To speak up or not to speak up. The conundrum.

To voice a tactful, science based, empirical data-based complaint or just shut up?

I advocate for dying people and their support systems. It’s an intense environment and as the clock ticks the precious time away, I need to draw all my reserves to remain patient, tactful, alert, and be part of the solution to many questions.

But last week was too ridiculous. I was super angry. I had a private hospice patient in a world-renowned cancer facility. The Palliative Care team was following him.

THEY DIDN’T TAKE THE TIME TO KNOW HIM. (No, I’m not going to soften this. I’m not throwing you–Palliative Care team– under the bus, this is the truth.)

They addressed his pain control with paranoia and a condescending fluffiness that made me furious. At home, my patient was in perfect pain control on Methadone and as soon as he was admitted for vomiting, they changed his pain med regimen. Then, three days later when he was out of his mind with pain and disorientation, they assumed he was perforating his colon, so they cranked up everything. As soon as I entered his room I knew he wasn’t –as they said in front of he and his family, “perfing.” There was lots of old blood on his sheets from a blood draw; the bright overhead lights were on and I could smell feces from his colostomy. He was quiet, but no…he was zonked. There’s a big difference between someone who is comfortably sleeping and someone who is drugged to practical coma.

I politely asked the nurse if his appearance was acceptable to them. She was actually surprised I asked her such a question and she said “yes.” I asked for new bedding and told them that I was going to change his sheets, then asked the very kind cleaning person to get a table lamp for me to place on the windowsill for a more homey appearance. I turned off the overhead lights and gently, calmly changed the sheets. His four children were there so I couldn’t go on a rant, but they could see that I was disturbed by the ignorance of the medical team.

We went out in the hallway and I tactfully asked the medical team questions that they would not answer. I asked them why they took him off Methadone. They looked at the floor. I asked them why he wasn’t on Hospice care after he requested it as soon as he was admitted. They looked at the floor. I asked them why they said he was “perfing” when it was obvious to this old nurse that he wasn’t. And I asked them to keep the family’s naivete in mind when they were speaking during bedside rounds. Be gentle. Compassion.

I knew it was about money because the family had given me full permission to have access to his medical records, so their silence was not about breaching confidentiality.

 MEDICAL CARE IS ABOUT MILKING MONEY FROM THE INSURANCE COMPANIES AND AVOIDING LAWSUITS.

The public must begin speaking up. I’m furious.

 

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