Doctor Asked For A "Kind" Nurse

[LasVegasRN]

Let me preface this thread by stating a few things:

1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views.

2. Whatever your belief, please respect the beliefs of others.

That said, I admit to not understanding how parents can stand by and watch their child bleed to death.

Teenager, throwing up blood for 2 days, H & H 6.1 and 17.0. Platelets 14. WBC 1.0. Pancytopenia. A religion that does not allow blood products or transfusions. Essentially we will be watching this patient die. As the majority of us know, some fresh frozen plasma, units of packed cells, the ability to SAFELY do an EGD and the patient would be discharged home in about 2 days.

Instead, in 4 hours when the next CBC was done, the Hgb was down to 5.8.

I overheard the attending doc asking the charge nurse to assign a "kind" nurse as this was a "difficult" case. I felt that was unnecessary, because as hard as it is for all of us to watch this, we still treat the patient and family with compassion.

My main point: I'm hoping someone could explain to me, how in the world can you stand by and allow your child to die?

Harsh question, and I'm sure an age-old question, but I do not and can not understand it.

[kittyw]

Never mind. :) You went back and found it.

[LasVegasRN]

So far, I'm getting a "No" from the insurance for two reasons (which I anticipated): First, if treatment can be administered here, no reason to transfer. Second, if the treatment at the next facility will be experimental, it won't be covered.

Currently their medical director is reviewing the clinical information I faxed over and I provided the direct cell phone numbers to the attending doc and Heme/Onc doc.

And so it goes....

[deespoohbear]

Originally posted by LasVegasRN

Well, Hgb is down to 4 today, platelets at 7. Starting TPN. We got an accepting physician at a teaching facility with the assistance of our JW liason.

I've been on hold with the patient's insurance company now for over 11 minutes. This is just to get to a live person to talk to. ~sigh~

How long can one live with a Hgb of 4 and platelets of 7? Wow, that IS low. Lowest Hgb I can recall is about 5 and platelets of 15.

[fab4fan]

We had someone recover after dropping to Hgb of 1.8. That's the lowest I'm aware of.

[zambezi, BSN, RN]

Hello everyone...this has been an fascinating and informative post to read...i have a question that is just a touch off subject...i work in ccu, occassionally we will get patients that are JWs, they have signed the no transfusion card, have the no transfusion namband on, etc...however, being post-op, often they need volume, esp if they are bleeding...we dont give hespan if h/h are too low... to my knowledge albumin is considered a blood product and can't be given...is that correct? second question....is is ok to autotransfuse the patients own blood from CT drainage if they are bleeding? What about pump blood that is the patients own? Thanks for all of the good info...i will print out the links by fab and hang it in our unit...seems we have this discussion each time we have a patient that is a JW...:)

[frannybee]

We've got a pt in at the mo who regularly drops to below 5, but he's a long-term receiver of blood products. We're looking after a JW pt with NHL who has epo every 2nd day and has been having some pretty aggressive chemo and radiotherapy. It's never been an issue whether or not she receives blood. She's stated her wishes and they've been followed. If the docs forget and prescribe blood (her Hb was 4.1 today) we just remind them that she doesn't want it and they cross it off. No biggy.

My only peeve with this pt is that she witnesses to everyone that walks through the door, and on an ambulance transfer to have an EEG, she asked me to hand out her JW literature. I refused as I don't share her beliefs. She offered the leaflets and 'religious discussion', her words, to other pts in the ambulance who declined politely. ('Thanks but I'm quite firm in my Catholicism and I don't want to discuss it' was one response). She insisted that they take the literature anyway. The other pts, who were all quite elderly, felt pressured into taking leaflets they had no intention of reading just to shut her up.

Before anyone gets offended or thinks I'm generalising, please know that I understand that the vast majority of JWs will and regularly do take no for an answer. It just really bothers me that this particular JW doesn't back off when someone declines a bit of paper.

My parents have been buying Awake and The Watchtower for many years, partly because the articles and 'Young People Ask...' are always really well researched and written, and partly because we know if we have regular witnesses calling, we won't get called on by others. Our regulars know full well my mother is atheist and that I don't know what I believe, but they are very respectful of that. We've grown quite fond of them and get worried if they don't turn up. Mr JW had a CVA 3 yrs ago and they didn't come for 8 wks - Mum rang the church elders to find out if they were alright.

I've only had one other negative experience with religious representatives, and that was when a pair of young American Mormons on mission approached me on my way home from school when I was about 12. I couldn't stop to talk so they asked if they could phone me at home later. I explained my parents wouldn't appreciate that and would be angry; they then suggested that one of them could pretend to be my boyfriend when he called! I hightailed it home and locked the door tight. I know that not all Mormons are so rabid in their missions, but it only takes one bad experience to form a permanent negative impression in some peoples minds. Luckily I'm smarter than that. :)

Vegas, I offer you my silent support in keeping your head and heart together while you look after this patient. It's an awful situation to be in but you sound like you're doing your absolute best for her and nobody can ask more than that. Thanks to you, Fab4Fan, for being calm, wise and very gracious in explaining your beliefs to those of us who don't understand but want to. :kiss

[hoolahan, ASN, RN]

Fab4, not only are you a wealth of knowledge, but you could be my nurse anyday, and vegas could be my Case manager!!

[fab4fan]

zambezi:

1. Albumin is considered a "fractionated blood product,"

therefore, it would be up to the individual's conscience.

2. Use of cell-savers are considered up to each individual's conscience, so in that case it would depend on how that person felt.

3. I'm not sure about "pump blood"...do you mean blood from a perfusion pump? As long as the circulatory process is uninterrupted (and it's the pt's own blood), it would again be up to the individual.

From the webpage:

Physicians face a special challenge in treating Jehovah's Witnesses. Members of this faith have deep religious convictions against accepting homologous or autologous whole blood, packed RBCs [red blood cells], WBCs [white blood cells], or platelets. Many will allow the use of (non-blood-prime) heart-lung, dialysis, or similar equipment if the extracorporeal circulation is uninterrupted. Medical personnel need not be concerned about liability, for Witnesses will take adequate legal steps to relieve liability as to their informed refusal of blood. They accept nonblood replacement fluids. Using these and other meticulous techniques, physicians are performing major surgery of all types on adult and minor Witness patients. A standard of practice for such patients has thus developed that accords with the tenet of treating the "whole person." (JAMA 1981;246:2471-2472)

Jehovah's Witnesses accept medical and surgical treatment. In fact, scores of them are physicians, even surgeons. But Witnesses are deeply religious people who believe that blood transfusion is forbidden for them by Biblical passages such as: "Only flesh with its soul--its blood--you must not eat" (Genesis 9:3-4); "[You must] pour its blood out and cover it with dust" (Leviticus 17:13-14); and "Abstain from . . . fornication and from what is strangled and from blood" (Acts 15:19-21).1

While these verses are not stated in medical terms, Witnesses view them as ruling out transfusion of whole blood, packed RBCs, and plasma, as well as WBC and platelet administration. However, Witnesses' religious understanding does not absolutely prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations; each Witness must decide individually if he can accept these.2

Witnesses believe that blood removed from the body should be disposed of, so they do not accept autotransfusion of predeposited blood. Techniques for intraoperative collection or hemodilution that involve blood storage are objectionable to them. However, many Witnesses permit the use of dialysis and heart-lung equipment (non-blood-prime) as well as intraoperative salvage where the extracorporeal circulation is uninterrupted; the physician should consult with the individual patient as to what his conscience dictates.

Copyright © 2000 Watch Tower Bible and Tract Society of Pennsylvania. All rights reserved.

[fab4fan]

franny: That situation is really inappropriate; if any of the elders come to see her, perhaps a nsg. supervisor could take one of them aside and explain the situation to him, and he in turn could talk to her. "No" should mean "no." Some of our older bothers and sisters are a little more...how to say it diplomatically, persistent.

And to all who've posted thanking me for sharing this info: Thank you. As I said before, it can be a very emotional issue, so I appreciate being able to discuss it in a professional manner.

[LasVegasRN]

I agree 100% fab, you've helped me with this case in more ways than you know.

[MomNRN, BSN, RN]

I have to say that I have found this thread enlightening and knowledgeable. It is discussions like this that keep us on our toes and inform us of topics we might not be fully versed in.

When I first read Vegas' initial post, I knew it would be a hot topic. But, with only a few rude comments, it has gone on very well. I'm only sorry I wasn't home last night and had to read these posts tonight.

We are all adults with different perspectives and life experiences. I am very glad I am not Vegas. Although I try to be objective and professional, everything you have learned and observed in your lifetime does affect who you are and how you act.

Thanks to all for sharing your viewpoints.

[susanmary]

Originally posted by fab4fan

BTW, everyone benefits from the advances that have been made in bloodless medicine/surgery. I think most medical professionals agree that there are risks with transfusions, esp. now. Just as we understand the effects of indiscriminate use of abx., blood is now being seen as not the "only" option.

Beautifully stated. Sue