Published Oct 20, 2004
i'm just so damned sick of it and have seen it too many times.
these futile interventions for ca, end stage chf, copd....mds just keep on prescribing new and different treatments. God forbid they admit that their patient just needs to be kept comfortable during the remaining months of their lives, and not days.
nurses see the futility; we can tell when a patient's time here is limited
why do doctors persist in doing everything possible, even if it debilitates the patient even further and makes their remaining time self-limiting in terms of appreciating any time they have left.
typically hospice patients are serviced for 1-2 weeks.
for the past couple of weeks, i've been desperately trying to report a patient's advanced respiratory decline. they ended up giving him a trach and he died, so, so anxious and miserable.
whose needs are mds catering to? themselves? it would not seem to be for the patients.
i vigilantly recorded all objective data yet they ( i won't elaborate) kept on writing o2 sats 96% on ra.....
yet he was anxious, combative, used accessory muscles to breath, diaphoretic and had these eyes that just begged to you.
why was i the only one that saw it?
he would have benefited from ativan and morphine but no, his sats were good.
and i'm heartbroken. he died a needlessly horrible death.
what will it take to give some of the doctors a much needed dope-slap?
who can i write to? the ama?
any input would be muchly appreciated and moreover, needed.
it probably won't help, but i just wrote the ama's council of ethical and judicial affairs, sharing my thoughts and experiences.
i also asked for referrals to try and undo much of this barbaric concept of heroic life saving measures.
again, if anyone has any ideas as to who i can write, let me know, will you please?
A big hug for you (((((((((((((((((((((((()))))))))))))))))))))))))))))))) I couldn't agree with you more....Let me add I have also had difficulty with the majority of geriatric NP's I've encountered. Aren't they capable of seeing what we see, or at least respecting our judgement, or are their egos that large???
I'm sorry for your loss. It's very discouraging to know you have the ability to help, but are unable to do so..
I worked 3.5 years doing hh and hospice. I changed jobs at the end of August and am working for a hh agency that will be adding hospice pretty soon. We are in a rural isolated area and many of the hh patients that would be good hospice candidates stay with us and hh since the nurses and office are local. The nearest hospice comes 1.5 hours up the river and up the mountain. They do a good job but it is hard being so far away when the patients need help NOW. We try to do a good job for our patients and those that would be hospice we treat that way even though they are technically hh.
Problem is the local doctors have no idea how to deal with hospice patients and seem to not take what we say seriously. I admitted a man with end stage lung cancer 2 weeks ago. He is a very stoic fellow and denied any pain. I went over and over with the family that they needed to call us any time if and when he started having pain. On the first visit I went ahead and called the MD to get an order for Lasix (to try to pull some of the fluid off of him to help his breathing.) They had an old rx for him for Phenergan. He was c/o nausea and I told them to give him the Phenergan to help with the nausea and rest. He was also very anxious so I asked the MD for Ativan. 10 pills of each were called in 3 days later when I went back. 10- that's it. The man is dying.
The next week when I went back he was in much pain. They had an old rx for hydrocodone 10/650 that the family hadn't told me about. They were giving that to him and it wasn't touching the pain. I called the MD office and reported this asking for Duragesic, Oxycontin- something longer acting for the pain and also for breakthrough pain meds. I told them the family would be by to pick up the rx later that day. I was very specific about what he was taking that offered no relief and again pointed out that he was pretty much eaten up in cancer and suffering.
2 days later I went back. He was still in pain. The MD had given them a rx for hydrocodone 7.5- less than what he was taking with no relief. I had no idea any of this had happened. Yes, the family should have addressed this to either our office or could have called the MD office themselves. They should have taken some action but they are quiet country people who don't like to cause a fuss. They made the decision to change to hospice because his pain control was not addressed adequately at all. It reflected poorly on me, but I don't know what else I could have done. I blame the MD for this.
I have a feeling that they will not be happy with hospice since they are coming from so far away and aren't local. We had been seeing him more often than they will probably see him. I let them know that he could come back to us at any time and I wished them well. It just makes me so mad that the doctor did not address this better. I hate to see patients in pain. I think I did everything I could have done. I can't write rx but did make recommendations based upon almost 4 years in hospice.
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