So, the patient I was writing about, the man who's been bedridden for four years. To make his history short, he's status post left renal transplant and pancreatic transplant also. I mentioned in my last post that he has issues with depression. Well, today, some smart-ass Doctor who's never even worked with him before, goes into his room and tells him that his pancreas has failed. His blood sugars have been high because he's been on steroids to deal with renal transplant rejection, and while the pancreas is also being rejected to somewhat of a degree, it's not technically failing yet. Yet this Doctor, without even speaking to the patient's parents first (who were out in the waiting room), goes in and tells him his pancreas has been rejected. The man was in tears when I went in to remedy the situation. He wanted to sign out AMA and I told him I didn't blame him one bit. I called his Attending, and we discussed. His anemia that had brought him in (the reason for his admittance) was now better resolved after 4 units of red blood cells, tho not optimum but it was enough that he could leave. His urinary tract infection had resolved. He hadn't had fever for days. His strength was better. Granted, his BUN/creatinine was still elevated and his blood pressure was high, but he could go to dialysis and get his prescriptions at the pharmacy just as easy as he could in the hospital. So, the Doctor said he would sign him out first thing in the morning, to which the mom emphatically shook her head no, to which the Doctor said, "fine, sign him out AMA then." So, that's what we did. They called their ambulance service and he should be leaving right about now.
My main issue here is the insensitivity, not to mention the incompetent behavior, of the Doctor who conveyed this 'news' to the patient. She didn't know a thing about him, yet she took it upon herself to relay this (wrong) information. I came across this earlier, with a different Doctor, after I attempted to bring Physical Therapy on board. He's been in bed here for 2 weeks, and while the nurses turn him every so many hours, to ward off bedsores, he has a pressure ulcer on his left heel that's already reaching grade 2 or 3. I wanted someone to work his legs to better his circulation and also just to help keep his muscles from complete atrophy. The Doctor said, "sure, although I'm not sure what good it's going to do him NOW" ... right at the door of the patient.
I could have strangled him. I understand that things get busy and sometimes we forget that patients are real people, listening to our every word. But I mean, really, is it so difficult to move down the hall or even go into the Physician lounge to state your case? And in fact, the Doctor was in fact wrong, just because someone is bedridden with little hope of walking again is no reason to think that PT will do no good "NOW". It can still do a LOT of good "NOW".
To make things even worse, the patient had said that if he could get into a wheelchair he would stay. I had been off with other patients when they all tried to get him in. If I had only been there, I lift heavy weights and even though I have a bad back from years of lifting boxes/concrete/hay, I KNOW I could have gotten him into that wheelchair. Just the fact that he asked to do it sends a strong message. So, when I was with the family later, I told them about a lift that I used with a woman with Multiple Sclerosis who I took care of for a few years. It's a hydraulic lift that has a belt attached to a chain that raises up with really minimal exertion on the part of the person who turns the crank. I just got home when I remembered that I hadn't told the family how they could get one, and in fact realized that I myself don't know. So I called his nurse, who told me that would be something they would request through their social worker, and she said she would relay the information to the parents before they left with the transport ambulance.
We could have gotten him in the chair. I hope they follow through with that.
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