Restive State

No longer is this my work blog, just place to chat about life. No more nursing stories, no more work stories, just me, my thoughts and things I like to talk about.

'Til later...

Let me preface this post by saying folks need medical care regardless, even if demented and combative...access to health care should be a universal right. But shouldn't we question why at times?

Report read, "AMS, agitated, combative. O to self, swings, spits, calls out. From hospice. UTI? Comfort care?" Not a great way to start. That was pretty much the gist. Severe dementia, chronic subdural with midline shift and significant atrophy, recent history of fall. Ativan made her more agitated, and she was all mine, all night long. She was small, tiny in fact, swallowed up by the regular bed she was curled in a near fetal position in the middle of the bed. Sleeping. For now. Do the norm, vitals, assessment, make sure she wasn't wet or in pain (not an easy task that), all the time she was calling out, trying to tear her IV out, not a family member in sight.

I read the notes the doc had written, the records from the facility she came from (especially the one about history and difficulties with male caregivers) and could not understand why we had given up our last monitored bed. The family did not want anything done, she was there because why...? So I gave her scheduled meds, tucked her in to sleep the night away. Except for some moment of calling out, she slept. I began to think. If she was here because of a mental status change or a shift in her meds, couldn't the facility have handled this? Weren't they used to dealing with the degeneration that happens at the end of the life cycle? Or was it because the family was feeling guilty she had fallen at the facility they had left her at? I don't know and have no answers. A hospital is a place to get better (ideally) and she was not going to get better, or stabilized for that matter. For two reasons: first, her disease process was very advanced, no coming back from that. Second, family didn't want anything done. We had people in the ER that needed the bed, needed the lebel of care our floor provides, but there she was.

We got dumped on, plain and simple. No one wanted to deal with her, she was orphaned by the system and her family, left to the care of strangers. So I did what all good nurses do, the best I could do for her. Make sure she was comfortable and not in pain. Not thirsty. Not wet or dirty. Tried to comfort her when she called out, obviously freaked out by the strange environment and let her rest. Nothing else to do.

Perhaps it is a failing of the health care system. Or that the familial guilt was too overpowering. Maybe it was that overriding thought from the older generation that you go to the hospital to die, when passing surrounded by friends and family instead of semi-private cold sterility is a more human(e) way to go. Whatever it was, she was stuck in the middle of it and didn't even know. Trying to maintain mental and psychological clarity in this without reverting to cynicism is hard. Trying to care without attaching labels or comparisons is worse.

'Til later...