When does a patient become "incapable"

More on the same patient I mentioned in the last post (with the crazy family).

She needs a Mitral Valve replacement. Hers isn't working sufficiently to move blood through the heart. Clotting has already developed on it and had caused a Stroke/CVA already.

The problem is....she doesn't want to be treated. Sick all her life, she's says she's done. Now diagnosed in the past as Bipolar and Schizoaffective, the family and the doctors have deemed her "mildly retarded" and incapable of making her own medical decisions. It took 3 ethics committee meetings to determine this.

Personally, I disagree. She's been my patient for an entire week and I think she is completely of sound mind. (Albeit an emotional and sometimes kind of hostile mind) But they determined that this patient will get the open heart surgery she doesn't want.

This patient with a history of pulling out tubes, thrashing against restraints until undone, and throwing things across the room at the staff with be tied up in ICU for a week and then probably sent back to us with a healing open chest.

Yeah, If anything goes wrong....Who does the crazy family sue? Is it right to make a patient go through that kind of recovery without their permission?

I just find it odd that the "mildly retarded" diagnosis wasn't spoken until after she needed heart surgery.

Danger in the hospital

Hospital Shooting last year


Ironic, I just read When a patient threatens to shoot you from Emergiblog yesterday.
Then Today, we had a similar incident.
An Agressive, non-compliant, and very ill patient with agressive, non-compliant, and very mentally ill family member.
We ask disruptive family member to leave, they leave saying, I quote, "I will come back and GET you all"
This wasn't my patient, but the whole floor knew of the disruptions and trouble with this patient.
We called security immediately, they posted a guy on the door.

It's sad when we live in a day in age where we have to be scared of people when they say things like that. The nurse actually told me she was scared that person was going to come back with a gun. I can attest to that nurse being nothing but patient with this patient and family.
There's only so much abuse the staff was willing to put up with.
We are in the business of caring, yet some people still don't see it that way.

C.O.S. Vol. 1 # 8

Change of Shift Volume 1, number 8 is up! For those of you who don't know it's a Blog "Carnival" an interesting entry of links to Nursing posts! Yours truly has contributed in the past but didn't this time.
Please check it out!

NY and back to work

Well, I put off blogging for a week because I wanted to get some good pics. My friends haven't gotten them to me yet so I'll just show you these.


Central Park



The American Museum of Natural History


Polar Bear in the Bronx Zoo

I had a good time on my trip. NY is not a relaxing city. It was stressful combating crowds, figuring out directions. I yearned for the friendly atmosphere and slower pace of Texas. Above all, I missed my baby girl.

It surprised me how many New Yorkers mentioned Ground Zero and asked if we'd seen the "WTC site" yet. 3 NYers told us their stories.

I met Rupert Jee from David Letterman. Nice Guy. I went in to buy a Tshirt for a friend of mine who's a fan. He was working the register.


Rupert Jee at Hello Deli

The highlight of my trip was seeing a Broadway show, Phantom of the Opera. It gave me goosebumps and made me cry.



******

Back to work this week it seems so much more chaotic and busy. Sicker then usual patients. Every bed full. We also seemed more understaffed.

I sat with and held the hand of a Bipolar patient with Kidney issues who didn't want to be discharged last week.
She allegedly had left an abusive husband just previous to her admission and according to her, had no place to go. I talked with the MDs and the social worker. They had been unable to get her into a women's shelter and it seemed to me that they didn't quite believe her abuse story. I, too had my doubts about her story but I did believe she had no place to go.
I was the one who told her she was being discharged, her mood did a 360 degree turn. I sat and tried to convince her that staying at the Salvation Army would be better then going back to her spouse. When I left, she was still going back.....I hope she'll be Ok.
******

Listening to: "I want to want you" by Juliana Hatfield

Tagged!

Tagged!

While I was out of town I was tagged by Janet at Chocolate and Raspberries.
Tricky Woman!

I'm supposed to list 7 favorite songs.

1. "Silent all these years" by Tori Amos ~ Will always remind me of Jenni asking me to sing it acapella at lunch in High School.

2. "Love Song" by the Cure~ Reminds me of Mike

3. "Down so long" by Jewel ~ My favorite song to sing

4. "Movin out" by Billy Joel ~ Reminds me of being silly with my sister

5. "Turn me on" by Norah Jones~ speaks for itself

6. "Pump it up" by Elvis Costello ~Makes me tap my feet

7. "I alone" by Live- That man's voice is so sexy

I tag the first 7 peeps on my blog link list, unless you've already done it.