Ever notice how nursing homes have all these really picturesque names, like “Shady Glen” “Ocean View Manor”. But if the way patients look when they come in from these places is any indication of what the places actually look like, I think there are definitely some more accurate names for these places….

C.Diff Acres
Bed Sores n’ More
Our Lady of Perpetual Sepsis

I mean, these places ARE called NURSING homes right? There IS supposed to bed some level or nursing happening right? What’s even more disturbing is when you call the home to find out why the patient came in and they have no clue what you are talking about…

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on November 4, 2011, in Uncategorized. Bookmark the permalink. 4 Comments.

  1. Your point is a valid one but it only represents part of the problem. Units such as yours spend hundreds of thousands of dollars on treating these patients so they can be sent back for more neglect and suffering.Nobody seems to be willing to challenge the idea that the medical profession should always try to defeat death in all circumstances when there are many times when it could be viewed as part of the natural order of things just as birth and living.As you know ,the majority of medical costs occur in the last 18 months of life and the resources spent on this is at the expense of other societal needs as there are obvious limits on what society can provide .With all the boomers on the threshold of old age imagine how big a piece of the pie they will be consuming if the present situation is maintained and imagine who will have to be deprived if this happens.Your dismay at the poor quality of care in nursing homes is completely understandable but where will the resources come from to correct this given that the cost of NH care is already backbreaking for so many people?In ICU rounds, when discussing what can be done for the patients under your care, is the question ever raised as to what SHOULD be done given that what most elderly patients wish for is a dignified ,relatively painfree death rather living on regardless of the quality of life? I suspect that the question is too controversial and conflicted for it to be given a reasonable airing. This is a ways from the point you raised but your comments are thought provoking.

    • Actually, we push to make as many people DNR DNI as we can. Maybe push is the wrong word, but some of the attendings are not so sublte in asking the family “are you REALLY SURE you they would want to live this way?” Many people are indeed made DNR, but out of the 100 or so patients that have probably come and gone since I have been here, only 2 that I can think of have been actively had care removed and been put on a morphine drip. This needs to be done a LOT more in my opinion. The quality of life of many of these people is so horrible BEFORE they even get to the ICU, that while we might be able to get them out the door, we really haven’t done much for them big picture wise. Making them DNR DNI probably doesn’t do all that much in terms of smart use of health care or being “humane”, as we can do a LOT and prolong someones life for a pertty long time using med/fluids etc etc. The answer, in my mind, is for each person to think about these sort of things ahead of time, and let those around the know their wishes well ahead of time. But whats sad as well, as that so many of these people have no one, and then some stranger, appointed by the state, is making these decisions for them. Its definitely a hot mess.

  2. The Paramedic's Perspective

    If you want the paramedic’s perspective on this–sorry for the late reply but I just now found your blog and am reading through the archive–nursing homes are hell-holes. I work in an urban system, where the majority of nursing homes are staffed by the least-competent nurses you can find. My first time in one I thought I had walked into a geriatric hell. Patients were lined up in the hallway in wheelchairs, not doing anything, pressed against a wall, looking like they were lining up to take off and go see God.

    I have found cut-up apple chips (fresh) inserted into the mouth of a person in rigor mortis (not fresh) with what I laughingly must legally call a “nurse” standing over them SWEARING to me that their patient was fine “fifteen minutes ago when I checked on her”. What’s the onset of rigor mortis again…?

    Fun fact: Nursing homes all claim that they aren’t allowed to give a patient more than 4 LPM of oxygen by cannula. So every time I walk into an APE patient gasping and wheezing on 4LPM I want to punch somebody. Whether that’s the state or their medical directors, I don’t know, but somebody has to answer for why so many of their patients are cyanotic.

    But if you want to see some REALLY terrible patient care, go into the home of a patient being taken care of by a Home Health Aide or Home Attendant (HHA / HA). It is, without a shadow of a doubt, their first day on the job, they know nothing about the patient’s medical history or their allergies, nothing about their medications–but they have the family’s phone number on speed dial.

    I had a patient about a month ago–a 78 year old man on home oxygen–who I found sitting on the sidewalk slumped against his HHA’s legs. Apneic. Pulseless. I asked the HHA how long he’d been like that, and the honest reply was “ten minutes”. Ten minutes with a corpse slumped against his legs before someone called 911. Rather than call the man a murderer (first instinct), I laid the patient down and began CPR (second instinct.) When we removed him by stretcher to the ambulance–this is before he’s been intubated or IV access was established, since it was a very public scene and a very public sidewalk–he actually folded up the patient’s walker and tried to start putting the walker in the ambulance. During a code. (Oh, and he’d worked with the patient for three years–he just didn’t know anything about him. Apparently.)

    I don’t know if your residency includes ambulance rotations, but even if it doesn’t, I’d highly recommend some ride-alongs, especially in poor parts of town. A lot of the docs I’ve had rotate with me say that it’s a real eye-opener.

    ~TPP (not to be confused with TPA)

    • Shameful!

      And yes we do have a week of EMS each year where we do ride alongs…although I am trying to pull a few strings so I can fly during that week, which I am sure will be a bit difference experience.

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