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Credit: @ThinkAnneThink
nursing humor #medicalhumor #med #medhumor #funny #nursing #Nursingschool - http://bit.ly/2ByDqHG
A doctor discovers an important question patients should be asked
This patient isnāt usually mine, but today Iām covering for my partner in our family-practice office, so he has been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit wonāt be simple.
A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal failure. Itās a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.
Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I canāt blame him.
Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.
With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.
After 30 years of practice, I know that I canāt possibly solve this manās medical conundrum.
A cardiologist and a nephrologist havenāt been able to help him, I reflect,so how can I? Iām a family doctor, not a magician. I can send him back to the ER, and theyāll admit him to the hospital. But that will just continue the cycle⦠.
Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that itās useless to try.
Then I remember a visiting palliative-care physicianās words about caring for the fragile elderly: āWe forget to ask patients what they want from their care. What are their goals?ā
I pause, then look this frail, dignified man in the eye.
āWhat are your goals for your care?ā I ask. āHow can I help you?ā
The patientās desire
My intuition tells me that he, like many patients in their 80s, harbors a fund of hard-won wisdom.
He wonāt ask me to fix his kidneys or his heart, I think. Heāll say something noble and poignant: āIād like to see my great-granddaughter get married next spring,ā or āHelp me to live long enough so that my wife and I can celebrate our 60th wedding anniversary.ā
His daughter, looking tense, also faces her father and waits.
āI would like to be able to walk without falling,ā he says. āFalling is horrible.ā
This catches me off guard.
Thatās all?
But it makes perfect sense. With challenging medical conditions commanding his caregiversā attention, something as simple as walking is easily overlooked.
A wonderful geriatric nurse practitionerās words come to mind: āOur goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.ā
Suddenly I feel that I may be able to help, after all.
āWe can order physical therapy ā and thereās no need to admit you to the hospital for that,ā I suggest, unsure of how this will go over.
He smiles. His daughter sighs with relief.
āHe really wants to stay at home,ā she says matter-of-factly.
As new as our doctor-patient relationship is, I feel emboldened to tackle the big, unspoken question looming over us.
āI know that youāve decided against dialysis, and I can understand your decision,ā I say. āAnd with your heart failure getting worse, your health is unlikely to improve.ā
He nods.
āWe have services designed to help keep you comfortable for whatever time you have left,ā I venture. āAnd you could stay at home.ā
Again, his daughter looks relieved. And he seems ⦠well ⦠surprisingly fine with the plan.
I call our hospice service, arranging for a nurse to visit him later today to set up physical therapy and to begin plans to help him to stay comfortable ā at home.
Back home
Although I never see him again, over the next few months I sign the order forms faxed by his hospice nurses. I speak once with his granddaughter. Itās somewhat hard on his wife to have him die at home, she says, but heās adamant that he wants to stay there.
A faxed request for sublingual morphine (used in the terminal stages of dying) prompts me to call to check up on him.
The nurse confirms that he is near death.
I feel a twinge of misgiving: Is his family happy with the process that I set in place? Does our one brief encounter qualify me to be his primary-care provider? Should I visit them all at home?
Two days later, and two months after we first met, I fill out his death certificate.
Looking back, I reflect: He didnāt go back to the hospital, he had no more falls, and he died at home, which is what he wanted. But I wonder if his wife felt the same.
Several months later, a new name appears on my patient schedule: Itās his wife.
āMy family all thought I should see you,ā she explains.
She, too, is in her late 80s and frail, but independent and mentally sharp. Yes, she is grieving the loss of her husband, and sheās lost some weight. No, she isnāt depressed. Her husband died peacefully at home, and it felt like the right thing for everyone.
āHe liked you,ā she says.
Sheās suffering from fatigue and anemia. About a year ago, a hematologist diagnosed her with myelodysplasia (a bone marrow failure, often terminal). But six months back, she stopped going for medical care.
I ask why.
āThey were just doing more and more tests,ā she says. āAnd I wasnāt getting any better.ā
Now I know what to do. I look her in the eye and ask:
āWhat are your goals for your care, and how can I help you?ā
-Mitch Kaminski
Source
A beautifully written account of what it is like to be a good doctor, whose only concern is: āhow can I helpā.
I wish that everyone asked this question. I had a patient once who was in kidney failure as well as being diabetic. He attended dialysis 3 times a week and was totally noncomplient with his diet and fluid restrictions. His family was upset with him and with us as well as him being upset with us, his family and his doctor. I sat him down and asked him ādo you understand what will happen if you continue to be noncompliant with your treatment?ā He stated that yes he did and proceeded to explain that he would die sooner. We had a long conversation about the fact that this is what he wanted and that his goal was to enjoy what little time he had left. His daughter in law was a nurse in a neighboring LTC facility so I was concerned about the families reaction. I sat them all in a room and asked them to listen closely to what their father and spouse was saying and facilitated a conversation that allowed them to see that he was of sound mind, knew and understood the consequences of his actions and was prepared for the end results. We wrote up a plan where he would attend dialysis only if he was struggling and needed the immediate relief of removing a few pounds of fluid, he would eat what he wanted when he wanted and generally just enjoy life. He had a wonderful last month of life filled with joy, laughter, fun, great food and so much love. I sat with him as he was dying and he said to me that he had a wonderful life with amazing friends, a fantastic family that he was so proud of and a wonderful loving wife. He considered himself an incredibly lucky man. He asked for a chocolate bar and a Pepsi which I brought him and died within an hour of that treat. I wrote his final words down and framed them for his family. They were eternity greatful and still thank me if I see them today. All this because I sat and listened to this wonderful old manās final wishes and desires.
Depression at work
Co-worker to new employee: And thatās Gary over there, but watch out, heās little grumpy today! (Teehee)
Me: No, Karen, Iām not grumpy. I have depression and Iāve been struggling with it lately. When I struggle with my depression, I self isolate so as not to bring others down. Iām not mean or rude to anyone, I just keep to myself and get my job done. Honestly, it takes almost all my energy to come to work and keep my shit together, so while it may seem like Iām āgrumpy,ā I assure you I am not. Depression, Karen. Itās pronounced depression.
**Note: There are more than 3 million nurses in the United States and a study by the Robert Wood Johnson Foundation suggests that nurses are twice as likely to suffer from depression than the general public. By those numbers, more than half a million nurses suffer from clinical depression. Does that make them bad nurses? Or less qualified nurses? Hell. No. Doctors are depressed. Surgeons are depressed. Police officers are depressed. Paramedics and EMTs suffer from depression. I suffered from depression. It does not preclude us from being good at our jobs. However, if untreated, depression can affect our abilities to do our jobs effectively.
THIS
Watching the Grey Cup with my momma bear
ššššššššššššš
Cheering for ABC⦠anyone but Calgary!
GO REDBLACKS ā kick some Stampeder butt!!
Adding that miralax to my patientās drink likeā¦
a friend of mine posted this. today is too much.
Too real
𤣠for real though lol
Always askĀ peopleĀ with dementia for help
āHeās really combative,ā the staff member complained, popping in my doorway. āChristian keeps slapping my hand away when Iām trying to wash his face.ā
āOkay, let me come check this out with you,ā I suggested. We walked back into Christianās room, where he was pleasantly sitting on a shower bench. He didnāt seem ācombative,ā but I watched as my staff member took the washcloth and reached for his face. As her hand went up to touch him, he slapped it away. āSee!ā she cried. āLook what heās doing.ā
āHang on,ā I sighed. It seemed pretty obvious: he was afraid. Most people donāt like when someone they donāt know reaches for their face. āChristian, can you help me?ā I asked. āCan you hold this washcloth and wash your face while I wash your legs?ā Christian nodded and let me put the washcloth in his hand. I guided his own hand to his face and he began calmly washing while we cleaned the rest of him.
ALWAYS ask people with dementia for ātheir helpā with starting an activity. This could be anything: a shower, painting a birdhouse, a walk outside, completing a puzzle.
When people are asked for help, they are much more likely to agree to do the task.
If someone asks you, āDo you want to help me?ā you think to yourself, āDO I WANT TO?ā and thatās what you respond to. If someone asks you, āCAN YOUhelp me?ā you respond to the āCan youā part.
By making someone feel necessary and important, you are way more likely to get them to participate.
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