Just grin and bear it!

[mi_dreamin, BSN]

A little background...

I admitted a patient at the end of my shift Monday. From home with hospice, admitting dx UTI/sepsis/hematuria. He's 91, baseline non-ambulatory, very minimal verbal response, at times combative.

Plan of tx was abx, okay, I can see how that goes with comfort/hospice care, I'm on board, all is well.

Then, before I left Monday I get an order to initiate CBI, oh and can we draw another CBC since his Hgb went from 10.9 to 7.9?

Also we are doing a complete retroperitoneal UTS, which is, in and of itself relatively non-invasive, but what treatments will we do if we find something?

Now to my favorite part...

I had him again today and based on report, physician's notes, consults, and orders the care team is on board with him being comfort care/non-invasive measures. All of the care team, except his wife/POA/primary caregiver.

Denial is more than just a river in Egypt y'all.

She stormed out of a meeting with the palliative team, slamming the door, after death was mentioned. She INSISTED that he be given a diet order and spent all day yesterday and today force-feeding him.

No one is allowed to mention death or speak negatively within his earshot.

Today he was even starting to mottle but, "why aren't we giving him his cardizem and the other 9 (NINE!) vitamins that she gives him every day?

Tonight his IV went bad and his abx were switched to PO so of course I crushed them and mixed them is custard (what she happened to be force-feeding him at the moment).

I said "Mr. Smith, here is a bite with your antibiotic in it, would you like to open your mouth and take it?"

He cracked his lips open enough for me to slide the spoon in.

I put the rest of the custard/antibiotic on the spoon; "Mr. Smith, here's the rest, would you like to open your mouth for the rest?"

Nothing. I touched the spoon to his lips...nothing.

His wife became agitated, started trying to convince him that he MUST take the medicine.

I explained (again) that he has the right to refuse medications and that, perhaps, he has decided he is okay with the consequences of not taking them.

Her words (verbatim) were, "he doesn't understand the consequences...I don't tell him when there is medicine...I never tell him. If he knows there is medicine in it he won't take it...come on Dad, you've got to take it. I know it doesnt taste good, but no medicine does. You've just got to grin and bear it. How do you think women have babies? They just grin and bear it."

And then when he still refused to take it she burried her heas in her hands and with teary eyes said, "dinner was going so well! Oh, it was going so well!"

She's upset that when he d/c tomorrow he will be back under the care of hospice instead of home health

Y'all, I promise I'm a good nurse, and I'm truly not heartless, but you know some days there's that one person...

[Triddin]

You see it a lot unfortunately

[VampyrSlayer, CNA]

I'm sorry. That's so tough.

Also, his wife called him dad?

[mi_dreamin, BSN]

Yup. Also sweetie, honey, and daddy

It was even weirder because with the age gap he could have been her dad

[neonn965]

I get that it is frustrating but it really doesn't matter if the rest of the team is on board with comfort care if she is the one that has legal decision making rights for the patient (I'm assuming she does as health care POA?). It's really one of the biggest issues that I think nurses face in health care today. All you can do is educate and make sure they understand everything and then move on with the treatment plan.

There is no getting through to some people though and to them, any and all levels of quality of life are better than the loss of life. I know you're venting, and these situations get old for sure. It is just one of those things you see so commonly you just have to let it go eventually.

[applewhitern, BSN, RN]

You see a sickly old man who doesn't eat well and doesn't want to take his meds. The wife sees the man she married, loved, and promised to take care of. Why shouldn't she want him to have his medications? It is her decision and she has to live with herself. She isn't ready to let go. She has that right.

[CelticGoddess, BSN, RN]

I'm sorry. That's so tough.

Also, his wife called him dad?

My grandma and grandpa called each other "mother" and "daddy". It's a Hoosier thing (Which is why Mike Pence calls his wife "mother".

OP: There isn't a whole lot you can do. I see this a a lot. I had a hospice patient whose wife actually hastened his death because she would force feed him and give him coke to drink. He aspirated. Unfortunately, that will probably happen to this man.

[mi_dreamin, BSN]

You see a sickly old man who doesn't eat well and doesn't want to take his meds. The wife sees the man she married, loved, and promised to take care of. Why shouldn't she want him to have his medications? It is her decision and she has to live with herself. She isn't ready to let go. She has that right.

I hear you, I do, and I get that piece of it. In most cases I do see it that way and understand, and I tried to flip my persepctive with this case as well. However, I truly believe her "care" is to the point of diminishing his quality of life. When I talked to the hospice nurse she said that when therapy came to the home to evaluate him the wife was pushing him out of bed, he did not want to/was not able to participate.

I know that she loves him and doesn't want him to die and I get that, but I also feel that he has the right to refuse treatments that make him uncomfortable, which is most things at this point.

I know I probably sound heartless but I truly do understand why she feels the way she does. It is just frustrating to feel like I am not giving my patient the best care for him because his wife is unreceptive to education.

[mi_dreamin, BSN]

My grandma and grandpa called each other "mother" and "daddy". It's a Hoosier thing (Which is why Mike Pence calls his wife "mother".

OP: There isn't a whole lot you can do. I see this a a lot. I had a hospice patient whose wife actually hastened his death because she would force feed him and give him coke to drink. He aspirated. Unfortunately, that will probably happen to this man.

I am actually concerned about that...she wanted to know why we wouldn't bring him corn

[brownbook]

Gosh, I see dollar signs....maybe when he dies she loses the house or his pension or something?

I can (and have) loved someone with all my heart and soul but I know at age 13 (for my dog) or age 91 for a human they are going to die.

[cleback]

I'm sorry. That's so tough.

Also, his wife called him dad?

I think that's just a carryover from when kiddos were in their house. When my kids are around, I call my husband dad. I can see how it would persist. My grandparents did this too.

[psu_213, BSN, RN]

Also, his wife called him dad?

Not to take away from the issue at hand, but my grandmother called my grandfather "dad."