Thursday, January 30, 2014

This was an ethical problem with a simple solution.

If you have a patient who's been a heavy drinker and heavy smoker (like five 40-ouncers and a couple packs a day) since their teens, and they're now in their 60's, and they live with family members who are unlikely to stop smoking and drinking just to keep them healthy, and they also live in a food desert and have multiple comorbidities and things generally suck, it is not a dereliction of duty not to suggest that they get their carotid arteries Roto-Rooted in order to restore blood flow to their brain after a minor stroke.

Especially since no amount of improved blood flow is going to repair the damage caused by forty years of vascular dementia. You could've driven a truck through this guy's sulci. I mean, seriously. There was so little working brain tissue in his skull it would've been a crime to reperfuse it.

So we sent him home on blood pressure medicine that he won't take, and aspirin that he won't take, and comforted ourselves with the knowledge that, had we done everything in our power to make him better, he would've been nickel-and-dimed to death with tiny strokes. This way, what with the drinking and smoking and high-fat food, he'll likely have one huge stroke and that'll be it.


In response to a question below in the comments on the last post: Where I come from, "CCU" means "Critical Care Unit." It's the same as an ICU. NCCU, therefore, is Neurological Critical Care, whereas NSCCU is NeuroSurgical Critical Care. There is no difference, just as there is no difference between an LVN and an LPN--they're both skilled nurses who aren't allowed to hang blood in this state. The difference in terminology is a conceit of the facility, nothing more.

And with that I'm going to go eat junk food and fall down for a couple of days.


Geno said...

Don't forget the 40's so you won't have to remember.

Silliyak said...

Obama's death panels have proved frighteningly incompetent as it turns out.

Anonymous said...

I have only just discovered your blog and as a nurse and a citizen really appreciate your frankness, honesty and good writing

messymimi said...

Simple solution. But not easy. Nothing in a case like this is easy.

RehabRN said...


If you are lucky, he'll have one big one and they'll find him when it's too late.

Or if he's typical of my favorite kind of dysfunctional families, they'll find him while he's still breathing, get him to the hospital, and keep him on life support ("because we ALL have to say goodbye" and/or because we feel guilty that we never cared before now) until someone has the wear withal (usually the DPOA out of state or equally far away) to say Mr. BadHabit didn't want to live on life support.

$100K or more later, instead of letting Mr. BH out of his suffering, we'll provide psychological support for people who never cared anyway.

That's the real shame.