Moral dilemma.

[MomRN0913]

As a HH nurse, I saw a pt, late when the office was closed last night because I was running late because my day was so bad. Should have been an easy visit. The pt is very functional but had a fall which caused a small bleed and they found recurrent brain mets. Pt is AAOx3 lives alone, hasn't been dizzy, unsteady or sync opal for 2 weeks now. She's starting radiation on Monday. Then she confessed she drove today and will on Monday and Tuesday bc she can't find a ride. The doctor never told her she couldn't drive. So I said I'll just clear it by the doctor. She told me to promise not to tell him godfor I'd she can't and he stops her radiation treatments somehow. So here I am stuck in a very crappy place .Ya know this is an hour after I'm supposed to be done on Friday. Call my superivosor who says I have to call the doctor and get a hold of him ( this is about 6:30 at night). She said she has no answer on how to solve this and I'll just have to take care of this one.This upsets me for 2 reasons. Obviously the crappy position my patient put me in. She has a lot of trust in me and I care for her. 2). I end at 4:30 on Friday. However, this is my issue to solve over the weekend. I'm not getting paid this weekend. No one is going to pay me for the calls I am making on my way to a baby shower. I get 2 stinking days where I do t want to think about work, because this has been destroying me lately. Work never gets left there ever.Anyways. I'm going to page this doctor on the weekend, and I think he may clear her, but if he doesn't, it's like I'm holding up her radiation treatments. Although there isn't much he could do short of calling the authorities to say she is. It cleared to drive.This is awful. And left in my hands. On my days off.Please pray this works out well.

[KelRN215, BSN, RN]

Does the patient have a history of seizures at all? If so, whether or not she can drive is determined by state law.

I doubt that not being able to drive would mean that the doctor would stop her radiation treatments. Does your state not have some kind of medical transportation service for people in situations such as this? I imagine if she starts radiation on Monday, she's already met with the Radiation Oncologist and even if the patient IS allowed to drive, I would wonder if the radiation center allows people receiving cranial radiation to drive themselves home afterwards. If they don't, they would probably help the patient arrange transportation. This is really the radiation center's issue to address (I imagine they're closed on the weekend) and they really should have discussed this with the patient when she had her mapping/planning appointments. And, who knows, maybe they DID since the patient told you the reason she's driving herself is because she couldn't find a ride... someone must have suggested to her that she needed a ride.

[netglow, ASN, RN]

Agreed. Do not, I repeat Do not take away someone's access to independence without reason.

Remember not to put yourself into people's lives unless you can be of help to them. You may have offered to check for her if the facility has a connection for transport for her. Or, you might have just suggested she arrange for a cab ahead of time for her visits as she goes on in tx. As mentioned above the facility will run the rad and discuss her tx with her, you might suggest she bring this issue up with them. It very well may be that they do not allow her to leave without someone to sign that they are driving her home.

One more thing. Your HH office needs to have a social worker - this is part of what they do for a living.

[MomRN0913]

Thanks for the replies. We have a social worker. The transportation was initially not an issue. Before I put one in, I assessed these social factors. She said she never has a problem getting a ride, her neighbors are excellent and drive her everywhere and take her shopping. I asked if this was going to be an issue when we started and she said no. Well, the story changed. On Friday night when everyone was gone. So a social worker will be put in on Monday.I called the doctor and he said she Should not be driving. I made him aware she is and I said how she did not want me to tell him. He just said to document that I made him aware. I think he has no intention on doing anything regarding it. He said she should probably be living in a group home to make it easier due to her social situation. My boss wanted me to call her grandson who is the emergency contact I do and tell him, but I don't feel comfortable about that. She awake alert oriented and I don't want to cause family problems.No real history of siezures. She passed out a d hit her head in the concrete causing a concussion. They found the brain mets on that ct scan. She is on anti epileptics but I read it was only as a precaution.The doctor told me that facility doesn't have transportation. We will see what we can do. It has been a crappy situation to weigh on me all weekend. I was just left to fix it somehow over the weekend on my own time. I informed the MD, I think I'm done there.

[netglow, ASN, RN]

Sounds good. HH and Hospice can really suck that way. You are really riding without a "horse" so to speak.