our patient:
- doesn’t take his medication, we inform him about the risks and document. He says he’ll take them ‘later’, never does.
- refuses his insulin, we inform him about the risks and document as well as chart.
- refuses his blood thinners, we inform him about the risks and document.
- turns his phone obnoxiously loud, also talks loud.
- insults us several times every day, gets passive-aggressive.
this is not psychiatry, patient is a young, AOX4, fully competent adult.
Fine, you’re a free man and free to do with your life what you want. But why go to a hospital in the first place if you are going to behave like this?
Yesterday we found him unconscious on the floor, vitals were normal, didn’t hit his head. He is being released tomorrow. Doctor agrees.
I have the feeling we’re going to see him again very soon, but he is the biggest asshole I’ve met in my nursing career.
Why do people behave like this? we are literally trying to give him some quality of life and he attacks us each time we open the door. why?
If any of you is a nurse and has some insight, I’m all ears.
Do please notice that I’m not asking how to deal with people like this: we document, chart and move on, but to understand why in the fuck people are like this.
Am psychiatric nurse:
This is a psychiatric issue, just not one that requires inpatient care.
Also we don’t discuss palliative care enough as a society eg: you are welcome to refuse treatment and suffer then die of your multiple chronic illnesses, but you will be much more comfortable doing it at home. I’m a DNR before the age of 30 for this exact reason: I wouldn’t do chemo or transplants or any of that either: just let me glide quietly into that good night on a slip-n-slide of benzos and opiates.
I agree with the MD that discharge is the best option. The bed will be much better suited to a patient that is able to perceive inpatient care as beneficial, because this man clearly does not.
I’m very interested in your comment, as I’m struggling with this at the moment. Kidney transplant and second go-around with cancer. Right from the relapse diagnosis I had a strong feeling I wouldn’t make it, but there were such strong assumptions from literally everyone that you just don’t give up. I think a big part of it is that I’m “only” 40. I keep trying to help them understand what life is like with chronic stuff, but you really just can’t get it without living it, you know?
I have a DNR but I’ve been thinking about stopping treatment for a while. Cancer treatment has been going on 9 months now and I’m just exhausted.
Does your family know about the DNR? What did they say?
Funny story; the DNR was actually a side choice. The main reason I got the advance directive filled out was to bar my family from trying to regain control of me if I an incapacitated. They’re also barred from visiting, or really even knowing I’m in the hospital. I also added the worst doctor I’ve ever worked with to the FUCK NO list cuz hey, while I’m here…
I literally just went on my state website, printed it off and filled it out, then made a doctors appointment and went over it with the social worker, and got it signed and filed.
I signed a DNR when I was diagnosed with cancer. I worked as a Paramedic for a long time. I just choose personally to not go through the huge suffering if things should go bad. I had the surgery but refused the rest knowing problems for someone young having major poisons pumped into their body. I was fortunate and didn’t have to use the DNR and surgery seems to have worked well for the time being, aside from some disability.
My family was understanding but I have always been open about my beliefs and desires about major illness and DNR with them. I’d suggest a frank conversation with those you love. Expect that someone won’t understand but also know your life is yours and not anyone else’s.
My dad signed an NDR.
Former ambulance crew, he’s done mandatory for to frail people and hated the torture he was putting them through. He said they should have had an NDR, as the process of sustaining life was destroying them.
When he had a bad incident, he got his paperwork. He doesn’t want someone breaking all his ribs too give him back a life with injuries on top of a chronic and slowly progressing other issue.