Our Own Misconceptions

[kmchugh]

Guys, please bear with me. Normally, I'd find the thread about public misconceptions pretty funny. I might even have my own additions. But this morning, I am just a bit bristly, and I find it really offensive. That's not your fault, it's mine. Like I said, my emotions are a bit raw this morning. See, we are taking my mother home from a rehab hospital (s/p fall with femur fracture), taking her off all of her meds (a list as long as my right arm, including lasix and digoxin) to allow her to pass peacefully. We will of course, put her back on her pain medicine (a story unto itself, I'll get there). This morning, I am a bit angry with the whole medical profession. OK if I vent?

First, my mother. 87 years old, severe short term memory impairment, hypertensive, hx of CHF, severe, painful osteoporosis, hx of lung cancer with lobectomy, recurrent lung cancer with metz. (Actually, there's lots more, that's just the worst of it.) And before I forget, chronic, severe pain for which she has been taking both oxycontin and percocet long term. Late last week, she fell and fractured her femur. My brother, who she lives with, called the ambulance. Seen at the hospital by an orthopod, who told my family that fractured femur repair was "resident surgery" and that mom would come through it "just fine!" (Know what two orthopods studying an EKG is called? A double blind and stupid study.) I asked prior to the surgery if anyone planned to discuss the surgery with anesthesia. "No, the surgeon said it would be OK, and I wouldn't know what to ask anyway!" (This from a brother with is a clinical Psychologist, married to a family practice DO who specializes in geriatric patients. In fact, that little brother, who happens to be a CRNA, would even have the cheek to ask is pretty annoying.) Of course, orthopedics gave my family the option of "taking mom home and letting her die of a broken leg," along the way not mentioning that she could be made comfortable, allowed to pass peacefully without surgical intervention that would likely as not kill her. But then, how could an orthopedic surgeon bill for that? "What's in it for me?"

She gets through the surgery, but upon emergence from anesthesia, is essentially unresponsive. This has been her pattern with surgery in the last few years, and it takes her several days to get over. Two days after surgery, she is discharged from the hospital, and sent to a rehab hospital. Day one at the rehab hospital, a physical therapist comes in to work with her. During the session, her sats drop (surprise!!). Let's get a chest x-ray!. Oooh, look! Spots on the lung! Is that metz, atelectisis, or maybe pneumonia? Don't know! Wonder if there is another CXR to compare it to? Maybe at the hospital?? Well, gee. We can't have anyone with spots on their x-ray at the rehab hospital!! But, that night, my sister the veterinarian finds mom pretty alert. The next morning (yesterday), she is alarmed to find mom far less alert, but far more agitated. A little investigation reveals why. The nurses at the rehab hospital, following protocol (orders?) took my mom off ALL her pain medications, and replaced them all (MS IV and IM, oxycontin, percocet) with Tylenol. Why? Well, that's what we do at the rehab hospital! (What, rehab ignores history and makes patients suffer because they can't be bothered with understanding chronic pain? They can't treat patients unless they patients can come off all pain meds?)

So, after this tragedy of errors and arrogance, after going through surgery, transfers, hideous pain, a lack of caring, and plain, blind stupidity, we are finally going to take my mom home to let her "go in peace." We could have done this a week ago, and saved her so much suffering. The thought of it brings tears back to my eyes.

And believe me, there is plenty of anger for my family as well. Since I am "just a nurse," I can't possibly know as much as my brilliant SIL who is a doctor. I can't be as smart as my genius brother, who is a psychologist I couldn't even be as knowledgeable as my pretty bright sister, who is a veterinarian. I'm "just a nurse." Nevermind that I've worked in ICU's. Nevermind that I am now a CRNA. I am just a servant of physicians, and couldn't possibly have any real knowledge.

So, maybe try to put yourself in the patient's shoes. Sure, some are a PIA. But others are not. Maybe that lady on the vent banging on her bed rail trying to get your attention is in pain. Or maybe she's frightened and just needs a little TLC. Maybe that patient you figure is just drug seeking really is in pain, and needs those meds to function on a day to day basis.

Sorry, this is rambling and venting. I know that. I also know you all to be pretty compassionate. We all need to vent about patients sometimes. This is just my turn to vent about how some people in the profession treat patients. Again, I apologize if I stepped on any toes. Thanks for listening, I really needed to vent. I'll be back after mom's funeral.

Kevin McHugh

[Morning-glory]

What a nightmare. I too have had my share of "what the hell do you know?".

Take care of your mom and yourself.

Hugs,

Jacquie

[traumaRUs, MSN, APRN]

Kevin - you have my sincere sympathy. I am so sorry that your dear mother has suffered so much in the last week. Even though we are adults, it still hurts deeply when our parents are ill. Are you utilizing home hospice services? My experience with home hospice has been wonderful. They more than made up for the stupidity of the hospital personnel. My father died almost three years ago when he voluntarily quit taking all his meds (anti-hypertensives and diuretics for end-stage CHF). He was alert and oriented and just didn't want to live if he couldn't still be very active. We utilized hospice care and they were absolutely the most wonderful nurses in the world. He was very comfortable and thanked me over and over for arranging for them. I hope that you won't get offended, but I will keep you and your family in my prayers.

[berry]

My condolences to you and your family, I think most in healthcare start to see pts as numbers not people because a variety of reasons . When a family member or we wind up on the other side of the bed rail, it is sadly an eye opening experience of just how impersonal the healthcare industry is.

[Danianne]

hugs

I have been on the other side of the bed rail and I know how it feels but I also know how it feels to have some to care for you. Your mom will feel better just knowing that you love her and by the care that you give her personally.

[CrunchRN, ADN, RN]

Wow - that is horrible. Taking her off all the pain meds after everything else is just brutal. I cannot believe none of the nurses advocated for her. As to you being "just a nurse". Thank god nurses are usually compassionate, empathetic, and have the common sense that other disciplines sometimes lack. That said - when it comes to a member of your family it is difficult to retain those qualities and hopefully that is the reason your sibling were acting like such dufuses! I am glad you are fighting the good fight for your mom, and hope you can take some time for yourself. I am sure the emotional toll and stress of all this is very exhausting. Your mom will benefit from everything you have done and are doing. Please take care, Kim.

[NRSKarenRN, BSN, RN]

Sorry you've had to experience the difference good/bad nursing care can make to a loved one's life. I've been in similar shoes with family, but as the only college grad. Since I've guided/cared for both sets of grandparents, numerous aunts and uncles through health crises and death, my family has learned the value of NURSING input and trusts nurses over the docs. Maybe it's time for your family to learn this as well. TRUST that nursing gut, chose your hospice wisely and savor the time remaining with your mother. She is lucky to have you for a son as your caring shines through. Your experience will enrich you and your care of patients as never imagined.

{{{{{{Hug from PA}}}}} to get you through the days ahead. We'll be here for you.

[suzanne4, RN]

Kevin,

Sorry that you are going thru this. I have had to go through things with both my grandmother and mother, but luckily they were both at a hospital that I had worked at for years and I was able to get what I wanted done for them.

There is absolutely no reason for anyone to have to suffer like this, and to hear that "you are just a nurse" puts the icing on the cake.

Just know that we are here for you.............((((((((hugs)))))))))

[mommatrauma, RN]

Kevin, sorry that you are having and had such a bad experience both with your mom's doctors and your family members...My thoughts and prayers are with you...

[talaxandra]

For what it's worth, Kevin, you and your family have my deepest sympathies at this awful time.

I'm so sorry that a situation which would have been difficult and heart-wrenching has been compounded by the arrogance and insensitivity of not just one or two but (it seems) all the health care providers involved.

Withdrawing long-term pain meds is heartless, and not even discussing alternatives to surgery for someone with as many problems as your mother has sounds short-sighted.

Having you profession and experience disrespected, and by your family at that, sounds like the last straw. I'm glad that you at least have somewhere to vent - and you know that, even when people here disagree, one thing we share is an appreciation that nurses have real knowledge.

I will be thinking of you and your family.

[Nurse Ratched, RN]

Dude, that sucks beyond the telling.

I'm so very sorry that your mother is dealing with all this and that your very relevant experience has been discounted by your family. I know we've all been on the receiving end of the "just a nurse" crap to one degree or another, but I can't even imagine the frustration you must be feeling.

I hope your mother's passing is as peaceful and pain-free as possible, and that you know you've done all you could for her.

[MissPiggy]

We utilized hospice care and they were absolutely the most wonderful nurses in the world. He was very comfortable and thanked me over and over for arranging for them. I hope that you won't get offended, but I will keep you and your family in my prayers.

I too lost a parent about 2 years ago; sadly, she got on hospice for less than 24 hours before she passed but I really feel like calling hospice in on the case is the best way of expressing your love for them, as the hospice folks are so caring and gentle - they are concerned overall with keeping the pt. comfortable, which is what you seem to be so angry about from the former care that your mom got; the lack of consideration. For now, spend some precious time with her before the end, but also take care of yourself. Reassure her that you love her and will all be ok after she is gone and give her permission to go; even if she is not conscious you know that the sense of hearing is the last thing to go, so somewhere in that state she will hear you and will be reassured.

You will be in my thoughts more than you can imagine.