Categories
intensivecare

Real Orders from a Patient Chart

WTF?!? Once again, I’d like to remind you that I work in an adult ICU.

Lol, so can the patient watch tv or not? And why is that my job???

Categories
intensivecare

When patients’ families get TOO involved

We have a patient here in the ICU whose been admitted to the hospital for two months. That is a long time to be anywhere that’s not home, especially when you’re sick. She has been in the ICU for more than a month.

During the course of her hospitalization, her mother has become her rock—as you would expect. But what the mother has become to the health care providers cannot be described so nicely.

Is she controlling? Yes. Is she demanding? Yes. Is this understandable? Yes.

But has she turned her adult child into a will-less person who can’t speak for herself? Also yes. Does she coddle her and tell the nurses she won’t get out of bed because she’s tired when getting out of bed is literally the only thing that will help her get better at this point?

Does she ask the doctors for opiates and benzodiazepines on behalf of her daughter’s severe pain and anxiety? Does the daughter as a result always looked totally out of it and unable to participate in her own care?

I can actually feel myself getting angry as I write this. Then why am I even doing it, you may wonder? Because today, we were presented with a list of unacceptable and acceptable nurses to care for this patient. And we were gifted with a daily schedule from her mom, in coordination with our supervisor.

Really? Taking directions from a non-nurse.

So, apparently the mom has caught on that the incentive spirometer is important. But she doesn’t seem to realize how important anything else is, nor does she seem to care that nurses may be off schedule due to their other patient’s medical condition or unavoidable delays in pharmacy or dietary.

Also, giving a critical care nurse a schedule like this insults the years they spent an education and training in order to become skilled enough to take care of patients who are trying to die all day every day. Not to mention that each critical care nurse usually has their own internal clock, rhythm and way of doing things. It follows the same trajectory as all the other nurses but also has individuality.

This is a DOCTOR’S ORDER that mother requests no tv watching. WTF?

In the end, do you know what’s really happening here? This mother, who can’t come and be with her daughter right now, and who feels very lost because she cannot control the diabolical illness affecting her child, has chosen to lash out at the only thing she feels she can control. The nurses.

But we are not her employees, nor her slaves. We do our best to accommodate the families of our patients but in the end, WE DO WHAT’S BEST FOR OUR PATIENTS.

And in this case, it might be forcing her to get out of bed, go longer in between doses of Ativan and the big D Dilaudid so she can wipe her own face and FaceTime her own mother. Because, just to remind you, I work in an adult ICU.

Categories
Quick Notes

Real things families said to me, # 2 & 3

A family of a terminally ill covid19 patient (who now has multi-organ failure on dialysis as well as bacterial lung infections on top of the damage done by the severe ARDS caused by the covid19 virus) asked that we call a doctor in Texas to discuss treatments with alien dna that could help. They were referring to “Trump’s doctor” Stella Immanuel who also swore by hydroxychloroquine, which is now disproven as a treatment for covid. One question: where do we get the alien dna?

Another family of a terminally ill patient (who also has multi-organ failure on dialysis plus more than 15 surgeries that started as a complex hernia repair at another facility) asked that we try a high dose cayenne pepper derivative to cleanse their loved ones blood and raise his blood pressure. I assured them that the medications he was on were much stronger than cayenne.

Categories
pandemic

100% True Things Told to Me by Family Members of Patients in the ICU, #1

“It doesn’t take a doctor to figure this out.” —a daughter, referring to her treatment plan for her mother that she has figured out after some time on the internet. FYI, her plan to fix her 96 y/o critically ill mother with covid19 who has been on a ventilator for 2 weeks and is 7 (out of 10) days through the severely ill Remdesivir clinical trial but now has to “pause” the antiviral treatment due to kidney failure: “just keep giving her the Remdesivir and then cure her kidneys with Lasix.”

I spent 2.5 hours on the phone with 2 different daughters because of this foolhardy notion. The problem is: I can explain clinical trials, multi-system organ failure, creatinine/GFR, and the mechanism of Lasix till I’m blue in the face. But A) they still won’t understand, and B) it won’t help them come to terms with the impending death of their mother and begin the grieving process. Still, I tried to help with both those things. There was one moment, when I paused to let a message sink in. And one of the daughters drew a shaky breath, followed by only silence. In that moment, I’m hopeful something got through.