Consequences of Bad Choices - page 9

I was recently involved in a multidisciplinary team evaluation of a patient who attempted suicide by placing a shotgun in his mouth. He survived the attempt but was left with only half a face. I... Read More

  1. by   Darla
    Quote from hbscott
    I was recently involved in a multidisciplinary team evaluation of a patient who attempted suicide by placing a shotgun in his mouth. He survived the attempt but was left with only half a face. I was consulted as my department does advanced 3D imaging work to include prosthetic reconstruction of such profound defects.

    As I was sitting in this team meeting a question was raised by a social worker on the visitation rights for his wife. The social worker reported that this woman had been married twice before and both previous husbands had successfully committed suicide. This was husband number 3 who had survived his suicide attempt and the wife wanted to visit her husband to "comfort" him.

    The question raised to the care team was the wife a danger to her husband knowing the general history as outlined above. We were not privy to all the details but there was some suspicion that the patient's wife may have been a contributing factor to the suicide attempt. I was surprised to see that the care team had differing opinions on this matter that pretty much split down gender lines. I found this interesting.

    The men on this particular care team felt that visitation for the wife should be carefully monitored until it could be determined that the wife was not a contributing factor to the patient's suicide attempt. The women on the care team felt that since she had not been arrested by law enforcement that the question was irrelevant. In fact one member stated that perhaps the only thing she is guilty of is making bad choices. It wasn't her fault that the men she chose to marry kept killing themselves.

    Since this BB is a wonderful place to sample such diverse, well educated and experienced opinion I thought it would be an interesting case study to present.

    Any thoughts?

    -HBS

    I would be extremely suspicious of the wife. Just because she hasn't been arrested doesn't mean the police didn't suspect her;perhaps they had no hardcore evidence. I would contact the police(again) and report my suspicions and ask them to continue an investigation. This sure sounds too coincidental that all husbands commited/attempted suicide. Be interesting to know what she gained from their deaths as that would give the police something to look into. Visits with her husband should be monitored closely! Keep us informed. Darla
  2. by   purplemania
    has anyone asked the patient his opinion?
  3. by   hbscott
    Quote from purplemania
    has anyone asked the patient his opinion?
    The patient left the hospital quite bitter at his ex-wife for many different reasons.

    The wife was never meaningfully interviewed so only speculation exists on her point of view or motivation.

    Hospital staff knowledgeable about this case still expresses markedly split opinions on the wife's role (actual or potential) in the events that lead to husband #3's attempted suicide.

    -HBS
  4. by   LesJenRN
    Quote from hbscott
    One more time for review....

    The Rest of the Story

    Now that I got everybody thinking it is time to reveal the rest of the story. I consulted on this case a little farther back than what most people thought. In fact this patient has been treated and released. He has a new face and a 2nd chance at life.

    While the patient was unconscious the wife was allowed monitored visits and when the patient was fully alert and oriented he chose to meet with his wife in an area off the hospital floor he was staying. His wife would bring him things from time to time but one day she just stopped coming by. The patient soon discovered that his joint checking and savings account had been emptied and his soon to be ex-wife had run off with her girlfriend.

    I wanted to present this "case study" as an example to some of our students on the practice dilemmas they will sometimes face in their various working environments. This case study is currently being published in several journals. I thought I would share it with our audience since nursing care was an essential component of his recovery.

    The wife was consulted but remained distant to the care team. In my opinion mutual trust was never established with the wife and that prevented any progress for providing care and treatment to her if so indicated.

    -HBS
    Thanks for putting this one out here. It got us all thinking....Would love to read it once it is published.
  5. by   CEO
    Quote from prmenrs
    I am concerned about HIPAA re: this discussion.

    YES I agree! too much info. ?professional

    And, the comment -my job is easy I just have to rebuild his face- this makes me wonder if the writer is feeling a bit self-important.
  6. by   hbscott
    Ignorance is the curse of God; knowledge is the wing wherewith we fly to heaven.

    William Shakespeare
  7. by   hbscott
    <<YES I agree! too much info. ?professional>> -CEO

    This case study has been carefully presented. No patient demographics, location and/or health care providers have been personally identified. No privacy rules have been violated implicitly or explicitly. The patient in this case study was fully informed that his case could be published and the patient signed consent forms acknowledging same.

    Professional Journals (medical, nursing, allied health) are filled with case studies that teach health care professionals many important lessons that are derived from the practice setting. This case study is no different.

    The anecdotal presented here illustrates the power of choices both in our personal and professional lives. There are consequences to our choices (some good, some bad) and sometimes the situation we find ourselves in requires a little critical thinking to sort out the various issues that we are faced with.

    -HBS
    Last edit by hbscott on Mar 22, '04
  8. by   BBFRN
    Quote from CEO
    YES I agree! too much info. ?professional

    And, the comment -my job is easy I just have to rebuild his face- this makes me wonder if the writer is feeling a bit self-important.

    And your sig line (CEO) is not a bit self- important? The OP has a right to be proud of the job s/he has. It shows great job satisfaction, doesn't it? Do you want the nurses in the hospital you're a CEO of to not high 5 each other every time they save a life, or prevent an injury, etc? Why shouldn't we be proud of our accomplishments? Having worked with a patient myself, who had to have a facial prosthesis (entirely different circumstances, though), I find the whole process of that industry fascinating.

    I also felt the case was presented in a professional manner. Thanks, HB- as a nurse, I LIKE the threads that make me think.

    On a side note: It's our hospital's policy to have sitters with all suicide attempt patients, no matter the circumstances surrounding the event. This could be another way to have "supervised" visitation by questionable people on a medical floor.
  9. by   NursesRmofun
    I agree with CCU NRS. I would say observation is the best way to go.
  10. by   hbscott
    CEO failed to cite the whole quote as noted below:

    "My job is simple. I just have to reconstruct his face. The psychosocial elements of this case are truly challenging and unique in my experience. The behavioral health aspects of this patient care scenario are going to be interesting to say the least."

    This statement was nothing more than acknowledging the fact that behavioral health dynamics can be much more difficult to treat than other patient care interventions including mine in advanced 3D imaging.

    -HBS

    Thank you lgflamini for your astute observations.

    Last edit by hbscott on Mar 22, '04
  11. by   missmercy
    Thanks for posting tha thread HBS!! It livened up a couple of lunches around here!! We felt that "monitored" visits would be OK. Wife needs serious help!!


    As to the facial reconstruction -- as a patient who has had major reconstruction for genetic jaw misalignments -- you should feel like your job is tremendously improtant!!! Thank God for people like you who help people like me get their face back!!! I have always been intensly grateful to the Dr.s and nurses who helped me!! They always said they were not "giving me a 'new me' but letting the real me out!!"" What a gift!!!
    Thanks again for the post -- and for sticking to it for sso long! Real interesting and thought provoking too!!
  12. by   hbscott
    Quote from missmercy
    Thanks for posting tha thread HBS!! It livened up a couple of lunches around here!! We felt that "monitored" visits would be OK. Wife needs serious help!!


    As to the facial reconstruction -- as a patient who has had major reconstruction for genetic jaw misalignments -- you should feel like your job is tremendously improtant!!! Thank God for people like you who help people like me get their face back!!! I have always been intensly grateful to the Dr.s and nurses who helped me!! They always said they were not "giving me a 'new me' but letting the real me out!!"" What a gift!!!
    Thanks again for the post -- and for sticking to it for sso long! Real interesting and thought provoking too!!
    Very nice words and thanks for the encouragement. I am also very glad to hear that the "real you" was enhanced by the various interventions of your health care team. I am so very glad to hear that things turned out well for you. Very happy indeed.

    Warmly,

    -HBS

    Last edit by hbscott on Mar 22, '04
  13. by   shezza
    Quote from lizz
    Interesting comments. I'm curious about the concerns that this could be a violation. How is this different from other situations that are posted on this board? Is it because the circumstances are so unusual it could lead to identification? I'm just a student and would like to learn more about the concerns posted here ...
    It seems to me that if we are going to worry about confidentiality to the degree whereas we don't post case scenarios, how do we learn? I have no idea where this case came from and do not want to know, but I found the case very interesting. We're told that in case studies, we should not give any indication of the patients name, address, or any personal details at all, but we really can't worry about confidentiality to the degree that we are constained from asking advice, or seeking guidance. Anyway, what happened? Shezza

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