Some people should NOT be on Dialysis

[nursewratchet]

OK, I have to rant   I have a patient in my clinic, Mrs N.  She lives in a nursing home, and has for 3 years.  She has been on dialysis for 10 years (she is 59).  She is married, although she tells me that the only time she sees her husband, or ANYBODY is when she comes to D.  She is blind, has no legs, and has a feeding tube.  The husband comes to the clinic, three times a week to make sure she "gets on".  Then he leaves.  She has for some time said she is "tired of this".  NO SHIT!!!!!  Anyway,  Yesterday, she comes in, on her stretcher, crying.  Husband is right behind her.  I  asked her what was wrong.  HE said,(not letting her talk)  she just doesn't want her treatemtn today.  I stepped in front of him, to get to her, and asked HER.  She started sobbing, and said she "didn't want to do this".  I talked to her, explained to her that she would die without treatment, Like she doesn't know this after 10 years,but I have to say it).  anyway, the husband is YELLING at her, to get her treatment.  She says no, so I tell the ambulance people to take her back to the home.  The husband makes this BIG scene, yelling at me to give her a treatment.  He says he is her power of attorney, and demands her to have a treatment.  I tell him, that since she is able to talk to me, his power of attorney means nothing to me, and he HAS to respect her wish, and I legally can't treat her without her consent. Anyway, he is going to report me to "somebody"  GIve me a break.  I have a big mouth, it will get me in trouble someday.  The other patients were about to deck him.    I'm still fuming!!!

[Hilrose]

Oh heck! I agree, if the patient doesn't want to have treatment, then we should respect there wishes... especially if they have been having treatment for over ten years...as long as they understanding what they are doing then nurses, doc should go along with it.  I have seen this happen at my dialysis unit, where the patient doesn't want to dialyise or do the complete 4 hours, the nurses just say to the patient you have to have it , it will save your life.... heck what can you do! I think this is a big problem!

[paul.karen]

He must be collecting her checks HUH.
So it would benefit him to keep her alive, seeing he only sees her on Dialysis days.

Speculation of course.

Get em Nursey
PS.  I hope you dont get in trouble :-(

[Razman]

I think that you were right.   The patient has the right to make that decision and with 10 years of experience I think she knows what she is doing.   I once saw a patient that was brought in on a stretcher each time , was very old, no family ever accompanied her and she had Alzheimer's .  As a volunteer I would spend time to help settle her down and the doctors agreed that sometimes it's OK for a patient to stop. We really wondered why the family allowed it.  What did they get out of it!

[kitkatz]

I know when I finally give up they better listen to me!  Got to give you kudos.  I hope you do NOT get into trouble over this.

[willieandwinnie]

  nursewratchet. I sure wish you worked at the clinic we went to. 

[Chris]

Didn't you write about this patient before about something else? Just her description seemed to familiar.

Anyway, I'm glad you stepped in. He sounds like a real winner of a person. I guess he would want his kidney back to if he donated and was going to divorce her. Whoever he reports to is going to make him look like an idiot anyway since you have witnesses anyway.

Hope day went better.

[coorsbob]

Hey heres an idea? Can we clon nursewratchet one I want on my D team.

[peleroja]

Yeah, we have one like that at my center.  The entire time she just moans "help."  Sometimes she says she wants to die.  Very upsetting to the patients.

[RichardMEL]

Clearly it seems there's something signifcant in it for the husband.. there doesn't seem to be any other obvious reason for him to be so forthright about it and ignoring HER wishes. If she wants to go and she's lucid than that is her call.. and given her situation I think I'd just want to quit too (horrible to "exist" liks that.. that is not living). I think you did the right thing and acted totally appropriately.

[nursewratchet]

He must be collecting her checks HUH.
So it would benefit him to keep her alive, seeing he only sees her on Dialysis days.

Speculation of course.

Get em Nursey
PS.  I hope you dont get in trouble :-(

  EXACTLY!!!  He does get her SS check...

[RichardMEL]

I think this guy should be locked away in a small room with that guy who wants his kidney back.....

 

[nursewratchet]

I think this guy should be locked away in a small room with that guy who wants his kidney back.....

 

  Lets do that AFTER he has to endure to years of Dialysis, with no vision and no legs, and no visitors.  What a life!

[RichardMEL]

Actually I was just thinking you should have said "hey buddy if YOU want it so badly how about YOU do her session for her" and stick a 15 guage in his face.....

jerk!

[swramsay]

This thread is disturbing. That woman is his wife for God's sake. Who are we to judge how people handle a very personal and difficult situation? People expect him to happily stand by and agree to watch his wife die? You've got to be kidding. Before someone can choose do die by refusing dialysis, they need a psychological exam to rule out depression etc. And even after that, if someone is declared fit to make that choice, of course it is going to gravely affect family members. I don't understand how we can expect a family member to happily go along with a decision to refuse dialysis like it was deciding not to brush their teeth today. Of course he's going to be upset and even more upset by medical staff dismissing his concerns as meaningless even if it ultimately is the patient's choice. We don't know what goes on in his life. We aren't living it every day. From his wife's description, I can guarantee his life is more difficult that most of ours. If it was my son on dialysis and he refused it one day and the staff simply went along with his wishes, I would have done a LOT more than that man did, believe me! Whether or not the man sits by his wife's side every minute is not an indication of anything. We cannot pass judgment. We aren't living in their shoes.

[jbeany]

I don't agree, swramsay.  Nurse Wrachet has been taking care of this patient for 10 yrs.  That's more than enough time to spend with a patient to get a good idea of what their life is like.  I realize not every center has nurses that get personally involved, but some of us are lucky enough to have nurses like that. 
I think quality of life should count more than quantity.  Blind, in a nursing home, with a feeding tube, and constantly alone doesn't sound to me like a life that counts as quality.  If she wants to stop, he should be respecting her wishes.
I've been in-center this week, and spent the last two sessions sitting next to an elderly man who is senile to the point that he doesn't understand where he is or why he's there.  He keeps trying to get up out of his chair and wander away.  The nurses are really good with him, but I have to wonder at his family's reasoning at keeping him alive when he clearly doesn't even recognize himself in a mirror anymore, let alone any of them.  I don't get the point of keeping him alive just because we have the technology to do so.

[MandaMe1986]

Wow I don't care who her power of attorney is, she said no.  Enough is enough, and she knows when its time.  I know her husband cared about her, I can fully understand.  But he has to undestand aswell that she is the one fighting.  She has been fighting for so long. And she is living in a home.  I worked in one.....that isn't a place to be happy about living in.  She knows what she needs, and maybe she needs to let go.  I don't know what to say.  But if there ever comes a time and I am put in that situation, I pray I have a nurse that is willing to fight for me.  You did the right thing.

[paul.karen]

I dont think a grown person needs a permission slip if they CHOOSE not to accept a medical remedy.

If that were the case John Travolta would be up for manslaugther for refusing his child medicine that would have maybe prevented his death.  It is/was against there religion.

And did you read the original post??  Only time family is around is to make sure she gets her Treatment to keep her alive.  So the checks keep coming?  maybe.  If he was that concerned about her maybe she would live at home with him.

i hear what your saying but maybe it is the other way around.
Ps.  Please tell me how his life is more difficult then any of ours??  Do you have inside info??

And yes i also am in support of assisted suicide.  We put animals who are in distress down.  Why should a human be FORCED to suffer if they know there ready to go elsewhere.

[swramsay]

All I know is when people tell me what they believe is right for me, all I want to know is...are they going to hug my child at night when he misses his mom? Or meet his first girlfriend? Or be there for his first heartbreak? Or pay the bills?  As much as I respect the opinions of my medical team and adore them as people, the bottom line is, none of them can answer yes to those questions. I was not passing judgment on anything anyone did or said. I was simply disturbed by the judgment I felt was being passed on someone else. Yes, it's a difficult situation but it's still not our place to judge or make the decisions for them. If the decision to end her life is to be made, then she has the right to do that if the proper procedures take place.  Even when that happens, it is still a very difficult and emotional time for anyone involved in her life and I just hope we can empathize rather than judge. You are right...I don't know what his life is like and neither does anyone else really.  I certainly didn't mean to offend anyone and I apologize if I did.

[MandaMe1986]

All I know is when people tell me what they believe is right for me, all I want to know is...are they going to hug my child at night when he misses his mom? Or meet his first girlfriend? Or be there for his first heartbreak? Or pay the bills?  As much as I respect the opinions of my medical team and adore them as people, the bottom line is, none of them can answer yes to those questions. I was not passing judgment on anything anyone did or said. I was simply disturbed by the judgment I felt was being passed on someone else. Yes, it's a difficult situation but it's still not our place to judge or make the decisions for them. If the decision to end her life is to be made, then she has the right to do that if the proper procedures take place.  Even when that happens, it is still a very difficult and emotional time for anyone involved in her life and I just hope we can empathize rather than judge. You are right...I don't know what his life is like and neither does anyone else really.  I certainly didn't mean to offend anyone and I apologize if I did.

I feel for you, as a mother.  I would have the hardest time letting go.  But I think just hearing about what they are going through. He has had his life with his wife, he isn't holding her at night, she isn't happy.  I just think she did the right thing by standing up to the family.  I know what its like to be on both ends.  And sometimes it takes a wonderful nurse, or doctor to stand up and defend the decision that was made.  Family is always going to have a hard time letting go. 

[jbeany]

No one's offended, swramsay.  We debate these issues on here a lot, and it's always good to hear all sides of an issue.  That's what Epoman started the site for!

[paul.karen]

:-)

people been trying to offend me for years.  Cant happen.  But if i sounded off im sorry for that.

Your comparison to her situation are two totally different scenarios.

But I have to ask.  Are you more worried about her husbands situation or hers??
Curious minds and all that kinda stuff

[thegrammalady]

in noi way is this an easy situation. power of attorney only means he can sign for her financially, it doesn't mean she's incapable. does she have a dnr? that doesn't just mean "i've had a heart attack, don't put me on a respirator" it means i can refuse to eat, refuse dialysis  etc and no one not family, or medical personal can legally force me. and i guarantee a nursing facility costs more than her ss check.  whatever his reasoning, it's not easy.

[swramsay]

:-)

But I have to ask. Are you more worried about her husbands situation or hers??
Curious minds and all that kinda stuff

I am equally concerned/care about both because both (or all) are affected and involved. Dialysis changes everyone's life - not just the patient's - on many different levels and to varying degrees that no one can fully comprehend. As a dialysis patient/cancer patient, it is not just about me. There are many sides to it all. There are many people involved. I always see and feel more sides than one. 

[kellyt]

This thread is disturbing. That woman is his wife for God's sake. Who are we to judge how people handle a very personal and difficult situation? People expect him to happily stand by and agree to watch his wife die? You've got to be kidding. Before someone can choose do die by refusing dialysis, they need a psychological exam to rule out depression etc. And even after that, if someone is declared fit to make that choice, of course it is going to gravely affect family members. I don't understand how we can expect a family member to happily go along with a decision to refuse dialysis like it was deciding not to brush their teeth today. Of course he's going to be upset and even more upset by medical staff dismissing his concerns as meaningless even if it ultimately is the patient's choice. We don't know what goes on in his life. We aren't living it every day. From his wife's description, I can guarantee his life is more difficult that most of ours. If it was my son on dialysis and he refused it one day and the staff simply went along with his wishes, I would have done a LOT more than that man did, believe me! Whether or not the man sits by his wife's side every minute is not an indication of anything. We cannot pass judgment. We aren't living in their shoes.

How do you come to that assumption if she, herself, says the only time she "sees" her husband is when she goes to dialysis.  And even then he just "drops her off and leaves".     And, it doesn't sound like he was "upset".  It sounded like he was angry and demanding.  I think that if it were my husband refusing the treatment I would be on my knees crying and BEGGING him to reconsider and telling him how much I loved and needed him.  I would not be yelling at him to "get on the machine".

Way to go NurseWratchet!  Patients have rights.