i am having extremely mixed emotions about dialysis use/abuse, especially with the increase in the numbers of elderly and substance abuse hiv patients going on dialysis. i always worry how sterilized the dialysis equipment is when they dialyze someone with hepatitis, mrsa, or some other infection... so hiv patients have only made me worry more.
most of the new
dialysis patients that i have seen coming in over the last 2-3 years are basically in the latter stages of one disease process or another, are elderly, have hiv, or are substance abusers still abusing and boasting about it.
1. patient "x" is an 68 year old from the nursing home and has come in and out of hospital with multiple issues. pt "x" exists on peg tube feeds and has a history of multiple strokes. they are diabetic and hypertensive pt "x" is unable to follow simple instructions, is non-verbal, and unable to recognize or interact with caretakers or family. pt. is a total care patient and has been since they went into the nursing home 12 years ago.
pt. "x" now comes in with a decubitus infection and dehydration, bun and creatinine through the roof and doctor "z" begins dialysis. pt. "x" discharged back to nursing home and with an outpatient dialysis clinic they will now be transported to 3 times a week.
2. pt. "y" comes into the er at 2 am. this is their third admission from the er for
the same reason in the same month .
the patient refused to go to their scheduled treatment and was too drunk, with their own mouth. urine tested positive for cocaine, opiates, and meth.
i really have issues with the deliberately non-compliant dialysis patient who tell you "i don't care."
3. pt. "z" is relatively young 53 year old who comes to the icu with a massive heart attack and survives. they are however now ventilator dependant with a trach, suffered massive brain cell death due to coding on arrival, requires tube feeds for nutrition, and dialysis for the renal failure that also occurred. they are basically stable so a nursing home is found that will take vent dependant patients and can get them to and from dialysis with a portable vent.
i don't know whatever happened to death with dignity or doctors knowing when to draw the line and say "enough is enough. what you have is terminal." i just think somehow that dialysis was once a medical miracle and is now an abuse. does anyone else feel this way ?
Aug 20, '10
hi and thanks. i am not wanting to debate right to life issues or cause any contention. i am not saying whether someone should or should not be on dialysis. i just feel frustrated and think there is a point where it becomes almost cruel to keep doing things "to" a patient. does anyone share in that frustration?
there is almost an insanity to medicine. just because we "can" do a procedure, should it be done? it is all so ethical i know .... but before i am hung out to dry .... i have walked in those shoes. i buried both my parents when i was younger, one from massive stroke and one of throat cancer.
my own son died when he was preschool age after battling cancer, but there was no active cancer when he died. he had been coded (pneumonia-respiratory failure) and was essentially brain dead on a vent. had dialysis been possible where we were lived back then (it was still new and not many centers did dialysis) i am sure they would have tried it to help, but i don't think his little body couldn't have stood much more. i had to make the dnr decision for him. after watching him seizure most of the day, with blown pupils, and even with me not being a nurse back then, i knew it was time to let go.
it can just be too much. hippocrates said "first do no harm." it is hard to care so much but it is also hard to see the things medical interventions can sometimes create. does that make sense?
Last edit by Scarlette Wings on Aug 20, '10
: Reason: trying to clarify without reusing same word