A need to vent on a barbaric happening
How do I start..........with the HIPPA laws as they are I have to be very careful and not give out any identifying information. Oh Hell here goes. I have a 69 year old resident that is a stroke victim. He is aphasic (can't really speak, but is able to get his wants and needs known) This man never complains about anything! He may swear at you now and then if he doesn't like whats happening but I have never known him to complain.
Friday night I went to work and the evening nurse tells me that he is complaining of abdomenal pain. Now this is the deal. you ask him a question he says yes or no. So I ask him if he is in pain, he answers yes, I ask him to show me where the pain is, he puts his hand on his abdomen. Now the evening nurse has alread gone thru the bowel movement thing, and given him a suppository which did not relieve his pain. I take his temp, hmmmmm its 103. Ok, time to do a full assessment. Lungs clear, uring clear, palpate the abdomen.......uh oh, guarding on the right and a very definite positive rebound. I call my supervisor and tell her I believe he has a hot appendix. She comes up does the same thing I did and agrees with me. Simple so far right?
She calls the doc, first roadblock. Resident is comfort care which means no lab draws, no x-rays, no hospitalization. With alot of convincing on the part of my supervisor and myself we get him to agree to send the resident out for evaluation to the ED IFFFFFFFF his wife says it is ok. Ok, this should be simple right??? WRONG!!!!
The wife refuses to let us send him to the ED. WTF???????? sorry about the language! So I give him an IM narcotic analgesic. NO effect from it. I spend all night trying to make this man comfortable.
The next AFTERNOON the wife finally agrees to let him go to the ED to be evaluated. Can you all guess what they found? A RUPTURED appendix! DAMN! if we had sent him in the night like we wanted, it would have been a simple lap appendectomy, and boom back at the nursing home within 24 hours. Now once the appendix ruptures, they have to make a large incision, do a peritoneal lavage (flushing out the infection and gunk) LEAVE the incision open and let it heal from the inside out. Meanwhile the patient would be on heavy duty IV antibiotics and be in the hospital a while.
Do they do this? Hell no! The wife wants him to stay at the nursing home. So they send the man back to me in excruciating pain to die of peritonitis. Again excuse the language but WTF!!!!!!!! Saturday night, Sunday night and last night I am with this man while he is in indescribable pain. The doc keeps upping the Morophine but it isn't helping.
Last night I was giving Roxinal (liquid morophine) 10mg by mouth every hour and still could not control this mans pain! Dear Lord! I had to go into the med room and close the door and kick something. I wanted to hit someone! Just wasn't sure if it was the wife for being a heartless bitch, or the doc for possibly not explaining to the family how horrific this death would be!
I so wanted to call in sick Sunday and Monday night. I did not want to be any part of this barbarism. The only that stopped me was knowing that I would do my damndest to make him comfortable. The family was not there all night to hear this man in pain, I was. My poor CNA's did not know what to do when I burst into tears this morning. But I knew there are a lot of nurses that are hesitant to give morophine when respirations are already suppressed as morophine will suppress the respirations more.
As I said, I have been doing this for 30 years and in that time I certainly have learned to be able to take a step back and do my job with out letting my spirit be crushed each time there is a death. Of course there are always those that get to you no matter what, but you learn to be objective and proud of being able to be part of a loving and peaceful passing. Just couldn't freaking do it this time.
If you read this far, thank you. I think I will go take my Vicodin and flexaril and Elavil and try to sleep and hope I don't have any more nightmares.
Please folks, be very careful and choosy who you pick to be your health care proxy, who you choose to make medical decisions for you, and make sure they know what your wishes are!