Hee! First let me say I am LOVING my new job!! I LOVE being back in the acute care environment again - yet not doing bedside care
It had been 10 YEARS since I took a verbal order from a physician and had to remember how to write it!! :chuckle Anyway, I always had fun with the docs, maybe because I was used to dealing with my Dad who has the same Type A personality. Well, I had to use my "charms" today on a sticky situation.
"Clark" is 8 days post CABG x 2. No insurance here, only has a state insurance from outside of Nevada which provides no coverage for anything beyond an acute hospital stay. He's no longer meeting criteria for an acute stay and although I'd like to send him for some inpatient rehab, no one will take him without insurance (gee, imagine that). So, the next viable option is home with home health care. Alas, Clark is not from Las Vegas so I have to find out where his "home" will be. Clark tells me he has allllllll kinds of family here in Vegas, no problem. Okay, so, who will you be staying with, Clark? Uh.. I don't know. Who should I call, Clark? Uh... I don't have their numbers. Where do they live, Clark? Uh... in Las Vegas!
Here I go calling the emergency numbers on the chart. No answer with the first number. Second number is disconnected. Hmmmm.
Well, here we are. Clark needs to go somewhere. Gotta come up with a plan for his doc. Clark is ambulating independently in the halls, no oxygen needed. Eating, pooping, and peeing like a champ.
Oh gee!! Here's his doc up here rounding on his patients! Heyyyyy Doc! Gee, Clark looks great, when do you think we can send him home? Doc says, how about rehab? I say, no can do, bro. No insurance. No washie, no tiki.
I say, how about home health? Doc ponders this for a moment, writes an order for discharge home with home health!! Success!
I go back and grab the chart looking ardently for another viable phone number. Find one, call, a grandson answers! I tell him, Clark is discharged, c'mon down!! Grandson says, er, um, er, let me call you back. I say, whoa, what's the address he's going to? CLICK! Hmmm. Ruh Roh.
Later that day.....
A son shows up. The floor nurse (my buddy 'ol pal) grabs him for me. Son (smelling of cigarettes and beer) says, I can't take him home. My sister isn't here and she will be back Sunday. You have to keep him here until then. Huh?? I say, nope, can't do that. He says, but he's not well enough to go home! I say, yep, he is. Already discharged. Son says, but I can't take care of him, I have to work! I explain that rehab would have been an option but Clark isn't covered here in Nevada. He has to go home. Son says, but he has private insurance! That's new to me, do you have a card so I can check his coverage? If he's covered, I can send him to rehab. Son says, rehab? He doesn't need rehab! We can do that at home!! *****? Son starts to get mad - "I'm calling his doctor and telling him not to discharge him!!". Okay, dood.
I call the doc. "Dr. Doc, just giving you a heads up. Clark's son is going to call you and tell you not to discharge him home."
Dr. Doc: "WHAT? WHO IS HE TO TELL ME WHAT TO DO??"
Me: "Yeah, what's up with that?"
Dr. Doc: "I AM THE DOCTOR, HE'S NOT A DOCTOR, WHO DOES HE THINK HE IS?"
Me: "The nerve!"
Floor nurse whispering in my ear: They haven't taken out his pacer wires yet!
Dr. Doc: (still ranting)
Me: "Um, Dr. Doc... he still has in his pacer wires... they haven't taken them out..."
Dr. Doc: "WHAT?? WHAT'S WRONG WITH THOSE SURGEONS? DO I HAVE TO FOLLOW UP ON EVERYTHING???
. YOU'RE SUPPOSED TO FOLLOW UP ON THE CARE OF YOUR PATIENTS AFTER SURGERY SO I CAN (continues to rant...)"
Me whispering to floor nurse: well, we can't discharge home today, can't go with pacer wires!
Dr. Doc: (still ranting)..."AND I AM GOING TO CALL THEM AND TELL THEM TO DO SOMETHING AND THAT PATIENT IS DISCHARGED! IF YOU HAVE TO CALL SENIOR PROTECTIVE SERVICES AND TELL THEM THE FAMILY ABANDONED HIM AND HAVE SECURITY COME UP YOU HAVE MY SUPPORT. I DON'T KNOW WHY PEOPLE THINK WE ARE RUNNING A HOTEL..(continues to rant)"
Me: Do you want me to call the surgeon for you?
Dr. Doc: (still ranting)"....YES! NO! I AM GOING TO CALL HIM MYSELF AND TELL HIM THERE NEEDS TO BE BETTER FOLLOW-THROUGH! Okay, bye bye!" CLICK!
I love our docs.
Tomorrow, I'm going to love our security.
P.S. When I left, Clark was refusing all meds, meals, and lab draws. Here we go!!
Jan 14, '03
My guess is that since he is refusing his meds, he's going to show EKG changes where the surgeon won't take out the pacing wires. He may end up back on a drip and will meet criteria to remain inpatient (if he'll let them start a drip). It's going to be an interesting situation.
Thanks, all. I'm really enjoying this mostly because the docs are supportive and LISTEN to the case manager's input. That makes the job a LOT easier!
Last edit by LasVegasRN on Jan 14, '03