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.

[LasVegasRN]

So many points to respond to.

First, Fab, thank you for taking the time and the risk of attempting to shed some light and understanding on this issue. As a parent and a nurse, I would have to agree that I would have to refuse this assignment. I don't think it would make me "un-kind", just that I couldn't participate in the case. I'm fortunate because I'm not directly involved in patient care and don't have to make that decision.

Second, Hospice is a viable option in this case for the following reasons:

- Unable to do the EGD for the reason Caroladybelle gave. The GI specialists refuse to touch this case with a Platelet count of 14.

- Hespan is not going to save this person, nor will the other volume expanders

- All the Procrit, Reglan, Protonix, etc is not going to save this patient.

- With hospice, the patient can have comfort measures and all the time needed with her family.

Pedi-tubes are being used for blood draws.

My next question and consideration I may have to discuss with the docs on the case today is DNR status and if I should proceed with a Hospice evaluation. It will be a sensitive issue to approach, but I have to consider it the same as with any patient who makes decisions to withdraw or not have life sustaining measures. Thoughts?

[LasVegasRN]

Originally posted by obillyboy

The golden rule..........Do to others .. well you know how it goes.

Not that simple. I would do whatever is necessary to save my child. Period.

[SmilingBluEyes]

Originally posted by LasVegasRN

Not that simple. I would do whatever is necessary to save my child. Period.

I have to agree. It is NOT an issue that can be simplified with such a pat line. WAY too complicated. I am not wise or kind...just a mom and an RN with a strong opinion, like everyone else.

[Hooligan]

I believe if God gives us the ability to comprehend, understand, and share the limited healing powers He entrusts us with, it is a sin not to use them.

I could not agree more!!! It reminds me of the joke about the the religious zealot in the flood...this is not to make light of the original post in any way but to further explain my believe... the premise is that there's a man stuck on his roof pleading to God for help during a flood. After a short while along comes his neighbor paddling by in a home built raft and offers help. The man politely refuses and replies "my God will save me" and he continues to pray to God for help. A while later the water has risen even higher and a rescue worker in a power boat offers his assistance and again the man refuses saying "thank you but no, my God will save me!" The rain continues to fall throught the night and the water has risen so high that the man is crouched upon the chimney shivering and wet and still pleading for God to save him. Shortly before dawn, the Coast Guard flies by in a helicopter and sends down a ladder for the man. Once again, he refuses and declares "my God will save me!" Unfortunately the man is overtaken by the flood and dies. Upon entering heaven, he asks God..."Father, why didn't you save me?" To which God rolls his eyes and replies..."For Pete's Sake, what more do you want? I sent you a raft, a power boat, and a friggin' helicopter..."

I personally believe we have acquired our knowlege for a reason and if we werent meant to use it, we wouldn't have it!

~Bean

[ayemmeff]

Originally posted by bean 76

I personally believe we have acquired our knowlege for a reason and if we werent meant to use it, we wouldn't have it!

~Bean

Are you including our knowledge of the development of WMD etc. in that?

Not flaming you,just curious?

It sounds a little to me as if you are implying that humans don't have any choice and any knowledge we have *must * be used.

[LasVegasRN]

I don't feel comfortable sharing too many details of this case - I don't want to tread on confidentiality issues, but at this time the patient has a new diagnosis and the physicians are discussing transferring the patient to a facility that is used to handling cases such as these. The Hgb is down to 5, petechiae is there, and now questioning intercranial hemorrage in addition to everything else.

I was involved in the physicians conference and all are extremely frustrated with this, but are handling it professionally (I really have to commend them). We have the house ethics nurse involved and I'll get started researching facilities. :stone

[nursedawn67, LPN]

Originally posted by emily_mom

Christian parents are often confused about the issue of corporal punishment, believing that they must spank their child in order to be godly parents. They take literally the phrase, "Spare the rod and spoil the child." Some religious teachers reinforce this notion by quoting scriptures out of context. Among the verses they cite: "Folly is bound up in the heart of a child, but the rod of discipline will drive it far from him" (Proverbs 22:15); "He who spares the rod, hates his son, but he who loves him is careful to discipline him" (Proverbs 13:24); and "Do not withhold discipline from a child; punish him with the rod, and save his soul from death" (Proverbs 29:15).

At first reading, these passages might seem to support spanking. But this is not the only way to interpret them. The term rod is used throughout the Bible in connection with the shepherd's staff: "Your rod and your staff, they comfort me" (Psalms 23:4). The shepherd's staff is, in fact, used to guide wandering sheep along the right path, not to hit sheep who stray. So a compassionate reader could interpret the Bible as saying that parents must lead and guide their children but not harm them. This teaching is developed beautifully in the book A Shepherd Looks at Psalm 23, by Philip Keller.

Finally, note that references to the "rod" are found primarily in the Old Testament. In the New Testament, Christ preaches compassion, love, and understanding, as does Paul. We would hope that all parents, hearing teachers warn about sparing the rod will remember Paul's words in 1 Corinthians: "Shall I come to you with a rod, or in love and the spirit of gentleness?" - William Sears

You are totally right, StevieLynn! Many of the Mennonites in our area believe in this, but they don't beat their children either. You can make anything sound like God's word when taken out of context. Thanks for bringing this up. :kiss

Wow I never heard it put this way that "the rod" can be a symbol for meaning "to guide". Thanks for posting that.

[Stargazer]

I hadn't heard that before either, Kristy, but it makes a helluva lot more sense to me. Thanks for sharing that.

Vegas, nothing useful to add except a big (((hug))) to you! This case sounds very difficult emotionally for everyone involved.

[JedsMom, ASN, RN]

I guess I would be the "unkind" nurse too. I just don't think I could stand by and watch it. Too much overprotective mom of an 18 year old in me I guess.

My SIL is JW. She and another JW came to my house many years ago to talk with me about the JW faith. The issue of blood was brought up then and I told them both flattly that if I had their beliefs I would not be there right then to even be having that conversation. The conversation ended shortly there after:o

Such a sad situation. Couldn't do it with my son. Not saying anything against them, I just couldn't do it.

[Flynurse]

Vegas, I can understand your frustration, and certianly it would be a hard case to take on at any level of care. In my own situation though I would do anything for any of my patient regardless of religion. That's just who I am.

However, I am a person and I do have personal beliefs and feelings of my own. In my own life I do not persecute anyone d/t his or her beliefs. But there are just some things that happen in each of our own lives that makes us go one way or another. Does not necessarilly mean that we would hate or ridicule, we just choose not to go that way.

Before I get too personal I think I'll sign off here. I send all that are involved in this and any other situation similiar my best...may you keep the strength to help those in your care!

(I really don't like getting so serious, it makes me grouchy!:) )

[LasVegasRN]

Flynurse, I think I understand what you are saying... it's not my religious beliefs that makes this case difficult, it's being a mother and a human. The plain and simple truth that faces all the caregivers and health professionals on this case is that we are all parents who can not and do not understand allowing a child to die.

Okay, on a professional note, I got in touch with our JW hospital liason who is assisting with finding bloodless facilities nearby (we met with the house ethicist) and proceeding from there. We also got a list from the JW liason of alternative treatments which thankfully we had already instituted the ones that are applicable in this patient's case.

[Hooligan]

Originally posted by ayemmeff

Are you including our knowledge of the development of WMD etc. in that?

Not flaming you,just curious?

It sounds a little to me as if you are implying that humans don't have any choice and any knowledge we have *must * be used.

Not feeling flamed...I just didn't think I would have to specify "medical" technology on a nursing board...