A rant and a rave

[caringpct]

First I would like to say a big thank you to all the patients and loved ones that help. Even though I feel I may be neglecting my patients, they are always happy to help by putting their blood pressure cuffs on, getting an alarm, or taping themselves up after holding. It makes my day a little easier not to mention helps get them out faster to enjoy their lives. Most of the time my unit is very short-handed and the techs work 12-14 hour days while the nurses are always in "meetings" or doing paperwork. My patients are so important. They make my day better.

Now for my rant.  As much as I care for each of my patients, it is so hard to sit back and watch a patient slowly kill themselves. I have gone over labs and fluid intake and things go from bad to worse. This patient is young and newly married, has so much to live for. I don't understand how they cannot take a more active role in doing better. They spent a month in the hospital (which they don't even remember) came back to D got off treatment early once and called in for the next saying they didn't feel well and ended back in the hospital. I'm at a lost. I can't make them care or change their ways, but it hurts to see them go through this. I love my job and patients but sometimes its hard.

Sorry, just needed someone to listen who understands D. I will go back tomorrow and laugh and smile with everybody and remember why I love what I do. Just frustrated right now.

[MooseMom]

Don't give up on this patient.  All you can do is be honest with this patient without trying to browbeat them.  They may be suffering from depression and is sort of in denial.  It's nice that you care.

[caringpct]

Thanks. In my mind once they break ribs doing cpr and spend 2 weeks on ventilators and another 3 weeks in ICU you would start to care and do what you have to live. Hopefully this patient will get better soon.

[MooseMom]

Sometimes people just have to learn their lessons the hard way.  Sounds like that is what might happen with this particular patient.  Most of the time, you just can't tell people anything!  I encourage you to just be there to provide a safe landing place.  I bet that this patient will come to really appreciate you.

[okarol]

For many patients the stress of a chronic illness can cause depression. This is a natural response to  overwhelming circumstances and sometimes acceptance is very difficult, particularly for young people. Imagine your life being forever changed, and try to see that some patients feel hopeless on dialysis.

I get upset when I hear a dialysis unit is shorthanded and over working their employees. The major dialysis chains are profiting millions of dollars every year, and there's no excuse for not staffing their units with good techs with reasonable pay and hours.

[Quickfeet]

I use to skip pills so I could feel normal. I ate food I wasn't permitted, so I could forget I had a medical problem. Denial is very dangerous. I learned the hard way. I don't skip my pills no matter how much I hate them now.

[monrein]

And sometimes patients really would rather be dead.  As blunt and as painful as that is to say, to read or to contemplate it is sometimes the truth for some people and can be the extreme end of the depression spectrum.
It's nice that you care even as you're frustrated with this patient and can you imagine how insanely difficult this is for their loved ones.
Many healthy people engage in self-destructive abuse of their bodies and they don't start off with a body that has already let them down.  We humans are bizarrely complex in our reactions to things  and in part that's what makes us fascinating.  Feeling that you have little or no control over this situation may be what you and this young person have most in common.

Thanks for caring enough to let it affect you on a personal level.   

[caringpct]

Just an update on my patient.
His wife called today to say that he couldn't make it because he didn't feel well. Of course he doesn't, he ran 2 hours last week total, and missed a treatment already this week! We told her if he didn't come in to take him to the hospital. He came in and ended up coding while on treatment. We sent him to the hospital and hopefully this time it will be a wake up call for him.

Thank you to everyone for all your comments. It helps to have other perspectives.

[sullidog]

We have a patient like this, the nurses and techs have told him the consiquences, his problem is they won't let him eat on the machine because he brings a 4 course meal and pukes it all up and since they don't let him do this on the machine he wants off early and doesn't wanna come in. I asked a tech does he know why he's hear, and his tech told me she thought he did but that he just didn't care. This same person comes in 10 kelos over, I'm serious I know cause I sit by this patient and hear them talking of course.
I hope he gets a wakeup call.
Troy

[karen547]

There are people like this at my unit as well, I hear them being spoken to by the nurses, etc. They bring in full blown meals, and are way over their dry weight, etc. I once tried eating a meal 0n dialysis and oh boy was that a mistake  hopefully this patient starts to realize the consequences

[murf]

The worst part about chronic illness is that never ever ends. Same thing, day in, day out. You know that whatever you do, it won't go away. Christmas is the worst. Everybody is letting loose with their diet but on dialysis, you still have to watch what you eat and drink. There is no holiday on dialysis. I don't have any real suggestions to the obvious depression that your patient is suffering from. Some people are born with an optimistic point of view and manage. I am one of those but I also get in the dumps knowing that tomorrow will be the same, and the day after and the day after... I suppose your patient is bit like an addictive smoker. They know what is wrong but can't help themselves. Maybe be constantly reminded that they are "a naughty boy" would not help as well.

[RichardMEL]

*sigh* it often boggles the mind how some people can treat themselves, and by extensions those that care about them - which includes you.

What can you do? There's not much - you have to protect yourself and your sanity by remembering that your job is to assist those patients, but at the end of the day it's their life and their decision - no matter how reckless or foolhardy that may be.

It's heartbreaking to even read this about some bloke I don't know. I feel the same about TexasStyle's husband. I also know folks who do stuff like that and just don't care. The ridiculous thing about missing a session because they don't feel well.. yeah mate you probably don't feel well because of the crap you're putting in yourself. If you had dialysis you migth feel a little better. A clear misunderstanding of what dialysis is there to do.

I feel for this guy's new wife in all of this. I'm sure she's frustrated and upset seeing this happen to him - and time and again into hospital etc. I wonder if anyone has sat with her and tried to explain the situation so SHE understands why these things are happening, and why he needs to be careful with diet, fluids and not missing sessions etc? If she knows it may help a little. If she's ignorant she may be supporting his missing sessions because he doesn't feel well - through ignorance.

It was drummed into us pre-dialysis that whatever you do ALWAYS GO - even if you feel sick , have a cold or something. I've never missed a session and as much as I don't like being there I never intend to miss one.

Again though you need to remember yourself and your feelings and try to not take it too personally. You can only do so much and are NOT responsible for what patients decide to do. It is very frustrating and upsetting, but at the end of the day as long as you do your job to the best of your ability.. if they're not willing to do theirs.. that's not your responsibility.

 

[caringpct]

Unfortunately the wife does know the situation. It has been explained to her on several occasions. I try not to lecture him, I try letting him know I care and hate seeing him like this.

Richardmel- You sound like my boyfriend. He tells me that I need to stop bringing work home with me. If I didn't worry about others then I wouldn't be me. Besides there are too many people in the medical field that don't care about their patients and what they do, they are just there for the paycheck. I want to be a person that makes a difference in people's lives. I want to make people feel the best I can.

[RichardMEL]

thank you - I take that as a compliment that I sound like your boyfriend!

I think it's a GREAT attitude that you have - and it is true many in the medical field don't _appear_ to feel. I think a lot cut themselves off emotionally because they have to. I can't imagine how some nurses and doctors work in their fields day in and day out when it would be a constant reminder of mortality and some could even take a patients death as a personal sign of failure or something on those parts... and of course I'm sure you've had the lecture about not becoming personally involved with patients(for obvious reasons).

There's a line there and it would be oh so hard to not cross it at times. I wasn't trying to suggest to NOT care about these patients, but to realise that there's only so much you can do as someone employed to assist them. You can lead a horse to water so to speak (bad metaphor when talking about those with fluid restrictions!  ).

It's sad that the wife seems complicit, or in denial, or perhaps just feels helpless in terms of what her hubby wants (for example, texasstyle's situation as I understand it). In the end though this guy is going to keep finding out the hard way that his choices are only hurting himself and those that care about him - sadly the next time may be his last.

I also wonder if this guy si rebelling because he probably has everyone on his back constantly telling him to do this, do that, don't do this etc.. and perhaps he feels harassed, badgered etc and that is pushing him away rather than helping him to see the truth of his situation. Some people are like that.

I suppose I do agree with your bf though to try not to bring that angst home with you - if that stuff gets you down personally how will that affect your personal/home life? That's not very healthy for you as a person. I think that's another reason some medical folks become detatched - because they have to.

 

[st789]

Is soothing to know that someone like u caringpct know what dialysis pts are facing.   Thanks!