The phone in my pocket rings. I have been an ADN for all of three days now. I am still orienting, though my preceptor scheduled to teach a class while I covered the house. Her presumption of faith in me is both inspiring and terrifying. The er is calling. They have a patient that has been discharged, but the daughter is refusing to take the patient home, claming she cannot care for her mother.
My stomach knots at the prospect of confrontation. I do not feel ready for this. This was just supposed to be a summer job as a staff nurse in between sessions of my regular job as a school nurse. They offered me a hefty paycheck and the role of adn; nothing more, nothing less. This was what I had gotten myself into.
I calm myself and remind my already jarred nerves that I deal with difficult people and family members all year long at school. But there it's different. There I know the rules off the top of my head.
I walk past my preceptor classroom and hear her giving a brief lecture on central line dressing changes. I decide I better fully assess the situation before I call her out. It seems like she's on a tear anyhow about the order of betadine and alcohol.
The er is hopping. They could certainly use the space the now discharged woman is occupying. I slide up the counter to get the story from the nurse caring for the patient.
"Mrs. Taylor was brought in by squad earlier this morning. Daughter said she couldn't walk. Doc ran all sorts of tests - nothing physically wrong. Patient can walk too, just is a bit unsteady." I nod and jot a few notes on my worksheet.
"I just think the daughter's had it. I need you to tell them they have to leave." the nurse rattles off the info without ever looking up at me. It seems she's had it, too.
I glance through the chart and head in to the stretcher slot. The patient is a frail woman with a pleasant smile; the daughter is well dressed and has permanent frown lines etched into her skin. I explain that the patient has been discharged and the hospital has no reason to admit the patient and that they need to make arrangements to get home.
"I can't care for her, she has to stay." the daughter gives as her defense. "I brought her here cause I can't take care of her."
I look over the patient. She rolls her eyes in her daughter's direction. It's obvious she is even less comfortable with this confrontation than I am.
"You guys can do whatever you want - admit her, send her to a home. I can't care for her." the daughter repeats and flips her cell phone open to send a text.
I explain that the doctor sees no reason to admit and that I cannot just send her to a nursing home. Especially at seven o'clock on a Friday night. I gently offer to arrange for transport to bring the patient home via ambulance. This is quickly vetoed as the daughter states she can't get her to the bathroom by herself. As I debate offering to send home a bedpan along with transport, the daughter threatens to "shove her in the car" and "leave her there all night" with a promise to return first thing in the morning to the er to start the process over. I advise them both in no uncertain terms that a call to aps would be made should that be the case. I quietly wonder what she would have done to toilet her mom if she kept her in the car all night. My stomach knots again. Perhaps it's time to call out my preceptor, or at least go and hide in the morgue and cry for a moment.
I take a deep breath and offer to call the after hours social worker to see if she had any suggestions. The daughter agrees, though I am worried she will just leave the er and leave her mother behind. I get in touch with the social worker who agrees that the patient does not sound appropriate for admission. "i suppose," the social worker sighs, "if the daughter just leaves her here we can admit for observation. Medicare probably won't cover it, though." she warns.
Meanwhile, I have a surgeon that needs to book an or add on for the morning, three nursing units have a laundry list of items they need from central supply and I still have to think about staffing for the night shift. Taking a quick cry break sounds better and better. I shrug that off and instead opt for a quick scream inside my empty elevator car.
I fill out the booking for the or add on, dash down to central and find all the items with impressive speed and stop by the office and make a few last minute changes to the nursing assistant float pool assignments. After swallowing half of my coffee, I am ready to return to the daughter of the year in the er. I am still half expecting her to have left the patient high and dry. To my surprise, she is still there, frown lines visible from across the room.
We hash out the details of the case again. I explain to her that we can attempt an observational admission, but that it would likely not be covered by insurance. This calms the daughter down, but she it still not satisfied. A rapid response is called overhead. I explain to the woman I would return after I responded to the emergency and we could decide what they wanted to do then.
I meet my preceptor en route. "how is your night going?" she smiles, reading the stress on my face. I fill her in as we approach our emergency.
When the patient was stabilized, I made my way back to the er, expecting to now have to find a room for this unnecessary patient. Without checking in at the nurses station, I round the corner and find the stretcher empty and the patient's gown tossed onto the floor.
"What happened to mrs. Taylor?" I ask as I return to the nurses station.
"Daughter didn't say a word, walked her out about fifteen minutes ago."
I shook my head and walked away. I am angered by the attitude that one could drop their mother off at the hospital as cavalier as dropping a stray dog off at a pound. Mrs. Taylor had apparently avoided the nursing home for another day, though I imagined this would not be the end of this. I haven't seen them since, nor have I had a similar situation since, but I am positive it will not be the last attempted elder drop I see.
