Monday, August 22, 2005

Dogs and Cats

There is this rule I have concerning patient viability: if an adult patient of about average height weighs less than my dog, then that is Not Good. This rule, over the years, has become more stringent and more likely a predictor of patient outcome, as we have gone from owning rather quite big dogs to, in deference to my spouse's preferences, sturdier but not-quite-as-big dogs.

So this admission was a cachectic 90-year-old man who looked the part of a poster-boy for cancer or some other chronic wasting disease. My wrists were of greater diameter than his legs, and I am myself rather slight.

His lungs rattled like loose tools in the back of 1960 Chevy pickup truck going over ten miles of bad road. Dragging chains. Karen Carpenter on her death-bed probably looked better. No kidding. And though my dog had been placed on a stricter diet by our ever-chastising Dr. Vet, this patient underweighed him by many pounds.

We settled him into bed, examined him, cranked up his oxygen a little, and then his deranged family came to the nurse station, demanding to know "what was wrong with him."

The oldest daughter seemed most insistent, and after sizing up the situation and escorting people to the patient's room, I pulled her aside and apologized for the lack of a family lounge on our unit. There in the hallway I simply said "Your father is dying."

I just tell people what I think. Of course, I cannot offer a medical diagnosis, but I do not feel comfortable holding back on things about which I feel some certainty.

She didn't want to hear it. "There's nothing wrong with him, he's never been sick in his life, he was very athletic, that's not what the doctor told us," and on and on. You could float a barge on it. And she accentuated her plaints of denial with demand after demand on behalf of her poor dad, who was doing all he could just to draw air without lapsing immediately into a coma. To my ears, his every rapid sour breath said "Vent me."

But as there was "nothing wrong with him" the daughter did not want such matters as artificial ventilation even to be discussed. Ever. Anywhere.

Every obvious and reasonable observation I brought to the daughter's attention regarding her father's plight was met with a ferocity I usually associate with large cats in the wilds protecting their babies from, say, hyenas or something.

As a matter of fact, she demanded that we get him up out of bed. "He wants to get up in a chair and he hates being in bed," she insisted. The tele monitor showed his resting heartrate at 140-something, and I explained that in my humble opinion and in light of the stress already suffered by this patient, perhaps now was not the right time.

"Then get somebody else to do it," she demanded. I looked to her husband, and quietly told him that as a nurse, I could not work like this. The look on his face said "sorry opinionless bastard" to me, and by then the daughter and other family members had assisted the patient to a sitting position at the edge of the bed. A moment later he fell over sideways back onto the pillows.

They were furious with me for assisting the patient to a more comfortable position in his bed. While I left the room they howled at me for my merciless cruel behavior towards their dear father in his moment of need.

As expected, my manager was brought into it, and he was as usual quietly supportive of me.

The next day, actually, it was my manager who cared for the patient, because we had sick calls and I suppose everybody just thought it would be better that way. I remember the family seeming to be a little less histrionic in its demands.

The patient died early that afternoon.


may said...

what do we know...nurses don't know anything. if it is THEIR father, they know what to do. denial and other feelings of distress are okay. but rudeness is mind matter what the circumstance.

Anonymous said...

"The patient died early that afternoon."

I think that's what they call presenting reality.

JaneAZ said...

That's so sad. I hope the patient's last moments weren't being embarassed at his bully of a daughter.

SassyNurse said...

This comes very close to what I hate most of having to deal with. The other side of it is the question of "When do you think it will be?" Or "Call me if he/she gets worse so I can be here." My honesty slipped out the other night when I found myself answering "The getting worse is already gotten worse. The next step is the other side." Sometimes my mouth works faster then my brain.