Doctor Asked For A "Kind" Nurse

[LasVegasRN]

Let me preface this thread by stating a few things:

1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views.

2. Whatever your belief, please respect the beliefs of others.

That said, I admit to not understanding how parents can stand by and watch their child bleed to death.

Teenager, throwing up blood for 2 days, H & H 6.1 and 17.0. Platelets 14. WBC 1.0. Pancytopenia. A religion that does not allow blood products or transfusions. Essentially we will be watching this patient die. As the majority of us know, some fresh frozen plasma, units of packed cells, the ability to SAFELY do an EGD and the patient would be discharged home in about 2 days.

Instead, in 4 hours when the next CBC was done, the Hgb was down to 5.8.

I overheard the attending doc asking the charge nurse to assign a "kind" nurse as this was a "difficult" case. I felt that was unnecessary, because as hard as it is for all of us to watch this, we still treat the patient and family with compassion.

My main point: I'm hoping someone could explain to me, how in the world can you stand by and allow your child to die?

Harsh question, and I'm sure an age-old question, but I do not and can not understand it.

[leeca]

Seems l'm getting a little hot under the collar. Sorry about that.

l grew up a JW, non practising now, but l copped a lot of teasing and l was hassled because of my parents beliefs, so l tend to go on the defensive if l feel under attack.

l can fully understand where the JW's are coming from, but l can also understand the docs and nurses point of view on the matter.

l know it can be hard for most to uphold a decision based on religion, as there is so many with different beliefs and when you don't understand where they are coming from.

l try to tolerate other peoples beliefs, and when it goes against my own, l try to respect their decsion do what l can for them and leave it at that.

But where children are involved l have no idea what l would do, as l haven't been in that situation, nor do l want to be.

Even tho l'm non practising l still would rather not have a blood tranfusion, this is part religion and part personal view.

l have two children who l don't want to receive blood tranfusions, but l don't know how l'd be in an emergency. My husband is not and has never been a JW and he said to me that if necessary he would agree to a blood tranfusion either for me or our children.

So l have a bit of a dilemma, so that last thing l'd need is docs and nurses getting in my case about blood. It really should be a decision between me and my husband.

l think it all boils down to having respect for other peoples decisions and asking them personally why they won't accept a treatment on offer.

[Disablednurse]

Leeca if you had read all of the previous posts, you would have seen that we were trying to understand the beliefs of the JW, not tearing them down or trying to find fault. I believe everyone is entitled to their own beliefs and I try to always respect them. I know what it is like to have different beliefs, as I have a SIL that is catholic. I did not know about her beliefs, so I asked her so that I would understand. I had friend that was JW, something came up that I did not understand about her beliefs, so I asked her. She explained and I gained a better understanding. People never know unless they ask. That is all we were trying to do is understand.

[caroladybelle, BSN, RN]

Originally posted by leeca

l'm so sick and tired of people making judgements on things they know nothing about.

First of all they do not sit back and allow their children to die, they are happy for docs to use alternative methods to help their children, like Ringers Lactate etc instead of blood. Docs prefer to use blood because its cheaper.

Think of how you would feel if someone tried to make you go against something you totally believe in.

A couple of comments:

Blood is cheaper than Lactated Ringers? Not in the USA. LR in an MD's office runs about $15.00 to $30.00. The T&C for blood runs more than that. And quite frankly, while LR is a volume expander, it still does not do the job that PRBC's will do - and an MD knows it. The PRBC's (especially in case of rapid blood loss) will restabilize the pt more rapidly. It is not done 'because it is cheap' - it is done because it is the best option for recovery.

Starting off with a derogatory comment generally does not rally people to your cause. Enough said.

Vegas:

Kindness can come in many forms and is a very ambiguous term. For an MD to use it in the way he did, displays a total lack of knowledge about what nurses do. And it is inappropriate.

I suppose as an onco nurse - that I have become comfortable with death. It is not the worst thing that can happen to a patient. Frequently, I think that death comes as a friend to many of my patients. And I am very accustomed to watching people die. I find it more difficult to stand by and watch a patient be "Flogged" (the MDs term - not mine!) with chemo, when there is no chance that they will live - because some friend/family member insists that they must fight - when they refuse pain med

because "we are suppose to suffer" in this life. This I find more difficult.

I would be saddened by this case - but if the patient is an adult - I would care for her. She has made a choice that is right for her - while it is not what we would like, we must support it.

It matters not that religion is a factor, it is the patient's will.

[Tweety, BSN, RN]

Originally posted by leeca

This statement is inaccurate.

Sorry, I did know a woman whose own children wouldn't speak to her because she criticized her church and the church threw her out. I just assume if an adult made a conscious decision to take blood, that would be the same as rejecting the church, and the church would shun them. That was an ignorant assumption, using my rational mind, and I'm sorry. I don't really know what I'm talking about.

"l think it all boils down to having respect for other peoples decisions and asking them personally why they won't accept a treatment on offer." Wise words, but your tone wasn't very respectful, but you later acknowledged that. Furthermore, I feel most of the posters on this board have been respectful.

That all said, I think blood is a bit over used. I wouldn't want blood for myself for some of the h&h's I see them prescribed for, unless I was actively bleeding.

I cared for a JW with a post-op hemeglobin of 4.6 and he did fine, he was middle aged. The MD's quit taking blood, because what difference did it make what his crit was, they did a bleeding scan, found no bleed, let him go home when he followed the normal post-op open chole course. I believe he got p.o. iron, but I've seen IV iron used as well. (Vegas, why are you still taking crits on your guy?).

But also would have to look at cost and length of stay. If taking a unit of blood saves money and gets me out of the hospital days earlier, I might go for that.

[Q.]

Originally posted by kittyw

leeca -

How about instead of post after post of you're wrong, why don't you tell us what is right? Take this as a time to teach us instead of just telling everyone else that they are wrong.

Kitty

[caroladybelle, BSN, RN]

Originally posted by ella1

As someone who was raised as a Jehovah's Witness - although no longer an active member - I find it amazing that people love to hone in on the old "they wont take blood" issue! Other religions believe in female genital mutilation for goodness sake but that isnt brought up every time that particular religion is mentioned!

Ella:

As a matter of information, after studying the issue of FGM - it is NOT a religious matter. There are no statutes in any major religion that advocate FGM as part of religious life. It has been found to be purely a cultural matter.

While it has been long associated with Islam, there is nothing in religious law mandating it. It occurs predominately in North Africa, the Middle East , SE Europe. It occurs among Christians (generally Coptic), Muslims, and many Animistic religions. It is generally used to insure female purity.

Thank you - we will return to the discussion at large.

[fab4fan]

3rd Shift Guy: A JW who takes a blood transfusion can be disfellowshipped. Any family members who are JW would not have contact with that individual unless absolutely necessary. Disfellowshipping is a very serious measure; it's not done lightly.

It is not, however, a permanent state. Someone who has been disfellowshipped for, say drug addiction for example, may be reinstated if he/she feels remorse and makes the appropriate changes. Disfellowshipping indicates that not only was the person aware that he/she had committed a grave sin, but also does not have a repentant attitude (similar to "willful misconduct").

A transfusion that is forced on a JW does not result in a disfellowshipping if the JW or family did their utmost to prevent it. This isn't meant to be used as a loophole by the JW or medical staff, however. An e.g. would be a Witness who was having surgery, told the doc no blood, has a signed "No Blood Transfusion" card, has the advanced directive indicating no blood, and writes on the op permit and anesthesia permit "No Blood."

This person has made it plain that he does not want blood. During surgery, a complication arises and the doc goes ahead and has the pt transfused. The pt should not be held accountable for that; he did his utmost to prevent it.

[geleesa]

Originally posted by caroladybelle

Ella:

As a matter of information, after studying the issue of FGM - it is NOT a religious matter. There are no statutes in any major religion that advocate FGM as part of religious life. It has been found to be purely a cultural matter.

While it has been long associated with Islam, there is nothing in religious law mandating it. It occurs predominately in North Africa, the Middle East , SE Europe. It occurs among Christians (generally Coptic), Muslims, and many Animistic religions. It is generally used to insure female purity.

Thank you - we will return to the discussion at large.

jeeze.....lighten up:eek:

[LasVegasRN]

Originally posted by hoolahan

People, Vegas is sharing her feelings and experiences here. I have read zillions of her posts, and she is definitely NOT a "bigot", "unkind", uncaring, stupid, etc...

Can we please express our opinions w/o the personal attacks?? Geez!!! I think Vegas should be commended for reaching out to many different resources, that I would have never thought of, she is not discrimintaing against the pt IRL, just is trying to understand a situation that is personally incomprehnsible if she were to place herself in that family's shoes.

Didn't mean to put words in your mouth Vegas, and I know you can hold her own, but there is a lot of judgement being passed here about you, that as your cyber friend, I do not appreciate or agree with! :kiss

Wow, thanks, Hoolahan!

I also want to thank those who sent PM's. Fab - again, thank you for taking the time to share and care to explain diplomatically.

Leeca - you are officially #6. Figure it out.

[P_RN, ADN, RN]

for leeca: yes I am sure.

[Disablednurse]

Thanks vegas for your PM.

[LasVegasRN]

Anytime, Disabled. :)