Do everything, doing nothing, nothing to be done, something should've, could've

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I had a frustrating day! One of my patients was a pulmonary fibrosis patient, new onset A fib, the family are true blue Western cowboys/ranchers. No insurance, patient hadn't been 'compliant', knowledge deficit and no insurance. Really, the doctor said the only thing for her is a lung transplant. Doctor had 'the talk', family wants everything done, pt full code. Meanwhile, patient getting no where hanging out in little hospital with no where to go but downhill. The patient used to raise pigeons in her laundry room, that's how she wrecked her lungs. They have a 100+ acre ranch, the two adult children follow the rodeo, they raise cattle and horses, not educated people, no insurance and haven't pursued medical treatments due to cost, they all live together on the family ranch.

Our medical system is so disorganized. I'm sick of being a part of this. I'm a part of something that falls so short. I'm sick of living in a nation where medical care is lacking for honest simple people without insurance, I'm sick of being stressed out by ambiguity. I'm sick of bandaid solutions from JCHAO and the rest, who approach problems in a vacuum, and look at eveything with tunnel vision. I'm tired of how we beat around the bush of death, then we are forced in the 11th hour to tell people "Your mother is going to die, do you want to allow this to happen?" We can't do anything unless you turn over your ranch to pay for all our beeping, computerized, spiritless taskmaters, who rule our lives and rule our deaths.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I hate nursing. I'm glad I'm going per diem. Our family is cutting back on luxuries and I plan on baking more bread and keeping my house cleaner.

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jls RN - THANK YOU! i'm at a similar place in thought. i'm sick of the ODs who really OD'd and ended up a vegetable - and we are footing the whole bill! and the mom who wants everything done for them. the hopeless CVA whose family wants everything done, including a PEG tube. and, down the hall is someone like your patient.

upon graduation from college, my son was without any insurance, and unfortunately, given his chosen field, entry level does not offer health insurance - so we (his parents)pay out of pocket for his health insurance. one visit to ER, one hosptalization, or one MRI - and it's all over financially without insurance.

this health system HAS TO BE FIXED! if only the policiticians, bean counters, administrators, jcaho, and all the rest had to "reap what they sew".

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Specializes in ED, ICU, Heme/Onc.
I had a frustrating day! One of my patients was a pulmonary fibrosis patient, new onset A fib, the family are true blue Western cowboys/ranchers. No insurance, patient hadn't been 'compliant', knowledge deficit and no insurance. Really, the doctor said the only thing for her is a lung transplant. Doctor had 'the talk', family wants everything done, pt full code. Meanwhile, patient getting no where hanging out in little hospital with no where to go but downhill. The patient used to raise pigeons in her laundry room, that's how she wrecked her lungs. They have a 100+ acre ranch, the two adult children follow the rodeo, they raise cattle and horses, not educated people, no insurance and haven't pursued medical treatments due to cost, they all live together on the family ranch.

Our medical system is so disorganized. I'm sick of being a part of this. I'm a part of something that falls so short. I'm sick of living in a nation where medical care is lacking for honest simple people without insurance, I'm sick of being stressed out by ambiguity. I'm sick of bandaid solutions from JCHAO and the rest, who approach problems in a vacuum, and look at eveything with tunnel vision. I'm tired of how we beat around the bush of death, then we are forced in the 11th hour to tell people "Your mother is going to die, do you want to allow this to happen?" We can't do anything unless you turn over your ranch to pay for all our beeping, computerized, spiritless taskmaters, who rule our lives and rule our deaths.

I am so sorry that you are feeling down about this. It's a symptom of a bigger problem in our society, we think that because the life sustaining measures are available, then it is automatically unethical to not "do everything", because anything short is "giving up", or even worse, we may be found negligent by a sue happy lawyer.

The fact is that this woman lived her entire life on her own terms, and now she is dying. Doctors have to offer all of the options to the family - insured or not - and of course, they love their mother, so why would they be the ones to "sentence her to death". Even when there isn't an education gap, families struggle with the concept that letting their family member die is not the same as killing them. I feel that part of my job as a patient's advocate is to have the family understand that too.

I can write for hours about this issue - I understand what you are going through and for what it's worth, I switched to the ER so I could get away from it for awhile. People still die, still get put on "life support", people still come to us with big educational needs, but I do what I can in my allotted time, hopefully have set the educational groundwork for another nurse or doctor to run with, and I don't have to deal with the issue on the same person and family for three consecutive shifts in a week. It was too much at times.

Blee

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Thanks for the support. Amazingly, the patient made a huge turn around today and ended up doing well on 1L NC. The husband was so helpful and down to earth. He told me that they lost some lifestock to coyotes last night. I really enjoyed the quiet simplicity of this family. The doctor wrote for a social service consult to see if they could get them on medicare so she could get a lung transplant.

That family really loves each other and are totally tightknit.

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Specializes in midwifery, gen surgical, community.

I am just gob smacked (UK expression), that in the richest country in the world people have to beg to get the money to pay for a lung transplant.

Our NHS has many problems, but if something like that happens money does not come into it.

Good luck to your patient.

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For some reason this thread reminded me of the client in a nursing home that was nothing more than a vegetable after he had overdosed on PCP and it took six officers to subdue him. He was the first person I ever saw who had the "doll's eyes" sign. His poor mother and brothers would make a trip all the way up from Mexico on a regular basis to visit him. All he did was lay flat in bed and eliminate with the help of tubes and was fed through a G tube. I know that the state was paying for him to be in this condition and wondered why there was no effort to ship him back to Mexico for his own government to foot the bill. At least if that were done, his pitiful mother would have been spared the trips that were not easy for her to make. Just a thought about who is entitled to care and who can't get any. Deplorable state of affairs if you ask me.

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