me. I haven't been around enough yet to have experienced that. As a nurse, HOW DO you handle that? I mean, legally/morally do you have any responsibilities there as a nurse? I don't think I ever thought about being in that position. Again, I say that keeping in mind that nurses don't get to diagnose, so what do you or can you do in situations like that? Where does our patient advocacy go from being appropriate and then crossing the line in situations like that? Or do we even have room to advocate in such a situation, considering again, that we don't diagnose? And how do you handle that when you come across it? That would really bother me if I realized that was what was happening. So I guess what I'm really asking is, even if I wanted to do something, I'm guessing it wouldn't be appropriate, so how do you handle that? Both professionally and personally? I'm sorry if I'm crossing a boundary here, but I rather do it here in a learning environment than to try to address it in a work place environment and end up getting fired over it, thinking I was trying to do the right thing. That's a little confusing for me. Thank you for sharing that with me!

I'm sorry you feel that way. But no,that's not correct. And yes, your right! That would violate the TOS! Frankly, I didn't have a PDR at home.

Not that I'm the one to make the judgement here, I REALLY recognize that, but it wasn't that the drug in and of it's self worried me, it was the amount that concerned me. It just seemed like so much. Although, when I looked it up, the max suggested dose was 8mg., but I'm not familiar with the circumstances with when that dose would be appropriate. I never dreamed you could give someone 8mg of Ativan! Four surprised me, can't imagine using 8mg, unless the patient used it on a regular basis and at higher does that what I'm familiar with (like .5 to 2mg doses). But again, I recognize I DON'T have the experience to make that call, which is why I ask about it. And again, it's not my place to DO anything about it, I was just curious. And if I understand your comment properly, no, she did/does not, to my knowledge take Ativan at all as an outpatient. As to the BiPAP mask, yeah, I don't know how well I'd handle that either! Thanks for your thoughts!

Sorry! Wasn't sure what you guys did and didn't need to know to help me understand what I was seeing!

Okay, so first of all, I'd like to suggest to you that you reconsider this particular part of your thought process. I'd like to see you re-name your feeling labeled "guilty" with "empathize" or "sympathize", as either of those would be appropriate. It's natural to feel bad for someone that you care about when they don't do well. The truth is, she's probably a very smart and capable girl who, regardless of whether or not she's ADHD/ADD, has developed some really bad practices/habits when it comes to school. If she is ADHD/ADD, some might even call them survival skills. I'm ADHD/ADD, ALL THREE of my kids are ADHD/ADD. My son in particular had a REAL problem with it because not only was he incredibly intelligent, but he was LAZY! ALL THE WAY through elementary school and middle school the boy simply made NO effort to do homework. Not sure he ever really turned in a single page of homework after about the third grade. Just wouldn't do it. He LITERALLY FAILED ALL THE WAY THROUGH UP TO HIGH SCHOOL!!! But because at the end of the year he'd make 3's & 4's on the end of grade testing, he was promoted on to the next grade! It INFURIATED me! It also didn't help matters that because he was so smart, he was also SO bored. But things being what they were, there was NOTHING that I could do about it (LONG story!) But when he hit high school, he found out the joy ride was OVER! He ended up graduating a year late, with his younger sister. OUCH! It was a HARD lesson for him. But the point is, sometimes the kindest thing you can do for someone is to LET them fall on their face. The SOONER it happens, the sooner they can begin to work on their issues, begin to learn responsibility. Were I to be frank, and honest with you, you have unintentionally been an enabler to her behavior. THAT DOES NOT MAKE IT YOUR FAULT! But it's still an important thing to recognize! We LEARN from lessons like these! You clearly ALSO got something out of this relationship being this way, or you WOULDN'T have done the things for her that you did for her over the years. Were I to guess, if probably fed your confidence and self esteem a bit. (Which isn't an all bad thing) But you might want to think about what YOU got out of the relationship that made it worth YOU doing HER work. (It's just a thought . . .you might find it helpful going into other relationships) Because you cared about her and were so young when you met, you didn't understand what was happening between you, in terms of the dynamics of the relationship. For what ever reason, it clearly worked for you throughout the years. But NOW you do understand it, at least to some extent. It sounds like you are seeing things VERY clearly for the first time. So this is truly about both of you reaching a critical juncture in life and relationship management, and maturity. Bottom line, you're growing up. What's worked for you in the past, isn't work anymore. She maybe growing, but it's clearly not in the same direction, or in an UPWARD direction. Stunted or lateral growth is not a good growth. I would personally try to sit down with her and in a lovingly, kind way, talk with her. (It truly is possible to have hard conversations in compassionate ways!) Explain to her that you care very much for her, your not wanting be rid of her as a friend, but that you've identified some relational patterns that the two of you have developed over the years that are clearly not healthy for either one of you. And that you care ENOUGH about her that you'd like to try to work through them with her, if she'll allow it to happen. But that there MUST be some "new relationship rules and boundaries" put into place or you are afraid that the relationship won't survive. I would in fact, look VERY HARD at some/all of the comments made here, as there have been some extremely insightful things said to you about this relationship. She doesn't need to know that you posted anything here, in fact, she might be really upset about that. I'm not suggesting you lie to her in any way, but just be careful with what you share with her about it, as she might actually see it as a betrayal. Maybe suggest to her that she seek out the appt with the psychologist/psychiatrist to be evaluated for the ADHD/ADD and offer to go with her the first time to take some of the "scary" out of it for her. Make positive suggestions, and show her that you're in fact willing to be a TRUE friend and be supportive of her, but the days of DOING IT FOR HER, are just flat over! That it MUST be that way, for BOTH of you to grow and be healthy. You OBVIOUSLY care very much for her or you wouldn't be so bothered by the whole thing. But, I will tell you to be prepared. She's probably NOT going to like what you have to say. And, she may completely reject the whole thing. But you are at a crossroads in this friendship. Make NO mistake about that. The ball will be in her court. SHE will decide what is and isn't important to her. But that said, don't forget that she's human and on the best of days, we all do deal with a certain bit of pride. So, if she gets upset or rejects the idea from the onset, she'll either stomp off in a tantrum after giving you a piece of her mind, or she may just get up and leave telling you that she doesn't have to put up with this crap and its all your fault because YOU let her down. Change is HARD. And it's harder for some than for others. If she does throw a tantrum, fine. let her do it. Allow her to get up and leave. Then give her a few days to calm down and either come back to you and say, okay, maybe you have a point, lets try it. OR if that doesn't happen, send her a text msg or email telling her you just wanted to check on her and make sure she was doing okay and that you care about her and if she changes her mind, to just let you know. Like the old saying says, 'You can lead a horse to water, but you can't make them drink!" However, sometimes, I'm not so sure you can even lead them to the water hole! All that said, if you do decide to sit down and talk to her about a new way of approaching your friendship and life in general, make sure to meet her in a neutral place so that you can both have the breathing room to get up and leave without it being a problem if you need to. You are ALSO ALLOWED to get up and leave if she begins to become verbally abusive. Don't allow her to "bully" you or walk over you like a door mat. That wouldn't be good or helpful for either of you. But in closing, I just want to remind you that sometimes the best thing you can do for someone is to just be honest. Again, in a kind and compassionate way. How she handles it will be the deciding factor. It's ENTIRELY up to her. If she gets angry and blows you off, curses at you, blames you for all the trouble, you may have to except that this is just not going to be a healthy relationship for you and it will be time to sadly move on. You ABSOLUTELY CAN NOT help someone that DOES NOT WANT to be helped! I do so hope it works out for you! The way you want it too! Best of luck!

Jul 20 by traumaRUs, MSN, APRN, CNS Admin Hi - I'm concerned that you have a lot of pt identifiers in your recent post about the female with resp distress..would you be okay if I edited it? Thanks. Tried to answer you. . . but system will not allow a response via private response, as I don't have 15 posts (I believe that's what it said). This was the ONLY way that I thought I could get back with you. Hope this works!!! But to answer your question, in short . . . PLEASE DO! I would be VERY grateful!!! Thanks much! - shellyscorner

So, as a new member to this forum, please forgive me if as a student nurse, I have posted in an inappropriate place. Okay, I saw something done the other day that made me really uncomfortable. And I'd just like to have some folks with some real experience give me their opinion! I'm going to apologize in advance guys, because I KNOW this is going to be a LONG ONE! But it seems like to me that you need to know as much of the story as I do in order to fully appreciate "my concern" and give me the most accurate answer as possible, AND so you can tell me to go stick my head back in the sand and mind my business, that I don't know enough yet to be calling a doctor an "ass" or to be questioning his treatment modalities! But, if I'm wrong, I'm wrong. AND I WANT TO KNOW IF I'M WRONG! I LOVE MY PATIENTS! And frankly, even though this woman was NOT MY patient, and I was ONLY an OBSERVER this night, IT BROKE MY HEART TO WATCH THIS WOMAN SUFFER NOT ONLY PHYSICALLY BUT EMOTIONALLY AND SPIRITUALLY AS WELL! As this doctor seemed to literally RELISH and TAKE DELIGHT in LITERALLY CRUSHING HER SPIRITS! There was NO RESPECT, NO DIGNITY, NO NOTHING EXCEPT WALKING ON HER, OVER HER, AND THROUGH HER! So, I was in the ICU observing. There was a adult female pt with chronic lung disorder. She is on multiple inhalers at home and is dependent on supplemental O2 (6L @ rest and 8-10L on exertion) who was in admitted into hospital away from her home town after having a "breathing flair up" 5 min out from her doctors office. On presentation she appears to be having an asthma attack but her diagnosis has proven to be elusive at best over the years. She was rushed to the ED and was treated with IV solumedrol and repeated breathing treatments and within 2 hours was then admitted to the hospitals MICU in critical condition in respiratory failure of unknown etiology. According to her records, she was intubated inside 30 min. of her admission for the next 36 hours before being extubated. On Sun she was transferred to the regular floor where she had two more "flair-ups" before being discharged to home on Wed. After discharge, she had a return trip to the local ED on Sat. where she was treated with breathing treatments and sent home. The following weekend she again presented to the local ED on Fri evening where she was again treated with IV Solumedrol and breathing treatments and discharged home. Both of these ED visits occurred after having driving an hour one way to see her PCP for a post hospital check up. On July 2 after having again been to her primary doc office the previous day and having had to go run an errand the increased activity once again caused her to present to the local ED where she was immediately treated with IV solumedrol, multiple breathing treatments, IV mag sulfate, more breathing treatments. and upon rechecking her ABG's it was recognized that she was again going into respiratory failure and was admitted into the hospital ICU. While according to her history, she responds to an asthma protocol, her condition usually gets MUCH worse before it gets better, and unfortunately as a result, it's not uncommon for her to have to be intubated until she gets better. Her records indicate that she not only doesn't fit the "bell curve" in terms of how "timely" she responds to treatment in the "expected/normal time frame", but she apparently falls off the edge of the paper, in terms of how long it takes to get an obvious improvement. IF she has asthma, it appears to be VERY refractive to treatment. She had been responding to treatment, but because she "failed" the d-dimer, they took her for a CT scan to ensure that there was no PE. She did NOT handle the CT scan (laying flat) well at all!!! So they rushed her back to ICU anticipating having to intubate her as she was moving almost no air at all. I'd like to make note here that I was really quite impressed (yeah, I know, with ALL my experience, right?) with how well this woman dealt with her situation! She was CLEARLY EXTREMELY PHYSICALLY uncomfortable! She was in TREMENDOUS pain, both in her back, due to the muscles tightening up but also in her chest from what seemed to be both restriction AND obstruction. But what was so impressive, was that she has seemingly developed distraction techniques over the years to recognize and deal with the expected and/or anticipated anxieties that would rather go "with the territory" exceptionally well! She really did not seem to be anxious, at least only in the most minor degree, as she recognized the vicious cycle that she could/would get into if she allowed the anxiety to get out of control. So, after getting her back into the ICU, it was decided that even though the pt stated that BiPAP USED to work in these situations, it NO LONGER does, they opted to try more breathing treatment and BiPAP. as the doctors felt that the asthma protocol wasn't working. Even though it had been prior to her laying flat for the CT. They put the BiPAP on her and left her in the room alone for quite awhile. While everyone else attended to "other things' and other patients, I stood outside her room watching her struggle to breath. I noticed that it didn't seem as if her chest was rising/falling, but her belly SURE was! You could tell that she was becoming more confused and disoriented as she seemed to lose the coordination and continued to fight, in an attempt to get the mask off. When I was sure that was what she was in fact doing, I alerted her nurse who went in and tried to get her to stop, but instead she began to fight it even harder. They had to take the mask off to try to reseat it properly, She was FINALLY able to make them understand that while she WAS getting SOME air into her lungs, MOST of it was just going into her belly and she was getting very uncomfortable due to the distension! So they removed the BiPAP and resumed the breathing treatments and she was appearing to begin to VERY SLOWLY and VERY SLIGHTLY beginning to respond to the treatments. This is about when the PCCM came in. I'm sorry, but this guy was a COMPLETE ASS!!! He and this patient CLEARLY had some sort of history together and it WAS NOT a good one! Initially, she didn't realize he was there, as he stayed out of her room and was just reading her chart and talking to the nurses. Later, it seemed that the more he saw that he upset her, the more, for lack of better word, "enjoyment" he seemed to take in it. He made it VERY CLEAR that it is HIS opinion that this woman's problem is ALMOST ENTIRELY of psychiatric in origin. And what little of it that MIGHT NOT be psych in nature, was TOTALLY due to Vocal Cord Dysfunction. She had had MULTIPLE PFT'S and has been r/o for almost EVERYTHING you can imagine! No COPD, SOME possible asthma, NO VCD after being scoped by multiple ENT's on multiple different occasions, r/o myasthenias gravis, no fungus', no allergies, AN AWFUL LOT of NO's BUT NO "YESES"!!! And apparently, according to her records, she has been extremely careful to keep her healthcare WELL centered to just two, occasionally 3 doctors (A PCP-Family Medicine, a psychiatrist, and an occasional Pulmonologist), to avoid even the appearance of doctor hoping and attention seeking behavior, AND on top of that, having seen the SAME PCP for 16 1/2 yrs., after a yr of treating her and realizing that he had to consider the possibility of a psychosomatic/psychogenic component to her disease. She began seeing a specific psychiatrist at her PCP's request and has seen the same psychiatrist for yrs, who has been practicing psychiatry for years. The goal was to r/o a psych component, monitor her for onset of new depression due to her chronic illness and lack of dx, and finally if all that was r/o, the goal was to establish a VERY LONG record of psychiatric stabiltiy. Which she states her psychiatrist has assured her is the case. Her records reflect this as well. This psychiatrist has ASSURED her that IN NO WAY does he see her disease process as ANYTHING BUT TOTALLY biologically based. Now, this pulmonologist that was treating her on the night of July 2/morning of July 3rd decided he was going "prove" that this was anything "BUT lung" And this is where my concerns come from. Knowing that this patient was in respiratory failure, and knowing that the ICU nurse was concerned that her airway was compromised sufficiently that she felt she should have been intubated at this time. Instead, the PCCM gave the ICU nurse the order to give her a bolus IV push dose of 4mg Ativan. Now, I'm going to preface this next part with I don't feel competent to decide HOW SEVERE her respiratory failure was, when I looked up the contraindications of using Ativan/lorazepam this is what I found: "Contraindications Severe respiratory Failure - Benzodiazepines, including lorazepam, may depress central nervous system respiratory drive and are contraindicated in severe respiratory failure. An example would be the inappropriate use to relieve anxiety associated with acute severe asthma. The anxiolytic effects associated may also be detrimental to a patients willingness and ability to fight for breath. However if mechanical ventilation becomes necessary, lorazepam may be used to facilitate deep sedation." Lorazepam - Wikipedia, the free encyclopedia. . . I know I don't get to diagnose, but it really concerned me that the patient was given so much at one time. It ABSOLUTELY KNOCKED HER OUT! When she finally woke up, the doctor shocked me when he looked at her and stated, "Well . . . It worked! So, it CAN'T BE LUNG!!!" It was at that point the patient really became aware of the doctor being in the room and WHO he was. At this point she became VERY upset and demanded that he leave the room. I really thought she was going to become hysterical she was SO upset. The nurse came in and began to try and calm her down, as she was concerned that her breathing difficulties would again flair. She just cried out that, "NO! She didn't understand! That this doctor had almost allowed her to die several years back and she was terrified of him! She said she didn't think it was done intentionally, but she DIDN'T know if it was because he had made an error or if it would have happened anyway. But that she didn't want him anywhere near her! Were I in her shoes, I can't say that I would feel differently. So, guys, am I making a mountain out of a mole hill here? I mean, I'm not looking to go and report anything or anything. It just really bothered me and I feel the need to TRULY understand what I observed that night. And I really look forward to hearing from you guys that have not only real nursing time under your belt, but also from ICU nurses that might have seen Ativan used in such a way before. Again, had she already been intubated/ventilated it wouldn't have bothered me so much, as I could have rationalized that she had the ventilator to breath for her. I just kept standing there holding my breath, afraid that she might actually STOP breathing! However, if I'm am WRONG, be gentle . . . I am still learning! I just want to make sure that I'm asking the RIGHT questions! Looking forward to hearing back! ~ Thanks for staying with me! I KNOW

I've re-read this MULTIPLE ways, MULTIPLE times. Each time, I have the SAME takeaway! The takeaway is that NO ONE above Ms. Hiatt from the ICU Director right on up to the upper echelon of the hospital up to and including the hospital itself is REFUSING to take ANY responsibility for what has transpired! WE ALL KNOW, POOP runs DOWN HILL!!!! AND GETS STIRRED WITH A BIG STICK!!! And the reality of the situation will have VERY LITTLE to do with it! I in NO WAY believe for one minute that they have had this many MAJOR errors in this short period of time and there not be a problem with some of their protocols! But they will NEVER admitted it! I feel so deeply for Ms. Hiatt, because the truth be told, I find it very hard to be believe that their wasn't something else that was going on in her life that was causing her some serious depression, and that this was just the last straw for her! A VERY LARGE STRAW mind you, but . . . none the less, the last straw. I hope she has found the peace that she was so looking for! Prayers for her, her friends, her family as well as for the infant and the infants family. This is a situation where no one wins. So, my prayer is that God will take the tragedy of this situation and use it for some unexpected good that will benefit all involved in some beautiful and unexpected way! ONLY GOD can pull that one off! That said, shame on the administration if in fact they let Ms. Hiatt carry the full load of the situation if some of it should have been theirs and they failed to stand and be held accountable. ONLY THEY & GOD will know the answer to that! Just so sad. . .