Nursing home patient approximately 999 years old, give or take a year or two, full code of course, demented as hell comes in as we like to say FTD (fixin' to die.) She is dry as a bone, tongue looks like beef jerky. Her rectal temp is 95.1 degrees - an ominous sign, meaning she has been sick long enough that her immune response is all used up. Hypotensive with a BP of 63/37 and a heart rate of 172. She also weighed about 72 pounds. Loving family wants everything done.
NOTE: if you truly love your grandma/mom/aunt/sister etc. don't make us torture them to death performing painful, unpleasant and often undignified things to try to save them when their quality of life is zero to begin with. If you do - may you be damned to eternal hell.
We are miraculously able to get an IV in and begin some fluid resuscitation. We put in a Foley to obtain a urine sample and to measure urine output. I insert the Foley and at first nothing comes out, I am about to remove it - thinking it is in the vagina - when out oozes a thick, horrible smelling brownish red material that is so horrible smelling that it makes a couple of us gag.
She makes a slight improvement and we sent her to the expensive, oops! I mean intensive care unit where she died later in the day from overwhelming sepsis.
And the nursing home nurse wanted us to believe that she had been fine up until that morning.
Tuesday, September 9, 2008
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'oozes a thick, horrible smelling brownish red material'
Sorry but EEEEEEEWWWWWWWW! Gack... hate futile care, hate families that can't see the truth.
Too bad there's no legal protocol to prevent families from dictating excessive medical care for people who are actively dying. Why couldn't the nursing home just provide comfort measures and let her go (because the family wouldn't let them?)?
Ya know, a little peri care could've gone a long way...
The care of elderly people (ever heard of the dual code status- full if witnessed arrest, DNR if unwitnessed--> not sure if you see this in the States??) and the chronically ill who have such low quality of life is such a sad prolonging of what would otherwise be a peaceful transition to death. I think death isn't the enemy- a bad death is.
Thank God she was too sick to respond to the treatment on which her family insisted. It could have been so much worse.
I think when people say, "do everything," they are thinking of what they have seen on TV: perfectly quaffed starlets with nasal O2 and one IV lying in a clean, comfy bed while doctors with serious looks on their faces perform miracles. If they had the slightest clue what "everything" really meant, they would be horrified.
I had a non-verbal, demented NH full codeur with a rectal temp of 92.5 the other day. Not too often you see that in an (at least temporarily) alive person.
It is pure and adulterated selfishness on the family's part to continue life-prolonging measures on most patients. If they could REALLY see what we see on a daily basis, maybe they wouldn't be so insistent on full codes and "do everything possible."
After a code, I try to "clean up" and make the patient look as decent as possible for the family. With an ME case, you can't do that--you have to leave tubes, catheters, everything as-is. Family has to see things AS-IS. And I haven't had one of these fail me yet. The family is HORRIFIED! They can't deal with all the suffering the poor patient probably had while we were trying to "save" their life.
Someone needs to go after the nursing home for gross neglect.
Fuckers.
Urosepsis is such fun stuff!! I am sure that the pt was fine until "just after change of shift when she just wasn't herself." I really think they only check the pt's right before and right after change of shift.
I had a pt once that was "shitting ice cubes" because her rectal temp was 88 degrees F. I kid you not. Needless to say, she died before she got to the ICU
This is exactly what happened to my mother. She was 70 and in rehab for a stroke at the time. Yes, we wanted everything done. She was in rehab and supposed to come home to us!! We had no idea that the neglect from the rehab center was fatal. Don't assume all family members know what you know.
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