| 10/07/08 06:27 PM |
#620
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Kelly Houston
I need to get something off my chest, and I know you are all good listeners so here goes. I don't expect anyone to feel like they need to give feedback...I just need to vent.
As some of you know, I am currently working at a nursing home/ rehabilitation center. A lot of our patients check in, graduate from therapy, and then return home. Depending on the diagnosis, progress, and prognosis, some of these peeps don't check out. They either die or become long-term care residents of the facility or go to an Assisted Living Facility.
It's great when I have patients that have had knee or hip replacements, or strokes or car accidents or the like that are "rehabable" and I can get them home in a few weeks or months. It sucks when they have to give up their home, or worse, their life. Jolee can relate to this 100%. It's tough when we, as health care practioners, realize that progress won't be made and that it's the end of life for our patients. It's even tougher when our patients (and/ or families) don't accept it, or are unrealistic about their future, or are simply unaware that they are in the dying process. Some of my patients are younger than we are, and some are 100. It varies, but I love them all the same.
Okay...here's my yesterday story that I was referring to earlier. I got a notice that I needed to evaluate a new patient just discharged from the hospital to address occupational therapy needs. I read his chart thoroughly and discovered that my offerings would be very limited because he is terminally ill with colon cancer that has invaded his entire body, with exception of his brain. This sweet fella was just driving and mowing grass 2 weeks ago, and went to the emergency room thinking he had a bowel obstruction. Well, upon surgical inspection, it was discovered that his old cancer had come back in full-force fashion and that no further treatment will help him (chemo or radiation). They performed an ileostomy on him (similar to a colostomy) and sent him to the "rehab center" for comfort measures. The hospital doctors indicated in his chart that his prognosis is very poor and that he is "terminally ill with an expected rapid downward spiral with only a week or two of life left at maximum."
I'm sure a few of you are wondering what the heck therapy can do with a dying person. Well, we don't do exercises and get people up walking and that sort of thing, but there are a few interventions that we can do to help with the dying process including educating staff on positioning needs, feeding and avoiding choking on food, oxygen management, toileting with dignity, range of motion to alleviate pain, etc. Most of it is caregiver education and support.
Well, I met "Mr. Smith" yesterday afternoon after reading his chart, and he was such a sweet jovial man and looked just like Jonathan Winters, if any of you remember him (actor). He was a little undone with having a colostomy bag and a catheter and IV lines and other forms of "tetherment" so I explained the function of each and helped him to be comfortable with them (as much as is possible). We had lots of small talk, and I wondered to myself why he was so engaged in lengthy conversation with me. I mean...if I had a week left to live, I would not want to spend it chit-chatting idly with a strange woman in a rehab center.
So, I asked Mr. Smith about his family. He said his wife had just rescheduled her gall bladder surgery for a week or two from now. I asked him why she did so, and he went on to explain that she's been frantic with him in the hospital and was waiting for him to "come home" before she had her surgery. Apparently, her surgery is not urgent but it is necessary in the near future. I questioned the timing of her rescheduling and, again, he said it was perfect timing because he would be "coming home in the next week or two." Okay...I was getting the drift that "coming home" meant "going to heaven" and I was still bewildered on the timing because...who knows the exact date of "coming home" but God, ya know?! I mean...does the surgery scheduler have connections we aren't privy to, or what?
Upon further discussion with Mr. Smith, I discovered that he (and his entire family) is under the impression that he has 2-3 months to live. "Coming home" meant going back to Hot Springs to his house to stay with hospice in the home with him and his wife.
Very long story short...he has not been told that this will not happen. His family is making arrangements for him to come home in the next couple of weeks so they can be with him during his last days. His last days are most likely coming very, very soon. I'm so upset that his hospital doctors were not straightforward and honest about this.
Anyway. Mr. Smith left today to go to another facility closer to his home and family, thank God. I hope and pray that someone can clue them all in on what's going to happen very shortly. I thought about him all night last night. I am not in a position to "break news" like that, but it really ticks me off when this sort of thing happens and I've seen it happen more times than I care to report.
Jolee...what's your take on this from your viewpoint? Morals and ethics, ya know the drill.
Take care everyone.
Stefanie- what's your next guess on my first concert? I need to read your voice.
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