I took care of a pt for the first time the other day and the whole scenario really bothered me.
An 80y.o., very depressed since their spouse died (no one wants to address this, but that's another issue). Post-surgery came to us intubated (which is the norm) but my colleageues weren't able to extubate due to pneumonia. When I got the pt the other day, they had just finished traching, even though the pt had expressly stated to the mds, family and in their living will that they didn't want to be trached.
Despite being fully cognizant of this, the docs after a bit of pushing, convinced the family (who was also fully cognizant of the pt's wishes) that "it's just pneumonia" and the pt "will get over it, so let's trache."
After asking around, some of my colleageues were all for it (I get the impression that the nurse taking care of the pt when the decision was made was also pushing the family for it), but I don't think that was right. Sure pneumonia can be treatable, and respiratory is (for the moment) the only system "in failure," but I still don't agree with what went on. I understand when you lay out the options and the family chooses "everything" even though the pt doesn't want it (living wills aren't legally binding in my state), but actively pushing for something like this that's against the pt's wishes is wrong to me.
What happened to respecting the pt's wishes? Or advocating for them? Am I off base here?
This is why I want DNR/DNI tatooed across my chest so there's no misunderstanding my wishes.
A tattoo is not a legal document and personally, I wouldn't pay any attention to it if a patient had that tattooed on them and coded. Who knows what the circumstances were when he or she got the tattoo? Drunk? Depressed? Thought it would be funny? Maybe was serious about it but has since changed their mind but, you know, since it's a tattoo it's on there forever?
Mr Ian
340 Posts
well i think he made his wishes patently clear.