Haven't Lost My Touch with the Docs

  1. 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!!
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  2. 12 Comments

  3. by   MissdonditaBsn
    Vegas,
    Glad that you are enjoying your new job. It's always great when we are doing a job we enjoy.
    I will be curious to know what will happen with your patient.
  4. by   flowerchild
    Glad to hear your lovin life Vegas! Would not expect any less from you. {{{{{{}}}}}} (A hug for you for just being you).
  5. by   Kayzee
    Loved your story....and so happy to hear that your happy with your new employment.
  6. by   LasVegasRN
    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
  7. by   SmilingBluEyes
    GOOD FOR YOU vegas. We are glad you are back too!
  8. by   OBNURSEHEATHER
    WOOT!

    Er, um... Vegas? I'm glad you're enjoying your new job and all, but I must admit I'm a little jealous of the time and enthusiasm you're showing them! Don't forget your nurse buds. kay? We need a dose of Vegas humor here daily!

    :kiss Heather
  9. by   LasVegasRN
    Awww, you guys are the sweetest! Heather - you rock, girl, always!
  10. by   BadBird
    Hmmmmmmmm,hey I know, since you live in Las Vegas why don't you keep Clark? Hahahahaha

    Sorry, just having a little fun. Glad you like your new job.
  11. by   P_RN
    Vegas you did well.

    Please excuse my total ignorance, but did the family actually abandon him?
    The reason I ask is one time I got a call at work that my cousin S_____ had been discharged and when was I coming to pick him up.......OK he was my cousin (my favorite in fact) BUT I had not seen him in nearly 16 years!!! I had NO idea he was in the state much less the hospital.........The SW was VERY insistant!!!

    I had NO idea what to do. Calling around I found a number for his brother G_______in Louisiana!!!! So I called the brother and bless his heart he hadn't seen S____ in over 3 years!!! The last time they had spoken (actually corresponded as S_____ was mute d/t a CVA) S____ was in England!!! But Bro G. got on an airplane and "picked him up."

    So did the family abandon your guy? I didn't abandon S____ and neither did his Brother.....I guess Im too softhearted.

    Unfortunately shortly after this incident S_____ was murdered. I regret the lost years very much
  12. by   LasVegasRN
    Here's what happened:

    The pacer wires were removed the next day and orders were written for discharge home with home health. I called the family - got in touch with a grandson and told him I needed an address to give to the home health company. He said he didn't know the address and would call me back. He never called back.

    I went back and talked to Clark asking for an address. He said he has "a lot of family" here but doesn't have any addresses. While I'm talking to Clark I'm doing an assessment: he's alert, he's oriented, he's ambulating fully, he no longer requires any oxygen. At this point, Clark has to be discharged to a shelter, he can't stay in the hospital.

    While I'm calling the few shelters we have here to see who will allow home health to come to their shelter, the son shows up. I call our social worker. At Dr. Doc's advice, I have security standing by at the nurses station just in case.

    I wait until Clark's nurse has all his discharge papers ready. We walk in together, along with the social worker (security gaurd in the wings). I ask the son if he has this other insurance card he said he was going to bring in. Nope, doesn't have it. I tell him the patient is discharged, here are his prescriptions, where will he be staying so I can notify the home health agency? "I don't know the address." Okay. Here is the number, call them when he gets settled and they will come out and see him. Goodbye, have a nice day.

    The son takes the prescriptions, he and Clark leave without incident.

    I got the distinct impression that Clark bounces from family member to family member, in whatever state they are living in. He was here visiting and had a big MI. Now, someone has to take care of him. Unfortunately, as the hospital all we can do is fix Clark's medical problem - not his social problems.
  13. by   sunnygirl272
    Originally posted by LasVegasRN
    Unfortunately, as the hospital all we can do is fix Clark's medical problem - not his social problems.
    exactly...we as nurses cannot fix everything.....

    ya dun good, vegas!!!








    PS..i think he woulda looked cute in the "big chair"!!!
  14. by   Tweety
    Glad to hear you're loving your new job.

    WTF is it that you can get inpatient care without insurance but not rehab. I can't tell you how many of our trauma patients increase their length of stay in acute care because they can't get to rehab. Or are sent home too early. But most of the time they just stay inpatient, when they aren't acutely ill.

    What's funny is my facility is a not-for-profit, treating all regardless of their ability to pay. EXCEPT when it comes to going up to our rehab floor.

    Rant ended.

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