Sunday, April 24, 2011

Stubborn, all of them

I thought some of those tough old Yankee birds were a trial when I lived in Massachusetts; they were nothing compared to these stubborn NH Yankees.

I got a 70 something year old man by private car for "trouble breathing", who needed a wheelchair assist from the door.  He was gasping like guppy; his O2 sats were in the 60's.  According to his daughter he had been having increasing shortness of breath for about a week.  He wasn't eating or drinking, and couldn't get off the couch for the last couple of days.  His daughter said "He has emphysema and his inhalers aren't working.  He has refused to come to the hospital, and wouldn't let us call an ambulance; I had to call my brother to help me get him out of the house when he finally relented".

No shit.  He was frail and cachectic, a bearded, grizzled old guy.  He was not on home oxygen.  He did not have nebulizers.  And he continued to smoke (until a few days ago).

"He refused nebulizers and oxygen, well, he is a smoker so even if he didn't refuse it he would probably blow himself up or start a fire".

We managed to turn him around without intubating him, but it took awhile and he was pretty tired.  I assumed he would go to the ICU, but apparently the hospitalist didn't think it was necessary. WTF.  The doc was a stubborn as the patient

Our doc was Arnie,who only works with us one or two shifts per month; in four years I have probably worked with him maybe 7 or 8 times.  I appealed to Arnie that, c'mon, he needed a higher level of care than can be provided on the medical floor. "I think he'll be ok".

Yeah, right; time for an end-around.

I called the nursing supervisor and told her that even on 100%, he desatted to the 80's with minimal exertion and in my opinion, nurse to nurse, (code for the doc doesn't see it that way) he was not appropriate for the floor.  She agreed.  But, since nurses are considered idiots who can't make decisions at this joke of a hospital we had to play games;  nursing supervisors at this religious institution being all female don't have much influence. 

We decided to have the hospitalist see the patient in the ER but still keep him a direct admit. Cripes was the doc downtown and was also given the heads up.  His wife is a nurse and he is one of the few who actually thinks nurses have anything to contribute.

"He's going to the unit", said Cripes.  "Cripes, he's on a non-rebreather!"


I took the shotgun approach to report and faxed it to everyone; the ER nurse I talked to.

"Oh yeah; he's going to the unit".

Like I sad.