After browsing the site for awhile, I feel I've calmed down enough to post about this rationally!
I was asked to see a patient tonight who has terminal Ca. It was a first visit for me...though this lady had been on service for awhile, I'd never seen her before. I was to go in and give her Decadron and 2.5 mg. of Haldol.
When I arrived, she was sleeping very peacefully, vitals stable, but resp. rate was only 8. When she awoke while I checked her vitals, she was not able to talk. I went back downstairs, and talked to the family about her history. Apparently, that morning, she had been walking and talking, though in a lot of pain. She'd even gotten up and showered, with assistance. Then, when the palliative care doctor came in, he gave her Haldol and applied a 50 ug Duragesic patch. This was at 2:30 in the afternoon, and she'd been sleeping steadily ever since. She had not even been up to go to the bathroom.
I told them I was concerned that maybe she was a little over sedated, and I was NOT comfortable giving the Haldol without checking with the doctor.
The attending calls me back (after a long wait) and tells me to hold the Haldol, and remove the Duragesic patch. He said to use Dilaudid P.O. for pain, but if that didn't work, to re-apply the Duragesic, but use a 25 ug patch instead of 50.
I carried out his orders. No sooner had I done so than the primary care doc. calls, flaming mad. He told me that what I'd done was totally, totally inappropriate. I should have reassured the family that it was perfectly okay at this point for her to have such a low resp. rate, and not be able to talk or respond to them. I tried to tell him, that YES, I agreed that would be so, if the patient were actively dying. But someone who was walking and talking earlier today, has good colour and perfectly stable VS isn't exactly end stage. He would have none of it, and continued to rake me over the coals. "You should have been reassuring the family, instead of getting them upset about this!" he ranted. "I don't know what kind of training they're giving the nurses, but it's not good! You should know better! Tell them to talk to her softly...it doesn't matter if she can't talk back...."
He then spoke to the family at length, then called me back, and told me to reapply the Duragesic patch, but only half a patch (put Opsite under the other half). As he was about to hang up, I reminded him about the Haldol: should I hold it or give it? "Hold it," he told me. "I gave her some this afternoon, so she'll be okay."
So, palliative and hospice nurses, what would YOU have done? I frankly think he forgot about the Haldol dose. If it hadn't been for that, I probably would have left well enough alone, in spite of the respiratory rate being so low. Right now, I am FUMING over this doctor's arrogance, and the way he treated me. His whole conversation with me took place on the phone, RIGHT BESIDE the patient's bed, with the whole family listening. The family was very understanding, and told me "You did what you though was right, don't worry about it," which makes me feel a little better. Still, it ruined my evening. I had hoped to finish early, and get in a workout at the gym before coming home. Instead, I got home after the gym closed, too angry and too uptight to even think of going to bed.
Arrggh. Gonna go for a nice, long walk with the dog, and try to get over this!
