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
