Saturday, April 23, 2016

Do not be this person.

This week I wanted to die, in a sustained and sincere manner, rather than return to work after my first shift back from vacation.


Because I had a patient. Who weighed six hundred pounds. That's a BMI of 79.9 if you're counting, and not something that you want to aspire to. However, the trouble was not the patient. The trouble was one of her family members, the one Person You Should Never, Ever. Be.

This Person was, she claimed, a cousin-level relative of my patient and, she claimed, a neuro ICU nurse. The fact that she was a neuro ICU nurse at a hospital in the most far-flung district of the most distant, inbred county of Back Of Beyond that Texas can provide didn't matter; she was, by God, an ICU nurse who dealt with brains and That was It.

She questioned why we were doing her relative's transesophageal echo under general anesthetic with intubation rather than at the bedside. They do them all the time at the bedside in her ICU, after all. I was forced to point out that with an airway that doesn't even register on the Mallampati scale (graded from 1 to 4, with 4 being the most difficult to maintain), a BMI of nearly 80, and the need for continuous BiPAP while awake, her cousin was not the best candidate for living through bedside sedation.

Then she accosted our doctors, asking why we hadn't either given TPA or done a clot retrieval on her cousin. Her cousin presented to her small-town ED ten hours after her symptoms began, thus making her ineligible for clotbusters. And she'd had a watershed stroke, which means that there are a lot of itty-bitty clots along one pathway that one large artery follows, so nothing to retrieve.

In short, the Family Member You Should Never Be knew just enough to be dangerous. We had it out when I found her increasing the rate on the IV pump. My patient had congestive heart failure, and CHF patients can't take a lot of IV fluid, even if their kidneys are working well, which this woman's weren't.

We all fell suddenly and irrevocably in love with Dr. Hernandez, who took the brunt of her questioning. When her voice reached near-hysteria levels as she demanded, "Why didn't you do MORE?? You haven't done ANYTHING!" he responded, "Why didn't *you* do more before your cousin reached six hundred pounds?"

Because, People, this is the thing: nobody weighs five or six hundred pounds without somebody helping them out. At that point, it's difficult, if not impossible, for your average five-foot-four woman to get her own food. Extreme obesity is like heroin addiction, but with family support and enabling. It's harder to treat than heroin addiction, but just as deadly. And the families of these folks have often been the go-to people for high-calorie food in quantities that would blow your mind.

So yeah, that happened.

It was kind of a long week.


messymimi said...

You've said what i've believed for a very, very long time. Once you get overweight enough to where you cannot get your own food, if your family continues to feed you so that you gain even more, they are not helping they are enabling. They are not being loving. If they love you, they will bring you salads and encourage you to get help and regain your health.

Mari said...

Aaagh - I hate dealing with family members like that! And I have never understood why families continue to feed people all sorts of junk when they are bedfast.
Hope next week is better for you.

bobbie said...

Twit. You have my complete and utter sympathies.
And bless Dr.Hernandez.

gela said...

That was me last week. Bible thumping family members behaving VERY unchristian like. Fortunately I stood my ground. I was still mentally exhausted by the end of the night.

Brian said...

You "had it out" when she changed the IV pump rate? You're far more kind than I. In my hospital that's grounds for immediate ejection. If the visitor has been otherwise cooperative and pleasant and the nurse is feeling kind, they might instead get one warning first.

Even if it's the patient's POA, still we call security and have them escorted from the unit. They can make their care decisions by phone from the lobby if they want. And if they make a scene out there, they can earn a ban from the whole facility.

Elle said...

That patient's family member didn't seem to realize there's a difference between being a patient's advocate and telling other people how to do their jobs. People these days often seem unable to behave with basic respect for others. If they had ever thought about being respectful, perhaps they would have considered saying, "Here's what we do where I work, but I want to learn from you and understand better why the general anesthesia was necessary and a bedside procedure was not possible." Instead, the person's fear took over and she ended up screaming and trying to be in control of a situation that was NOT IN HER POWER to control. *sigh* I'm an advocate for my 84-year-old mother because she often can't remember the sequence of events in her health care or the meds she now is taking. So I spend time having conversations with health care professionals, explaining her history and asking questions on her behalf. It's easy to be afraid and to question why certain things are being done, but you're right, a little knowledge made that woman a pain in the ass. Totally agree with the thing about the family being satellites co-dependent with the food addict. They probably grow up with the message "food = love," and they love the person, so they don't say no -- "I can't let her starve!" Good for the doc to stand up for the nursing team. I'm actually surprised.

B-Kat said...

Jo - I love reading your blog! I've been an RN forever and I hate stupid families. Including idiots in my own family.
I've quit wondering "How stupid can you be?" New levels of stupid seen all the time. That cousin should shut her yap and start washing and drying out the folds. For F sakes.

cowango said...

The families most times are the ones I find most tiring. The ones that accost you in the nurses' station, stalk you at the doorway of other patients' rooms. It's tiring, and all I can do to maintain even a hint of accommodation for fear the poor dears would give us anything other than an "excellent" rating on the PG survey. Stand your ground.

Lynda Halliger Otvos (Lynda M O) said...

Once again, you show us why nurses are heroes every day of their lives. Unbelievable that a person can get that heavy and "not" realize the unhealthiness, facilitated by the family and friends who profess to love. That "love" sounds like the love of an incestuous father for his daughters--i.e. not the kind of love we want to perpetuate.

Dr. Alice said...

Aargh. I remember a patient like this when I was a resident. Enormously obese, and wound up in ICU developing massive skin breakdown. My theory was that she had outgrown her blood supply. I remember the family standing around her bed feeding her, and of course that night she vomited and aspirated, and it all went downhill from there.

Anonymous said...

Nothing I hate more than a family member who claims to have a "medical" background. Have had everything from a physician sibling to a CNA child who all loved to put their 2 cents in and me fighting the eye rolls and stopping most of them. What gets me is the number of them who are questioning and confrontational - this usually comes from less educated people even med students ugghhh!

I have been a visitor in the hospital and never once told anyone what I did or where I worked. The last thing I want the nurse or provider to know is my background - it serves no purpose.

woolywoman said...

Ergh. I try to keep it quiet that I'm a nurse when I or loved ones are hospitalized. My md knows, because I met her as a resident. Ditto on the IV pump- time to leave the bedside. And bringing or buying food to the hugely obese? They'd get a bowl a cereal, a fruit basket, an 2 lean quisines day out of me. If you want more, get mobile enough to cash your check and drive to the store. But, I'm educated, heartless, and not codependant. Obviously this family is non of these.

RehabRN said...

We had a bariatric patient in the last year and I found myself holding in exactly what you said.

No one gets to 700 without some help. Sometimes you just have to say no.

If he/she would have asked for heroin, no one would have blinked at saying no.
Just sayin'...

BTW we had at least 3 workplace injuries related to this very patient. It is scary.

Amanda said...

Love this post! I work in Progressive Care and we have ceiling lifts in all the rooms. It is still amazing to me that to do a clean up on someone who is 600 pounds takes roughly 5-6 people...even with the lift. Don't be the family member!