Florida mull how to ration ventilators

It will be very interesting to see how this plays out. One can dream that this might set a precedent of sorts. We recently had a woman in the MICU for five long torturous months with end stage cancer. The origin was the uterus, but mets were to liver, lung and brain. There were lumps cropping up everywhere by the time all was said and done. levo was unreasonably high, dopamine was added very late in the game. Vented and sedated, TPN, horrific wounds which were cared for on a daily basis. For what??

The family threatened to sue us if we even mentioned DNR. Their insurance stopped paying at 60 days. We were completely stuck. When she finally went, her husband stopped the code after the third one that day.

Something HAS to be done about these situations.

I also have issue with futile care after many years in critical care and most recently working in Chronic outpatient dialysis. I have seen too many times pts from nursing homes in fetal positions and unable to communicate recieving life saving renal dialysis 3-4 hours 3 times a week. We move them from a transport stretcher to an uncomfortable recliner that isnt able to accomadate thier distorted body. Then I see the administrator who insist this person be referred for a "transplant" workup!!! Although we know that patient is by no means a candidate but go ahead and put them through all the blood work and the referral that's an 2 hour trip to be evaluated. When questioned I'm told "it's not for us as medical professionals to decide" yet of course our numbers look great for showing we did this or that many # referrals for transplant listing on CMS. Talk about futile care. I took a master's level medical ethics course back when I was in my senior year of nursing school (1979) and remember our discussions related to ethic teams set up for deciding who would get an organ and who wouldnt. This situation just brings to mind how much in the media it is right now regarding the political parties accusing each other of wanting to "pull the plug on grandma" in relation to health reform. I agree vents should be for those who are expected to recover and have a long productive life but I fear there will be those who slip through the cracks also. It is going to be interesting as to how this plays out as I also live in Florida. Staffing has been cutback so severly in my area in the hospitals that I fear for patients if this H1N1 outbreak does become an overwhelming pandemic. They have already laid off here many of the support services such as CNA's etc and put the balance on the Nurses they have kept besides the 15% pay cut. I think if it does arise here the system will be so overwhelmed I can see so many mistakes and law suits coming up with alot of angry families who will be quick to talk to the ambulance chasers waiting in the wings.

Too bad those chasers and families don't start to work helping to take care of the patients. It brings back memories of pictures I've seen of how a lot of patients didn't eat in hospital if their families didn't bring them food. Or of several patients sharing a bed in a huge hospital ward, no sheets on the beds, no real treatment.

As for futile care - I have often wondered, too, why we do so much for the terminally ill, many of whom say to let them rest, let them alone, let them go. They really should be deciding for themselves what care to get or to refuse. Med care is often so painful that many people just really would rather forego it, I think, but we somehow talk them into it. Hope dies hard. No one, I guess, really wants to die. What I have so often seen is that patients who are kept clean and comfortable want to live. When people are miserable, they want to be left alone to go meet their Maker. So what to do, what to do?

A shortage of money is not the problem, either. There's always plenty of that for whatever the powerful people of this world decide to spend it on.