This is the crying I wasn't able to do when I had to do this.
I had a patient, an old man with terminal lymphoma, who was being held over the weekend for placement because he was homeless. When the MD found out that he had $193 in the hospital safe, he discharged him.
After many attempts to find excuses to stay, none of which I could then justify to the MD, the patient resigned himself to go. He had multiple bags of possessions and no shopping cart waiting. I had to take that sick old man down to the street and dump him out, in the driving rain, on a Sunday.
I don't care what he did in his life to become homeless. He didn't deserve that. I was sorry to be the instrument of that cruelty.
you could have told the MD that you weren't doing that...
I mean, I don't know what the repurcussions would have been, but you could have done that.
I can't say what I would have done in your shoes, but either way you shouldn't feel responsible.
Life is hard. If anything it should give you a little more perspective on life...
I'm a people watcher, and I pay attention to people. It's saddening, but then again, you can look at it like going to the fair..."you always come home feeling better about yourself"
The social worker had searched for two days looking for a spot with no success.
The MD discharged him because he had money for a room. Formal placement would have had a better result and not parted a destitute man from his life savings. But they needed the bed.
I don't believe that I could have refused to do it given the circumstances.
I am always grateful for the opportunities I have been given and for my position in life. You are right. Many times I have said, "Wow, glad that's not me." It could easily be me. I have learned a lot from my patients, and some things that happen I now understand due to observing them and their problems.
It was just this one particular thing that struck me and never left. I'm getting it out of my system. Thank you for listening.
I think it was a good time to post it too, considering the holidays.
We took a TON of presents to this family tonight, who otherwise would not have been able to have a christmas. We left them on their screened in porch because the little boys weren't in bed yet.
I only wish I could be there to see their faces in the morning. It will surely be their best Christmas ever. Everyone in my wifes office, as well as a couple of other people, went in on it. My wife and I alone spent over 100 dollars on them.
I don't know what they look like and I probably will never see them but it sure made me feel good...thinking back to when I was a kid and how great Christmas was. We never went without and didn't know what it was like not to get lots of Christmas presents.
Tomorrow's gonna be a great day for those little guys. Their family doesn't have a car/phone/etc... so it will surely be a great surprise to them!!!
I refused once to discharge a patient that was too much for his wife to take care of on a Friday night. She needed help at home and home health could'nt visit until Monday. I told the doctor if he looked hard enough he could find a reason to admit this patient. His response was "Anne I can tell your an ER nurse" I asked him what he meant. He said that I "got too attached to my patients I saw repeatedly". I told him I fight for my patients despite what the criteria is to admit them. I don't feel you should feel guilty but it is through our experiences we learn to react to our future challenges.
Giving presents to little kids is a good way to cheer yourself up when you're down. I recommend it to everyone. Toys are not a luxury, they are a necessity. You did good.
Thank you for your comments. All I can say is I inherited the problem from another nurse. The order was already written. I wasn't the one who told the MD the guy had any money. I don't know how this MD found out. He would have had to peruse the chart and see it on the blue sheet. I don't know what his thoughts were or what was in his heart.
When the nursing supervisor of the hospital is requesting the bed space and pressuring for a discharge, and when the attending physician has written an order for discharge and departed long before you ever arrived to think about it, well, it isn't so easy. It sounds cool to fight for your patient, but it really wasn't my call. I am not qualified to manage the total flow of the hospital. From the standpoint of professional responsibility, I feel I did what I had to do. But from the humanitarian or moral aspect of it, I regretted having to do it. I resented the cirucumstances that caused me to have to discharge this guy like I did. And I do feel guilty.
We have hundreds, maybe thousands, of people who are needy like this in my area. You can see them begging at the off ramps, sleeping on the hospital lawn, hanging around the lobbies. It sucks. I have no solutions for any of this. Portable toilets, that's all I've got.
At my hospital we have an ethics committee number and a pt relations number I have been know to call when i felt the pt was not being treated right and I have provided pts with contact numbers to call themselves. Care coordinators tend to most of the details, but when it doesn't work, I believe pt advocacy is a very important part of our job. I know it is very different in different settings. However hospice or
legal aide may be other resources. Do not feel bad about your role though. You did what you had to do at that time. I often wish I was independently wealthy then could just care for the pts that tug on yout heart at all times. Bet burnout would be much worse then. Make yourself remember the good things you hsve accomplished in proportion to the areas you did not have the time etc. available to tend as you so desired.
God help our Hospitals now before we all know exactly how you felt. I know of thw insane rush to discharge for bed turn overs. I pray we find answers before we get in more frequent situations that Hospitals choose who we help and who we discharge on a money msking criterea.
Judyd,
We had an admissions staff make the comment that we couldn't block the other bed in our dying patient's room because they weren't dying fast enough. How do these people sleep?
But on the otherhand I had a pt dead over three hours before tne pronoucer resident got there to pronounce. This is the only place I ever worked that the policy was for the resident on call had to be called to pronounce. They shortened staff once and it was about 2 1/2 hours before we figured out how to get a transplant pt to a morge. Problems problems
Hallrunner I feel the sadness and pain you had to feel having to deposit that poor fellow out in the rain and leave him that way. I have no platitudes to offer that will make the heartache go away or lessen but I do send you a warm compassionate hug through the miles via cyberspace.
I can tell you're a good person with a large heart. It matters a great deal that this disturbed you! It tells you that you have the natural instincts of a great nurse. Now... only time can help you to cope with the copious mixture of good you accomplish on a daily basis- all the things you do that make someone's life better or bring comfort to others, along with the heartrending things we also have to contend with - and keep on going despite.
You learn to do what you can, and do it the best that you can, and adjust the best you can to the fact that no matter how good you are you can't change certain things;
You can't stop deaths- there will always be those patients you hate to see die but do nonetheless...
You can't stop every act of violence, drug abuse, suicidal behaviour, or other intentional foolish thing people do to themselves or each other out there... you can educate and try to make a difference, but you will never cure the world of these ills...
There will be poverty.. homelessness.. uninsured.. illegal aliens.. etc.. always.. You can do your best to try to find them food, shelter, treatment, social services and other help.. but you can only do what you can do.. there will always be poor.. you cannot fix the world's woes all by yourself..
You do what you can do-- and what you do makes a huge differences to many many lives- every day. **HUG**
The saddest thing I ever had to do was care for a preemie in NICU that had severe congenital defects (born with no kidneys) and follow doctor's orders & parents wishes and basically torture that poor neonate until she died....
The parents knew it was going to be born that way but because of religious reasons abortion was out of the question, so the mother delivered..
Then.. also because of religious reasons.. they insisted on every single measure possible to extend the newborn's life.. everything. It was hell on earth for 3 days --
That poor baby had a UAC, intubated, and got nuitrition via the UAC -- until even morphine couldn't still the baby's agony as it's abdomen swelled up nearly till bursting from the fluids it had no way to eliminate! Only after repeated pleading & begging the neonatologist did we convince him to disregard the parents wishes at long last & DC the UAC to stop putting more fluids into that baby..
3 days of watching it suffer in unbearable anguish..
and the parents would come pray over it-- while they caused it to die in agony... barf!!!
There are some things we see.. we'll never forget..
Hug more...
You've helped me a lot. I never get to hear stuff like that from anyone. No one has a clue what a nurse goes through except another nurse.
Okay, something I once saw, when I was pretty new, which is opposite to your story, but really the same:
They had a male patient who was a DNR. Someone goofed and resuscitated him (not me, someone else). The family was furious. So, to correct their mistake, the doctors ceased all nutrition and starved and dehydrated him to death.
I particularly remember this patient because, for some reason I can't remember, he was beet red. I remember him as a round, red face with expressionless eyes but alert. He took a long time to die. It was horrible.
The thing of it was, they were feeding him before, but after he unwisely made it through the code, the ethics committee chose starvation as a means to solve their unlawful life lawsuit problem.
Hallrunner... reading about your experience and how that poor fellow had to die... just makes me wonder about the real "ethics" of our society. Sometimes-- Jack Kevorkian's method seems to make a lot more sense.
At least a person would be given a choice about how they wanted to end their suffering. I don't mean like those crazies who take it on themselves to kill patients- lord no- but I do wonder if euthenasia may be more morally ethical than the laws we have that prevent people a means to end horrible suffering. Know what I mean?
cougarnurse wrote::bump: This may be an old thread, but anyone out there have something to add?
Medical ethics are going to go vitually out the window as healthcare reform is ushered in. The United Kingdom (England) system is full of stories of cardiac patients being turned out to die at home with nothing but directions to take Tylenol for pain.
I currently have a 58 year old patient hospitalized with compression fractures of her spine. She is developmentally disabled and I had her to several different doctors who refused treatment based solely on the fact of her developmental delay. The wisdom of their decision is that she is somehow less worthy of care as she may only have limited benefit from any treament (Huh - sounds a bit like health care rationing to me) . But for the fact that a prominant neurosurgeon at a teaching hospital took an interest in her case she would be getting no care at all.
Why are people with developmental delays considered less worthy of treatment? Are they not human? Do they not feel pain? Do they not bleed. This person has medicare and medicaid but neither will authorize testing to rule out underlying disease because as the denial letter states she is not a good candidate for successful treatment. I guess we are just supposed to leave her in a bed in pain and let her die.
Beware of what you wish for - with healthcare reform will come a new definition of medical ethics where the cost of care will be a huge consideration when deciding what treatment will be done - if we think the current system is bad just wait. Remember Obama himself was quoted to have said "why do a bunch of expensive tests and treatments that may not work when it might be just as effective to give a pain pill."
Last year I had to put down my 28 year old dog. I know 28 is one old dog! That would be almost 200 for a person. She really wasn't living anymore just wasting away.I know it was the right thing but she was my best friend for so long through so many things. There's a saying that old dog never really die they just fade away.
I hear you, Hppy. I had to do the same thing with our 18 1/2 year old dog. The vet had said he'd have never believed the dog's age, except he'd taken care of Barney from the time we brought him home as a puppy. We'd buried him at home in the back yard, which was his favourite area. God, it'll be 20 years this May.
The saddest thing that I regularly do is facilitate the last few minutes of an individuals life when (s)he is least able or prepared for it and neither are the loved ones. Usually they have no idea how sick they they were with say, stage IV carcinoma or endstage cardiac failure, because the providers were misleading so they are utterly shocked when no more treatment can be offered. No, there really are no more rescue chemo treatments to take and, no a pacemaker will not make a failed myocardium contract and a bypass will not help either. This information is delivered by the intensivist who they don't know and nurses who they never met take care of them in probably the most intrusive environment they ever will see. If it goes well, we withdraw support in favor of palliative comfort care and their suffering ends. Often they go down in a blaze of aggressive treatment; hardly glorious. In the end we, not the physicians, sit with the family and help them begin to put the pieces together.
I'm with you R. I think the truely saddest thing I ever had to do as a nurse was to hand a deceased infant to his father's arms after a crash c-section that was just to late. The baby was perfect in every way, full term all the fingers and toes in the right place. Mom had a placental abruption and we had a heartbeat right up to the first cut - but he had bled out before we could do anything. Almost lost the mom as well.
[QUOTE=hppygr8ful;135131]I'm with you R. I think the truely saddest thing I ever had to do as a nurse was to hand a deceased infant to his father's arms after a crash c-section that was just to late. The baby was perfect in every way, full term all the fingers and toes in the right place. Mom had a placental abruption and we had a heartbeat right up to the first cut - but he had bled out before we could do anything. Almost lost the mom as well.
It's a truely humbling experience.
Peace and Namaste
Thanks, Happy. Oddly enough we've got that in common, almost. A few years ago, we had a mother with an amniotic fluid embolism go into cardiac arrest- IN THE TUB!. Had to pull her out with dad in there rubbing her back, very unceremoneously put her on a bed and section her right in front of him. I got to do the compressions all through the case while a perfect, albeit slightly blue boy was delivered. The circumstances were tragic enough but it was torture to listen to dad sob uncontrollably in the room knowing his world was falling apart right in front of us. Everyone was focused on keeping maternal perfusion going and rescuing the baby and there was nobody to spare for him. Obviously this was a worst case scenario and it went well, but I think important lessons about delegation and prioritization were learned that day.
pay attention to people. It's saddening, but then again, you can look at it like going to the fair..."you always come home feeling better about yourself" 