I hope that they get the same compassion some day

Nurses General Nursing

Published

Specializes in Corrections, Cardiac, Hospice.

Have a lovey lady admitted to my inpatient hospice unit tonight. History of MS. Went to the hospital with gangrene in her toes. They amputated 8 toes, then told the family nothing more could be done to send her to hospice. Ok, first of all, why even do the surgery? Why not just keep her comfortable? THEN to top it all off, they did not medicate this poor thing with anything for pain "because of her breathing?" Seriously? Not even freaking Tylenal? Advil? NOTHING? What is wrong with these people? She came to me on a venti mask that the family was told they were not allowed to remove to give her water. I fed her a popcycle. Then asked (after 4 doses of Morphine) if she would like the mask off her face, she nodded wildly. By the time I left, she was sitting up, hydrated, with 5 l/nc going and medicated for pain watching the syfy channel. When I told her I was leaving, she kept saying, Thank you, Thank you, Thank you. What the heck is going on?

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Specializes in Cardiac Telemetry, ED.

Maybe they amputated cause sepsis isn't really a fun way to go. What was the issue with her breathing that they wouldn't medicate her? It's true that morphine causes histamine release that can exacerbate respiratory problems, but there is dilaudid and fentanyl...not sure why they wouldn't try those.

You didn't mention how far postop she is....I know some surgical nurses are very strict in the immediate postop period about maintaining NPO status until they are certain there will be no aspiration or N/V as a result of PO intake post surgery.

It sounds like you did a great job with this patient. Now kick your feet up and relax...you deserve it.

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Specializes in OR.

They did surgery to prevent her body from going septic and possibly into shock then dying...that's why. And do you honestly believe that anyone can be comfortable with eight gangreneous toes? I think NOT!

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Specializes in Corrections, Cardiac, Hospice.

Yes, I do believe someone can be kept comfortable with 8 gangrenous toes. I have taken care of people with entire feet that are black and rotted that are kept comfortable. My point is this, I am a HOSPICE nurse. They come to me to die. Why do surgery on someone who will die anyway, why not just keep them comfortable until they die? It couldn't possibly be because some doctor wants to make a buck or two on a dying woman's rotting feet could it? Then to NOT keep her comfortable, PLEASE! This is 2009, not 1899, NO EXCUSE!

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Specializes in Agency, ortho, tele, med surg, icu, er.

I dont know why after confirming hospice placement, she was not given pain medication or taken off a mask she did not want on.

I will play devils advocate and say that they may of had the surgery to see if they could remove all the infected pieces. And that during the surgery they may have discovered further necrosis or signs of impending sepsis that they could not not address on the hospital table. I dont know many surgeuns that would do a procedure just for the "money" unless its a boob job. Seems strange that if that was the case though that they wouldnt of just done a below the knee amp. Anyway gluck and Im glad you made your patient comfortable.

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Specializes in ICU/Critical Care.

It's rather simplistic to say "Why do surgery on someone who is going to die anyway?"...that's not always the case. You don't just not treat a patient because they are going to die anyway. Now if this patient was a hospice patient prior to the surgery, I don't see the point in amputating the toes. But if the patient wasn't hospice before the surgery and the surgery was performed, the patient's prognosis worsened and then hospice was consulted, thats a totally different situation. I'm pretty sure the surgery wasn't about the doctor making a buck or two. I see a lot of this in the ICU. Patients who are going to die anyway but the family can't make a decision whether or not to make the patient hospice, in the meantime the patient needs to be treated and yes, sometimes that means surgery.

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I'm glad you made her comfortable, Shay.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I'm with you 100%, why amputate in the first place.

However, I'm thankful to know there are nurses out there like who whom advocate for comfort.

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It sounds like the decision to admit her to Hospice was made after the surgery, once the toes had been amputated. It was possible that they couldn't get all of the infection and opted to not take anymore after discussion with her family about her history and prognosis. Surgeons will jump out of surgery to consult with family when there are unexpected or negative findings.

It's all subjective. If the decision to make her hospice was based in part on the surgical findings, their actions make as much sense as any of these things can make.

The only reason I can think of for the lack of pain med is that the staff didn't want to compromise her respiratory status too much. Now, you can read into that as much or as little as you want to. In any event, I don't think they were conspiring to keep her in pain.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Maybe they amputated cause sepsis isn't really a fun way to go. What was the issue with her breathing that they wouldn't medicate her? It's true that morphine causes histamine release that can exacerbate respiratory problems, but there is dilaudid and fentanyl...not sure why they wouldn't try those.

You didn't mention how far postop she is....I know some surgical nurses are very strict in the immediate postop period about maintaining NPO status until they are certain there will be no aspiration or N/V as a result of PO intake post surgery.

It sounds like you did a great job with this patient. Now kick your feet up and relax...you deserve it.

She should've received Morphine or whatever she needed to take care of her pain. Dilauded and Fentanyl are much stronger--with Dilauded being 6 x more than Morphine, and Fentanyl causing only short-term relief.

She was far along enough to be moved around, so maintaining her NPO was cruel.

That was mean, and inhumane.

Glad you were placed there as her angel....

Good job, and God bless.....

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Specializes in Cardiac Telemetry, ED.
She should've received Morphine or whatever she needed to take care of her pain. Dilauded and Fentanyl are much stronger--with Dilauded being 6 x more than Morphine, and Fentanyl causing only short-term relief.

She was far along enough to be moved around, so maintaining her NPO was cruel.

That was mean, and inhumane.

Glad you were placed there as her angel....

Good job, and God bless.....

I was just throwing out possibilities. Personally, I don't think there is enough information in the OP to reach any conclusions.

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