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Not Getting in the Middle of It

Ohhhh I have been away for awhile. I did not think anything could rival my blogging addiction, but my husband wanted to get an Xbox. Many hours have been sucked up playing Catan, Carcassonne, and Viva Pinata :-) I am completely hooked.

Anyway.

A patient I had a few weeks ago was intubated, even though she told her family she did not want to be. When the chips were down, they chose to tube her. She was pretty pissed when the tube came out.

I tried to talk to the doctor about it. I told him she didn’t want any of this, and that her wishes should be respected. He said that she had been unresponsive at the time that the decision was made, the family chose to tube her, and in the absence of documentation to prove her DNI wishes, that was that. But the thing that really got me was this: “It’s between her and her family. I’m not getting in the middle of it.” He said that to me twice.

For some reason it really bugged me that he said that. Isn’t that our job? To get in the middle of it? I understand the lack of documentation, but he brushed it all off, wanted to get on to his next patient.

The other thing that bugged me: When he came to see her, he sat at the computer, looked at her labs, wrote a note and left. He didn’t even go in and see the patient. Was it because she was sedated on a vent? Or was it because I was doing a sedation vacation on her and she was actually awake but difficult to communicate with?

It is very difficult to communicate with people on ventilators. They try to talk but they can’t. It’s hard to lip-read around a tube. If you untie the restraints to let them write they either go for the tube in their moment of freedom, or what they write isn’t legible. Communication boards are a nice idea, but when someone’s coming off sedation, their limbs feel as though they weigh a ton. It’s actually quite difficult for an elderly person to even hold their hand steady enough to point at a picture. If they can even see the pictures and words.

Still, I managed to ascertain that she was ready for the tube to come out whether the docs thought it was appropriate or not. It took me a long time to figure this out and I had to watch many bouts of frustration while she tried to get her message across. Many patients gesture wildly and when the guesses I proffer aren’t correct, the frustration in their faces is heartbreaking. They sometimes literally throw their hands down and close their eyes in defeat.

It’s hard when people who are in charge of your well-being can’t understand what it is you’re saying. It’s scary to be tied down to the bed with a tube you never wanted stuck in your throat while you wait for test results to come back. Test results that determine whether we remove the offending tube, or whether we put you back to sleep to wake you up another day and try again.

I managed to figure out what she wanted, though. It took some time, lots of guessing, and perseverance. It took some patience waiting for her to get over her frustrated moments enough to try again. And then, finally, the tube came out, and she confirmed her wishes to me immediately.

After all that… I summarize the major plot points for the physician and all I get back is, “I’m not getting in the middle of it. She needs to work it out with her family.”

Well good for you. Problem solved (for you). Now you can get on to the next patient. You may as well have written your progress note from home and faxed it in for me to put on the chart. Enjoy the fee you collected on your “patient visit.”

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Trying to decipher what the vented patient is trying to say is hands down one of the most frustrating things about working in the ICU. I can’t believe this doc wouldn’t go in to the pt’s room PARTICULARLY because she was on a sedation vacation (that’s the only time where you can come close to communicating, right?). I wouldn’t be surprised if this was a result of a guilty conscious for not “getting in the middle of it.”

You did the right thing by advocating for your patient. It’s too bad the doctor didn’t see it that way…

How ironic that you blog about this. I spent the morning trying to get my hands on a copy of “five wishes”. I am being evaluated for a transplant now so I imagine my code status is going to have to be changed. My father in law passed away two weeks ago. He had a MI in the Ct scanner, and they didnt know he was a DNR and called a code on him. He was brought back to life after being bagged and chest compressions, and put on BIPAP, and for two days he was on a morphing/narcan, BIPAP no BIPAP rollercoaster. What a way to go. More info regarding this subject needs to be givin to the public. Period. Geena, please contact me at robertwalkingeagle@gmail.com Thanks

Sounds like he’s a little fried.

so much for being an advocate, right? it is always hard when family members don’t agree about things as important as this, but the docs’ words and explanation usually bear a lot of weight.

Geena,
I love you! why sint there more likeyou?? Not one nurse,NOT one DR.Would take any thing,any Q” from my dad.Even though on his admissions,he Signed NO “Power of Attorney” and NO Advanced Directive, They allowed his sister to be his Contact and his POA? My father was not married,he didnt give her this,and I am his next of KIN!! as was my 4 other sibblings! YET,they deflected me..I asked for a matress, for him,his room stank(now I have all the records and I was right all I asked for,by day 5 BED SORES) and after the orignial first surgery,he hemmoraged!! so…they went back in,?HE never stopped recieveing blood 2-3xs a week. FOR THE NEXT 6 month of his life! he was on vent,took over 45 days to get a trecsomoty?? and he was sleeping with his eyes open? for 10 days,the doc told me and my sister,later when he was awake and I was asking if he has his phsch meds? this doc,his surgeon said you should be glad he is agravated!! WE thought he was brain dead?THEY let us be tourted like that and never told us any thing about him not one thing untill he woke up,THENafter that statement,NOTHING again!!! blood pout of every orofus,and then jaundace,sepis,ecoli,dciff,strepA,and MRSA,…yet the wore no phnemonia like a damn PEACOCK!?
HE kept asking begging me to help him,the first week of his hospial tourture,I wanted simply to get all his records,surgical notes from both and films to bring to a independant second opinion, THEY deflected me, HUMM I WONDER WHY?
well, I now again know that I have all the records,during the second surgery a needle count was off??and what did they do?he never could use his legs,arms barely,and breath,and never stopped recieveing blood,did something go wrong??WHAT DO you think??
so I see all the nurses doing things with NO GLOVEs,including fixing his bed sore machine ,IVS,his room stank!!! I make a complaint to the health dept,senior sirveces,they send me right back to the very people doing it.
I have every bodys name,and times(shifts) I took photos….I have a ATTORNEY.My father had money in the bank,he could have purchased a citron the first week??? WHO even cared that I begged the nurse to NOT GIVE HIM reglan Fenergrin,compazine!!! They said its not a allergy?? you get Akenostesa(sp) extrapromidal anexity,like hell!!! you cant move,and even further,it does lipademia,and other things ,as when he developedthe sepis, well before he developed the calcium and all that stuff malabsorption!! In my heart That could have been avaioded by#1 no reglan 2# proper mattress and care? #3 nutrition.
besides what the hell they did wrong during surgery,creating any medical intervention FUTILE,bet they made him suffer.THEy with help pain meds…untill they got rid of me,and then gave him a shitt load to kill him”"comfort care initiated” I never saw him again”afetr every dai allmost by his side for sometimes 16 hrs) that was oct 31 2006,he died,they NEVER called me,and THEy wouldnt let me see the body,after 3 days I was called by corperate office”when will you get the body”?? you know your aunt says he has money?
HA ass,I am using every bit of it for a attorney,that hospital will not get on red cent,and I dont want iT!
when fatehrs die daughters cry??WHy when NURSES saw how I was simply there to protect him,and make any ounce of his last exsistance,any more comfortable? I am a Christian that doesnolonger trust,HATe drs,and know they just cover their ass….I am 47,have copd,AM I NEXT?just administer comfort care NO THANKS!
to think that they ODEd him then NO OXYGEN<removd it,and ALONE WAS HE..I cant let this go…I suffer ,PTSD,I am seeing a therapist 3xs a week…I dont want to be alive,waiting for death and tourture?? WHY is this the answer?how can nurses and drs allow people like my dad to be so negalgantly cared for and deflect the one who trys to help him..I can accept death,NOT WHAT TOURTURE and ABUSE of POWEr..HIPAA HIDEING is allowed and it is crimminal..sinfull and evil to just let him lay with bed sores from day 5!! 18x14x3.2 cm deep!!!
that is just one! I have true photos,my husband took,I could not see him like that.fetr being dead so long OH MY GOD..another day gone….I HATE THEM ALL for what they did,and dint let me do….THEY lied and had my visits to 15 min 1x aday and put that my presence made my dad tired??? NO they threatened me,and LIEd.I have wittnesses..SUE the one nurse wasnt using gloes,and I asked sue,where are your gloves?thei wasnt the first time,but first I asked a nurse! she was doing stuff to the VAC machine!! BEd sore??? COME ON?? they killed him..
linda

I think this is the most frustrating thing about Dr’s as a nurse. If you aren’t even going to bother even going into the room, or speaking to the patient while you are in the room why not pay me the big bucks and just let me make the decisions. I’m already the one who calls you 10 minutes after you leave because you forgot to order things the patient needs that I know they can have, but can’t give them with out an order. GRRR Vent over. Don’t get me wrong, there are amazing Dr’s out there too.

Are all intubated patients in your ICU restrained?



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Alltop. I don't know how I got there either.


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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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