I had this patient in an ICU setting a couple days ago. Patient background -- approx. 70 YO M had an open nephrectomy about 3 weeks ago. He went out to the ward POD 1 and came back to the unit on POD 3 after vomiting and a severe aspiration event requiring intubation. He was very ill initially (hard to oxygenate, in ARDS) and this persisted for about 3 days or so after the aspiration. Since that time, he has remained ventilator dependent although in stable condition. Very lethargic/deconditioned, being tube fed, etc.
I took care of this patient the second and third day after he came back to the ICU after aspirating. The only family that decided to show up at the hospital after all these complications was his sister and his niece on the 3rd day. Patient has a wife and 4 children. Sister/niece were understandably very worried. I explained to them the severity of the situation and that he had made some improvements over the last 24 hours (true by the third day.) Sister/niece were concerned that none of his immediate family had shown up and wondered if they needed to call them in right away. I told them that this wasn't necessary and that he was in stable (although serious) condition, and then they asked me for my opinion on what I would be doing if this was my family member. I hesitated to answer, but I told them the truth, and that was that I would be at the hospital every single day if that was my dad. I think they took that to heart and talked to the rest of their family (patient's wife/children), although I can't verify this.
Fast forward two weeks. I haven't cared for the patient since. I get him a couple of days ago and the son I never heard a word from during that initial period calls wanting lab values. Apparently he had been doing this on a daily basis, and it had been ok'ed, so I gave him all the info he wanted (from other staff that have done this, son is NOT medical. No idea how he is interpreting this information.) He then told me he had been in over the past weekend for a 1/2 hour and took issue because apparently the patient's leg had slipped out of the side of the bed and he was too weak to put it back in himself...worried that his dad was in pain with that, etc. He asked me if I could get a bed that had rails that go all the way down to the end of the bed so this wouldn't happen again. I told him that no bed that I know of like that was available and generally we keep our patients on our ICU beds unless contraindicated because of the mattress having some protective affects for their skin, etc. and I would make sure that he had all the rails up and was adequately watched so he wouldn't slip out of bed. Also went on to detail that patient was in an ICU and had 2:1 staffing, we looked at him frequently, etc. so he didn't need to worry that the patient wasn't being taken care of. Also explained that the patient was very lethargic and didn't move much on his own (and indeed, for my entire 12 hour shift, patient did not have his legs out of the bed. They stayed exactly where I repositioned them.) He was very adamant that we get him a new bed or completely pad the patient in the bed with pillows so the leg that he observed being out of the bed for a very short period of time 2 days prior, when I wasn't even taking care of the patient, wouldn't fall out again. He was like, "Well, I saw it, and it did happen, so can you just do that so it doesn't happen again?" ....like trying to place blame for something. And, something very minor in my estimation. I really didn't know how to respond after I gave my lengthy explanations as to how I would ensure that the patient was adequately cared for. I was pretty bewildered at his behavior and just let him talk at me some more and then let him say goodbye.
What IS this? Is this guilt, at not having been there before, or not being there often enough? Is he a control freak? How do you explain this weirdness? And a better question -- how do you deal with it?
