DRS ARGGGGHHH! Can't live with them, can't shoot them!

Published

Specializes in Emergency room, med/surg, UR/CSR.

I spent the last two nights taking care of a women who is alive through the "miracle" of technology. She's not a pretty site, swollen, unresponsive, decorticate posture, you get the picture. Her primary doc comes in and asks how she doing so I tell him, "she's doing terrible. Her output is about 140 ccs for 12 hours, and it is wrong for her to be in this condition." Well, he waltzes over to her bed for all of 2 minutes and waltzes back and tells me 'well she has bowel sounds (yeah right...NOT!), and her labs are improving so she could end up getting better, he doubted it but she might get better. I just look at him and tell him "no she won't." Well, he smarts off that I don't know that and that it is the family's decision anyway. I agree with that statement, but I wanted to tell him and that HE is her doctor and HE needed to be frank with the family about what she is going through, and that they need to be kind and let her go to her Lord. But I didn't. The whole situation just brought back memories of my mom so I walked off and started crying. I thank God that her doctor was kind enough to tell us the brutal truth about her prognosis, he was also available to us whenever we needed to talk to him. He always returned my phonecalls and talked frankly with me about my mom, he even called me at home long distance to let me know that her condition had deteriorated to the point of no return. He was so great. Anyway, I digress, with this patient, even though he knows her output is not even a tenth of her input, he is keeping her on feedings as well as IV fluids, she is so swollen her eyes are bulging and her skin is weeping. It's disgusting! :trout:

Query:is it legal to kill a doctor for stupidity and arrogance if you're careful to hide the body where it can't be found?:uhoh3: JK!!!!!!

Sorry this is so long, just had to vent.

Pam

Up Vote Up Vote ×

I'm so sorry... how sad to have to witness this. Is there another doctor you can consult, or can you call her doctor? She can't be comfortable with that much fluid buildup, isn't there someone you can consult?

So sad...

Up Vote Up Vote ×
Specializes in Critical Care/ICU.

This is the perfect example of the kind of patient that needs attention by an ethics committee. Is there not one that you can call for a meeting with the help of your NM? This sounds more than sad....it sounds unethical.

Up Vote Up Vote ×

I agree with the ethics committee suggestion.

My brother was a CHI too, and he ended up herniating a week later. His neuros were always open with me too, but not so much with my parents. They treated me as a peer so were more willing to share info with me. They left it up to me what details I thought my parents should know. They did not hide anything from them, they just weren't as negative in their prognosis. For example, they told my parents that my brother would probably survive, but told me that it would probably be with a huge neuro deficit.

Up Vote Up Vote ×
Specializes in burn.
This is the perfect example of the kind of patient that needs attention by an ethics committee. Is there not one that you can call for a meeting with the help of your NM? This sounds more than sad....it sounds unethical.
I worked at a large MAGNET state teaching hospital for 15yrs and everytime I went to the NM with such a problem her response was, "sure, but nothing will be done anyway and they will make all our lives miserable." I think administrations job there was to make sure NO ONE said anything about the emperor (sp?) being naked...:angryfire
Up Vote Up Vote ×

Ethics committees are just toothless tigers. I've never seen them result in ANY action. I'm sorry you had to deal with this Traumamama. I have been there too many times too.

Up Vote Up Vote ×

The only thing I've seen an ethics committee do is rubber stamp what the doctor wanted to do anyway. I'm so sorry you are having to deal with this, and I really feel bad for her and her family.

Up Vote Up Vote ×
Specializes in NICU, Infection Control.

Who's in charge of the service? Is there a doc in charge of the ICU? Even docs have bosses. Try to talk to him. You may not perceive a difference, but it WILL get talked about amongst the physicians, things may change in the long run. And, who knows, he might reconsider. Probably not, but miracles happen.

We have a doc, if we tell him "x", he says "y", and sticks w/it. HE'S THE DOCTOR, dad-gum-it, and don't you nurses forget it! Not to mention, he's the man. Cultural thing in this case. Drives us crazy, frequently. :angryfire :banghead:

Up Vote Up Vote ×
Specializes in Med Surg, ICU, Infection, Home Health, and LTC.

query:is it legal to kill a doctor for stupidity and arrogance if you're careful to hide the body where it can't be found?:uhoh3: jk!!!!!!

pam

yes. i am sure it is. lol. but remember no matter how deep you bury the body, the wild critters might dig him back up... so cremation might be in order.

:gandalf:

Up Vote Up Vote ×
Specializes in CCU/CVU/ICU.

I agree with all that stuff.

However, i am curious as to how 'frank' you're allowed to be at your place of employment? When taking care of these types, i'm generally up-front and honest with the families. Families need that. If you hide behind "it's a HIPPA law that blah blah... " or "you'll have to talk to the doctors blah blah"...or, etc., it can sow distrust or a lack of faith in your competence.

There're obviously 'bad' and 'good' ways of doing this, and it's one of the more difficult skills that icu nurses need to develope (master!), ...though (unfortunately) frequently they dont...

NUrses are often the person that initiates the 'DNR/comfort measures' stuff with the family (meaning gets the idea/thought-process going...doc just makes it official).

As you said docs come in and go, whereas we're exposed to these grieving families for hours/shifts/days on-end. It's been my observation that nurses who 'hide' behind hippa laws and defer to doctors (withought being completely open) have a rougher go of it than those nurses who are more open and honest.

Up Vote Up Vote ×
I agree with all that stuff.

However, i am curious as to how 'frank' you're allowed to be at your place of employment? When taking care of these types, i'm generally up-front and honest with the families. Families need that. If you hide behind "it's a HIPPA law that blah blah... " or "you'll have to talk to the doctors blah blah"...or, etc., it can sow distrust or a lack of faith in your competence.

There're obviously 'bad' and 'good' ways of doing this, and it's one of the more difficult skills that icu nurses need to develope (master!), ...though (unfortunately) frequently they dont...

NUrses are often the person that initiates the 'DNR/comfort measures' stuff with the family (meaning gets the idea/thought-process going...doc just makes it official).

As you said docs come in and go, whereas we're exposed to these grieving families for hours/shifts/days on-end. It's been my observation that nurses who 'hide' behind hippa laws and defer to doctors (withought being completely open) have a rougher go of it than those nurses who are more open and honest.

At our place we can't initiate the conversation, but if the pt/family brings it up we can answer questions so that they can make a decision. We cannot, however, answer questions about the pt's prognosis.....not officially, anyway. Sometimes a meaningful look or a well-phrased comment can give enough information for the pt/family to understand what's happening.

Up Vote Up Vote ×

I too watched my Mom die from non-treatable Vulvar CA, and I agree I was fortunate with the Dr who kept me "in the loop". It was a horrible death, and I'm thankful that the Dr was honest with me, and helped me seek hospice, which eased Mom's journey. By the way, at the time Mom was dx'd as untreatable, I was still in nrsg school. Day I graduated, she was in ICU from a bleed, and Doc said it was OK for her (she was also an LPN) to pin me. She eventually died at the facility I worked at as a GPN. I was always informed of all options, and her prognosis was made clear from the beginning.

I also agree that a look or gesture can say what legally we can not. I'm ALWAYS as honest with pt's family as I can be, and I think they appreciate it as much as I did when I was in that situation.

Up Vote Up Vote ×
+ Join the Discussion