Rationing Healthcare

Today I sent a patient to rehab that had either been in rehab or in our hospital since September. She is originally from Africa and was here visiting her daughter when she got sick (required multiple surgeries). I am told by various people that the cost of her care is anywhere from $3-4 million. She has no insurance, and is covered by Mass Health. So, the good citizens of Massachusetts as well as the hospital are covering it. In all this time.....I can't help but wonder how that money could have been spent elsewhere to help more people. Imagine all the well-baby visits, the medications that could be bought for the elderly, the basic healthcare that could be paid for that people can't afford. Yet when this woman needed help nobody questioned not giving her the care she needed--not even for a second.

This is a good thing, because no where else in the world would that have happened. Healthcare is often for the rich, and in this country it is not. But the fact is that even this country has a limit to its resources. How should they be rationed? What is fair?

Norovirus

Just curious.

Has any other cities been hit with the norovirus? I managed to catch it over the holidays in Cedar Rapids, IA. Upon return back to Boston I hear that the area has also been hit hard. Anybody else?

Lesson Learned

Taking care of Mr. V was quite a challenge. He was the first trached patient I had ever cared for as a solo nurse since I’ve graduated nursing school. I’ve assisted plenty, but haven’t really been on my own, so I looked forward to the experience.

The wife was just as much as a challenge, she sat there all day and wouldn’t listen while I would talk to her husband and explain to him the situation and what I was doing and why. I spent a great deal of time talking to the patient even though he wouldn’t respond because I knew he could hear me. I assumed that she would be listening to all my teaching information, as well as to why I was doing the various interventions. Little did I know that she wasn’t.

My second day taking care of him he was terribly ill: newly septic, 2^nd time with pneumonia, positive cultures of EVERYTHING. I was deep suctioning him every 30-45 minutes, coarse, thick, tenacious secretions that were a lovely shade of green. I was very worried about the patient, and there was a possibility of a bed for him on the RACU (respiratory acute care unit). I worked and worked and managed to keep him on the floor.

The next day Mr. V was looking a little better. More responsive, less suctioning, temperature was not as high. This is when the wife decided to tell the CNS and Social Worker that she felt she wasn’t getting enough information, and that she wasn’t pleased with my care.

Obviously I wasn’t too happy to hear that as I for the previous two days I had spent about 85% of my entire day in his room attending to his precarious position. I felt as if I had given my spleen to the patient, and this is what they think??? After a chance to cool down and some reflection I knew I had to do the right thing and apologize to the wife. She was right, I hadn’t been attending to her as much as I should. I put my pride in my stomach and my heart on my sleeve, and apologized to the wife for not communicating enough to her. I explained that I’ve been so concerned with her husband that I hadn’t realized that she wasn’t getting the information she needed to know. I then went on to explain the reasons behind my nursing interventions, and went on to teach her how she could help us care for her husband. I taught her some leg and arm stretches, and showed her which lotions to apply to his feet and lips. I also explained more about his tube feeds and how Infectious Disease was now on the case and would that could mean.

After I apologized to her again, she looked at me with misty eyes and said “apology accepted.” I can’t believe that in all the care of her husband I hadn’t thought to care for her. Her husband of many years has been in the hospital for almost 30 days after surgery, and she wasn’t even going home at night—but rather to a hospital reduced hotel room close by. How could I forget that? In the end I opened up a better dialogue for her and I, and hopefully for her and other staff so that she will feel more comfortable telling us what she needs.

Lesson learned. As hard as it was dealing with a challenging wife, I had to remember that she had needs too. She cares for her husband a great deal more than I do, and she knows him as a person, I only know him as my patient since he can’t talk. I need to remember to take a deep breath, show more patience, and try to take care of the difficult families as much as I do the difficult patients. Definitely a good thing to be reminded of, no matter how hard it was to face I was wrong.

Patient Advocacy

It is such an important part of a nurse's job to be a patient advocate. I think I spend about 20% of each day fighting for what I think a patient may need above and beyond what the doctors think. I care about the quality of care I give a patient, and I hope that it shows. In a recent example I had to harass the team of surgeons for 3 DAYS to get the staples removed from the surgical incision that had been in for 30 days. Granted the patient had a lot of other things going on that were of much greater importance, but the last thing she needed was to have another chance of a future complication.

To any other nurses out there, don't give up. Continue fighting the fight to get the patient what they need. We do this job because of them, not because of us. They need us to fight for them, they need us as advocates, be strong.

Christmas Eve Code Blue

Hmmm, December was indeed a crazy month. I'm not too pleased that I haven't had much time to post--or anything exciting to post about. Then came Christmas Eve.....

I'm quietly sitting at the desk, finishing my documentation and waiting for my shift to end. Then I hear another nurse scream from down the hall "call a code" and we all rushed into action.

The hardest part for me that night was rushing into the room, helping get the backboard under the patient, and then getting handed the ambu bag. It was the first time I've ever tried to initially resuscitate somebody, and it was incredibly frustrating. I couldn't get air into his chest!! I never had problems with all those dummies in CPR class, I had no problems making a good seal with the face mask, I would re-adjust his head over and over, and still couldn't. I could get his cheeks to puff out nicely, but no visible chest rise. By the time somebody was handing me an oral airway the code team had arrived and they had him intubated before I could hop off of the bed and get fully out of the way.

In the end he didn't make it.

I have spent much time thinking about what I was doing wrong and what to do better next time. I guess I will always remember this, as it was my first attempt.