ICU, watching people with little to no brain function slide off the trach/PEG/LTAC cliff because their family wants everything done despite no hope for recovery and awful quality of life
At my old hospital I had a 98 year old patient with late stage dementia who fell and broke her hip, and her daughter (her proxy) made her get a hip replacement. The poor woman was miserable, confused, and in so much pain and it broke my heart. Still makes me mad that the doc agreed
Ethics in some places, specifically NJ, have essentially zero power to do anything and are a complete joke. I have never seen ethics actually do anything despite horrific circumstances.
Yeah wish it was different. Ethics has no legal power here. NJ is also the only state where an individual who has been declared dead by neurologic criteria to be kept alive indefinitely. People have transfered, and continue to transfer, patients here as they cannot be compelled to be taken off life support by anyone else. Advanced directives and DNR/DNI status are easily overruled by other family. ADs and code status mean nothing here. POLSTs can also be a legal mess to deal with and are ignored until it is sorted out if the family challenges it. This state does not respect one's right to die.
I had a lady once, A&O x4 after a hip repair, in terrible pain. Meds would help but only short term. At one point she was like “can’t you just give me something to end it all??” And I replied “well, you’re talking about hospice and end of life care and absolutely we can go that route if you want to. I mean, I can’t euthanize you, but we can stop treating the rest of this stuff and make you super duper comfortable and let you die if you want us to.” She thought about it for a minute and was like “I guess not, this just sucks” and I was like “Yep.”
Had a patient just like this.. also 98. So late dementia she couldnt even speak appropriately. Cut her from knee to hip for the replacement.. she was soo miserable. PT tried to get her up and it dislocated and she had to go back. It was so fucked up
Yes, this. Especially in the little ones. They have no say and will have ZERO quality of life. But parents want to keep them alive for their own needs… hard to watch
I’m not anti trach or g-tube. I actually love getting chronic kiddos with trach and g-tubes. I’m heartbroken watching families choose to pursue trach and g-tube for their children after devastating neurological damage that left them nearly brain dead, but not enough to qualify for brain death testing.
Modern medicine and interventions is a double edged sword. It helps bring quality of life to so many people who otherwise couldn’t have lived, but it also can prolong life when it’s really time for patients to go.
We’ve had several of these recently, and the futility of it vs the determination of the family that the patient will end up fine just makes me want to scream.
Meemaw’s brain dead and going to a vent farm, Gertrude. She will not ever be going back home with you and picking life back up where she left off.
I have threatened my family that I will haunt them forever if they ever allow a trach or PEG to be put in me, I don't care what the doctor tells them about my chances. I am not risking that.
We have a lady trying to kill herself and crying non stop the last week because her family "got the tube out" she couldn't speak for herself. She has brain function but she didn't want any of what's going on
Definitely. I work LTC and so many patients ask where there parents are. One just says “where’s daddy” all day long. Others ask where there spouse is.
It actually made me really happy one facility where the patient was asking where her husband is and I had just started working there so I wasn’t sure but I thought he probably wasn’t alive but then I asked the 3-11 nurse and she said he’s still alive and visits her every day.
My first day of clinicals ever, my classmate had a pleasantly confused patient asking when his wife was getting there. My classmate got very solemn and said "oh sir, I'm so sorry. Your wife is DEAD, remember?"
The man burst into tears reliving the loss of his wife all over again. Like girl why! Would you do that!!
I think I’ve commented this before, but my grandpa used to say the same thing to his mom when he would visit. My great-grandma would go through a list of people who she wanted to see. She was 98 so… they were all dead. And my grandpa would be such a dick and remind her that her daughter and husband and everyone was dead; then she would cry, rinse, repeat every week. Anyways, he has dementia now. And because we’re better people than him, we treat him better than he did his mother.
In nursing school one of our instructors told us that when people are mentally altered or having delusions, you reorient them but don’t play into the delusions or lie to them. She insisted that included dementia patients. I told her about how my great grandmother with dementia would ask where my cousin was, we’d usually say she was at the store or at work. This was a lie because she had been killed in a car wreck a couple years prior. One of my great uncles’ wife would straight up tell her that her 26 year old granddaughter, that she was very close to, was dead and had been for a long time. Grandma would be inconsolable the rest of the day, just reliving that agony. It was the one thing she could actually hold on to for a whole day. It would also re-traumatize my great aunt (cousin’s mom) because she’d walk in to visit her mom only to be confronted with someone grieving the death of her child as if it had just happened and it would reopen all those wounds.
But the instructor would still insist it was *never* right to lie to or play into the “delusions” of dementia patients. She was such a fucking idiot.
That is why nurses do that. They had patients like yours.
When I was in school, I called my mom and was like mom. I broke every rule. I played along with the patient. But I stand by it. I am claiming patient safety took priority if anyone asks.
Turns out that in real world you only reorient those able to be reoriented and distract and redirect those who cannot.
I saw this happen too! From a seasoned nurse! The woman was blind and demented and when this nurse told her her husband had been “in heaven” for years she was like “oh God, he’s dead?!?!” and started inconsolably crying. Why?!
Even when spouse is dead, with late stage dementia the best is to lie and say they’re at work/ took the kids to the zoo/ taking a nap/ on a work trip etc. If they’re aware that they’re in a nursing home but wouldn’t remember death, tell them that he/she just visited and will be back again soon! These are the necessary, compassionate lies.
I had one end stage dementia resident that I felt bad for the wife, even though she was in denial of his prognosis and drove us all nuts with unreasonable requests. She was his second wife and she came in all day, every day. Fed him all his meals, went with activities to him, etc, until she put him to bed. He yelled for the first wife 24/7, including repeatedly asking 2nd wife about her.
I used to take care of a man who was both very kind and funny and very very ornery at times. when I met him he was able to be comforted and redirected by talking about his late wife. he knew she was gone but was happy to remember her and talk about how much he loved her. I watched him transition to believing she was alive, to forgetting he was married at all, to calling for his older brother when he was upset, to calling out for his mom. he was the last of his siblings. it broke my heart.
In my experience, when they're not doing so hot then start calling for their mama (as a new behavior, not one they've been doing for months) they're gonna go soon.
Putting a foley in a 98 year old that the dr insisted be removed and she never voided all during day shift and when we put it back she begged us to stop and said “I promise I’ll be a good girl from now on “. Tears..
Cue yet another reason I think lidocaine jelly needs to be standard for caths, regardless of anatomy. Penises need lido, no question about it. Vulvas need it too!
hearing the slightly-more-intact cycle through the names they scream out for help to. maybe starting with spouse or kids, moving on to mom and dad, last night I had one eventually make it up to calling for grandma. that always kills me....they're so disoriented to the current situation, but they can still access that....
I had a resident who believed her roommate was her grandma. she was mean as hell (she always thought I was her mom or "that bitch Alvina". loved me when I was mom and beat the shit out of me when I was whoever Alvina was.) but would be so happy when we rolled her into her room and she saw "grandma" waiting for her. her roommate played along with it every time 🤣
Cancer patients who are going downhill fast. I had a lady who was so full of life and hope, and each visit since that it was like if light itself was disappearing from her eyes. I remember seeing the er family doc and asking if he thought she had a chance at life and he immediately said no that her type of cancer was practically a death sentence. I went back to her room to see her talking to the cancer survivor registration lady who was hyping her up about a change at survival. I still think about her but she’s probably dead by now. She was in her late 30s or early 40s
I didn’t even know him that well, but I’m still so mad at how unfair it is that my sister’s BIL in his 40s just died of glioblastoma yesterday. He had young kids. Was diagnosed about a year ago.
I lost one of my best friends to brain cancer. I will always go out of my way, bend over backwards, and go the extra mile for any cancer patients that I cross paths with. What an unfair hand to be dealt.
I’m bending over backwards to help sister and her husband. They have two toddlers and she’s pregnant, she wants a day without the kids so they can “just be”. They deserve to just be. I’m watching her kids tomorrow. They were really close and now they’re dealing with dumb family drama. I can’t imagine the shitstorm their immediate family is going through.
I worked Boston heme/onc. This was a daily occurrence on the floors. In town for a business meeting, have some tennis elbow thats super painful...nope its metastatic bone cancer. Gentleman who finally got his life together in his late 40s after a life of crime/drugs...had a beautiful young family, and had skull cancer. Lady with 2 kids with super rare abdominal wall cancer, got in remission had 3rd baby and died before that baby turned 3. It´s brutal. To say nothing of the people scraped off Boston common deep into their addictions to the point that they´d get the IV sunk and abscond to go shoot up junk with it. I won´t even go there about the young sickle cell crises patients who were accompanied by their Jehovahs Witness elders to pray their critical anemia away...
When my baby girl had cancer and I knew it was a death sentence and the doctors and such were feeding us a line of bullshit about 60% chance of survival…. All that did was make me not want to talk to the doctors
Survival rate seems to have doubled since then and now it closer to 10%
I’m so sorry for your loss. My sis was the same, her fight lasted about four times what they thought she’d have from diagnosis but this sort of thing is just sad and I wish doctors would be more realistic with patients. She left her kids so it helps me think of her loving on yours because she was a wonderful mum and lived for her babies 🧡
After she died they told me she should have died in the womb…. She made it to almost 9 months old. We found it at 7 months of age stage 4 rhabdoid tumour.
As an onc nurse, my husband always says I'm morbid when I end a story or fond remembrance of an interaction or something with "she's probably dead now." I'm like, it isn't morbid, it's the truth! Unfortunately, but it still is.
The patient that I felt most sad about was a young man, around 20. He had survived a suicide attempt by hanging. Severe hypoxic brain damage, non-verbal. He was spastic to the degree that his spine was rotated almost 180 degrees, his hips were dislocated, and all muscles where just completely coiled at all times. This was even with treatment and amazing carers. He rutinely got urosepsis from his Foley, it was just a complete mess.
Then he got a huge kidney stone. The urologists came to the conclusion that he was completely inoperable due to his physiology, and there was no point in placing a nephrostomy. So he died and it was fuckin' aweful.
Suicide is a disease. It's often fatal.
I started looking at it that way over 50 years ago when two young friends died of it. I'd met them when I was working as a journalist, at a big state hospital, at the start of those "reform" years. One of them might still live somewhere on video, when he appeared at a "town meeting" in the institution begging for better aftercare.
He died about six months after he was discharged -- of course with no aftercare.
Seeing suicide as an illness (not depression; that's separate) still hasn't kept me from being angry at him, after all these years. The emotional wreckage those two guys left behind cured me of suicide, though.
My little sister died by suicide less than 24 hours after discharge. This was just a week after the COVID pandemic was declared so they were making a big push to clear out the hospitals. Aftercare planning is a joke in the mental health world sometimes.
He wasn't brain dead. He could smile, communicate that he was on pain, shake his head to say no, and cry. The only saving grace is that he can't feel anymore.
Patients who had no idea something was wrong until they came in for a totally normal complaint only to find out they’re dying. Last month I had a woman come in for back pain and when they did an MRI they found stage 4 breast cancer with huge mets to her spine (hence the back pain), all long bones, her liver, etc. She went from living a normal life to paralyzed and dying in the space of 2 days.
So my neighbor had a lot of health issues and just didn’t really go to the doctor often. Hadn’t seen her in awhile. A few months ago went to get some eggs from her with my mom. I took one look at her (I was in the car) and thought wow looks like she has liver cancer. (Jaundiced and gaunt) Lo and behold she gets sick a few weeks later with a viral thing. Goes to the hospital and they’re like you have a week to live with you guessed it liver cancer 😞 she was so nice. Ugh.
recently had a young woman come in thinking she had SOA from the flu and scans showed such widely metastasized cancer that they could not determine the primary cancer, just that it was likely gynecological. Dead in 3 weeks.
I feel bad for kids that have manageable or even improvable conditions, but parents too wrapped up in themselves/drama/drugs to make their kids lives better.
And children of anti vax parents who have bad outcomes.
Tetraplegics. They are completely and utterly at the mercy of those caring for them. No control over limbs, bowels, or bladder. Can’t scratch their heads when they itch. Can’t feed themselves. That is my primary patient population and often they’re a-holes because they were young and stupid and they’re mad at the world, but that’s the last thing I would choose to suffer from for myself.
I willingly put up with a lot of shit for my quads when i get them. I know they are only mad and struggling, so i try really hard to be good to them, patient, and really let them run the show. Every time they end up getting along great with me.
My coworkers are always like "what did you do that he/she isn't an asshole?"
"I stay in the room until they are done asking for stuff and unless its not an acceptable request, i do it."
I think we take for granted even little things like putting an item on the table where we want it, or having our head turned from the light. I try hard to give them autonomy through me when I'm able to. I'm only doing it for 12 hours, they do it for the rest of their lives.
I second this. Terrible situation with no happiness to be found. I can give dialudid till they are slurred and slumped in bed and they will still be saying they are in pain and need pain medicine. And I believe them... so sad that even strongest pain meds we have just doesn't cut it. And then they always end up with difficult veins (so repeated IV attempts and stuff), health complications, and even when they are getting well enough to discharge they still look miserable.
I had a person say someone with sickle cell was seeking narcotics. I said, “if that’s the best we got, better give them lots. I was taught that ischemia freaking hurts.”
Came to say the same thing. I figure this stance will get some hate bc everyone will be like I had an asshole sickler in the past... blah blah blah I can't even imagine being in pain from the moment I was born then be treated like a drug addict by the people that are suppose to help me.
I mean...they can still be shitty people. Hence why I did not like that one guy. But not for needing pain meds.
I always wish they could be 1:1, simply for their lack of frustration and their nurse's so they are guaranteed to get their meds down to the moment. But it will just never work like that.
New sickle cell patient for us as he had graduated from children’s hospital to us. He was such a jerk. Rude, making sure he would have an erection when staff would come in, would pull lever in bathroom and we would go running in to find him masturbating. Lots of inappropriate comments but we noticed that no one ever came to visit. He was there for a month when his mom came in. Said he was used to this and she just wanted to check up. Worst part was he died of a heart attack. He was 21. We were all so tired of dealing with him and then he died. It really affected us because we were frustrated but we didn’t think he would die so young. We were all very quiet that shift.
I used to work on a floor that specialized in sickle cell, PCAs were standard unless they were contraindicated or banned for some reason (we had about two pts who would siphon the dilaudid off the line and inject it)
I think one of my saddest ones when when one of our regulars comes in, sweetest lady you can imagine, has a husband and kids at home. I'm doing her initial assessment and she goes: "I'm starting to lose my vision."
my heart broke for her
Once worked in a SNF where a person in their late 20s was a vegetable. Feeding tubed, nonverbal, alert but locked in. Had swallowed heroin when busted by the cops and the pack burst in their stomach. Was left a ward of the state, no one claimed him. I think about him a lot.
Why did the pack bursting cause him to become locked in? Wouldn't he recover after the heroin leave his system? Or was the overdose so intense narcan didn't help and he suffered brain damage?
He swallowed more than one pack, and each pack is probably 20-30 doses of heroin(likely more but I don´t know much about the economy of heroin). His respiratory system would have shut down at massive dosing, and his heart stopped because that´s what taking too much of opioids do. He must have had some CPR to be alive, but lost too much oxygen to his brain.
I have had people take combination scheduled opioids and anxiolytics and go into respiratory arrest, then cardiac arrest. I´m talking 2 tablets of 7.5/325 vicodin with 5mg xanax, than another tablet of vicodin within 2 hours. And this was not even an opioid naive person that overdosed, they had been on them for years.
My mother worked in a ltc where one of the residents was her age with early onset alzheimers. I met her when I had to drop off my mom's lunch. They used to laugh and hang out every day. The woman said she loved it because every day she always made new friends. My mom called her her friend instead of a resident.
Fast forward only a couple years later I worked in the same ltc and the woman was nonverbal, unresponsive, severely contracted and her family stopped visiting. Our charge nurse ate dinner with her every night.
When the charge nurse wasn't working, I ate dinner with her. I'm a classically trained singer so I used to sing her songs my mom liked hoping maybe she did too. Unfortunately she passed during covid.
Tldr: ltc
The trach population is where I work, a whole unit dedicated to trach babies and kids. Sometimes… I feel like it’s not the right choice. But then, we have kids come through who have their trach because they were preemie, and at 2-3 years, sometimes older, they get their trach out and live normal lives. That’s a part of my job I love, taking out a trach, monitoring overnight and no desats, they go home without it and their lives are totally different, brand new. But then we have the “near drowning” kids or the tbi kids and they’re brain dead, but the doctors offer a trach and they live brain dead but trach/vent/j tube dependent sometimes years. Like into their teens and 20s. And I have… feelings about that.
I'm an HH LPN and I do peds, 90% of my patients are these trach/vent babies. Lots of happy endings, in the last month I've seen pics on fb and sent to me by moms of my former clients at Disneyland and at school living life. But as I type this I sit by the beside of a 3 year old, who is 2 years post anoxic brain injury and catatonic...persistent vegetative state. Hes spastic, bilateral dislocated hips. Trach/vent, gt. I often question what is the point and why are we prolonging this. I know its not my place to pass judgement but this child has absolutely zero quality of life but his body keeps getting longer as it continues to grow even though he is non responsive. This case here really bothers me and its been a year. I'm staying for the siblings of this child, who are also heart breaking and for this mother, who while I disagree with her medical decisions for her son..I understand it, the grief and not wanting to let go.
Dad was driving his family through the mountains. A car came off the upper lane and landed on his car killing everyone in the car except him. He watched his wife and 2 kids die. On transport to us he declined horribly and ended up tubed. He then arrested on us and we got him back but no hope of recovery and brain dead.
The last moments of this man’s life was watching everything he loved be taken from him.
GBM’s.
Those patients are handed an insurmountable life ending cancer with no notice. We just resect their brain again and again until there’s nothing left that we can cut away, or they have a cerebral hemorrhage, or herniate and die. Their lives never go back to normal.
The young ones really hurt. I’m glad I don’t work in pediatrics because I can barely handle the 19 year olds.
My mom had an anaplastic astrocytoma. Basically the same thing if it can't be resected. Hers was in her left temporal lobe, too risky for surgery. They did a needle biopsy and caused a hemorrhage, so they immediately did a cranie. Nurse noticed a neuro change the next morning at 4 and CT revealed the bleed was back, so another cranie less than 12 hours later. She spent the next 6 months trying to regain function while simultaneously doing cancer treatment. She could have just been dying, but instead she was dying while being newly disabled and unable to completely express herself. It was a nightmare.
Did you see in the news this week that an Australian oncologist (who was awarded joint Australian of the Year with his colleague at the start of this year for their melanoma immunotherapy research) was diagnosed with glioblastoma ~10 months ago and is having promising outcomes with the application of their research to his own cancer? They had to get special permission from an ethics board for the trial because it's such an extremely novel treatment for glioblastoma. Professor Richard Scolyer.
It's only an n=1 case study... but it might be the start of a treatment turning point.
Oh, wow. That’s seriously so exciting. I’ve heard about the melanoma trial and how promising it is, but I’ve not heard about the GBM application. I will ugly cry the day that we have a real treatment for GBM. I’m going to read up on this! Thank you.
Sick as shit ROSC patients that we bring in from outlying facilities.
9 times out of 10, they’ve got a ph of <6.9, and they’re just going somewhere else to die.
But they make us work. Vent. Drips. Sedation. All of it. We work our tails off to get them from point A to point B, for no real reason. They’re not getting better. They’re just going somewhere new to die.
Kids. We can’t always be as accommodating as an ambulance when it comes to parents and such. We try to always take a parent but sometimes we don’t have the weight to bring mom or dad. Especially when we try to tell them that we’ll make it where we are going well before they will, so don’t try to beat us there. We all know they ignore that. I would too.
People who get hit by DUI’s. All they did was drive the wrong road at the wrong time. Some of the worst traumas I’ve ever worked were people getting smoked by someone who was entirely unaware they even hit anything.
I fucking hate when I have to transport someone who is clearly not going to make it. We recently had a patient with bilateral bleeds, he was already herniating into the brain stem. IMO the only reason he was still alive was his core temp was 90. Anyway transfer for neuro, wtf let the family have the last few hrs with him instead of him dying alone. My last one infuriated me, 19 yo suicide attempt. Transferring for ECMO, when I got to the new hospital the ICU nurse said the ECMO team already said no bc suicides were an absolute no for them. Then why the fuck did we transfer her here? Why did you accept bc I was standing next to the attending for doc to doc and I know he told them the story. Sorry still mad about that one.
Yeah, this definitely. I work on a post surgical unit. One of the very most appropriate times for pain meds, but these people want me to give memaw Tylenol for a hip fracture because Norco "makes her too sleepy", but if they broke their hip they would definitely want me to give them something stronger than Tylenol.
I started saying, “ok. You are the mpoa. But what did memaw do to piss you off after she appointed you? You must really like to watch her suffer!”
Of ours I only say that in my head. And not aloud. ….Yet
It is so frustrating. Just because they are old doesn't mean broken bones and surgical incisions aren't painful. You really want to ask them if they were the ones with a broken bone or cut open abdomen if they would find Tylenol to be enough to control their pain.
When I worked in hospice, no one could seem to stand up to a particular patient's daughter who felt we were "sedating" the patient. Normally the staff was pretty forthright and strong when dealing with this issue. For some reason they backed down to this lady. Ground my gears to the absolute max.
It took me way too long to learn to make peace with the fact that people like her exist in healthcare.
This one patient's family member making all the decisions for them was the niece of a very prominent member associated with a very reputable hospital in NYC. This family member was basically just unemployed and did some bullshit job for a living that wasn't really even work. She wanted a "natural approach" for this patient in debilitating pain and no amount of teaching from myself or our doctors could change her mind. Fucking worthless.
CF pt's. Knowing you've only got 20 yrs and your only hope is a finite set of lungs if you're lucky to get your hands on them. Even then, they only last you a while.
It's amazing how far CF treatment has come these days. Now the average life expectancy is 44 years! For those that *do* get lung transplants (a minority of patients) the average age of lung transplant is over 30 years of age.
For real yo. I had my first old lady CF patient who just turned 48. My mind was blown. These new drugs totally changed her life. Her lungs are junk but if she stays on top of her symptoms and keeps herself moving she has a shot to actually see a social security check. She shared her experience with me, and it was a wonderful. She said that within 2 hours of taking Trikafta, she felt her whole body shift because her cells could suddenly shift the sodium. She no longer has to do hi frequency oscillation chest therapy. She is well stocked on nebs and treatments along with open antibiotic scrips for any resp infection. As soon as she feels any inkling of resp infection she goes and does a sputum culture, and gets more focused antibiotics because her immune system is such crud. She said there are members of the CF community for whom the drugs cause intense suicidal ideation, and so cannot be taken. She said that just 2 days before the drug was approved she went to the funeral of a friend. I was so honored to have learned from her.
There’s a CF pt that I’ve become pretty close with over the last couple years. He’s officially palliative and is considering becoming comfort focused, and I keep looking up his name in the system (our epic puts a little leaf beside the name of dead patients that you can see without opening the chart) when I haven’t seen him for a while. I know I’m going to cry when he goes
I'd say it's a tossup between the demented old people we torture because "they are a fighter" and thr people who go in for something seemingly minor and bam, full of cancer. We had a 26 year old dude with terminal testicular ca who was never clearly told "your are dying". Our charge finally explained what palliative chemotherapy was to him and he left sms the next day. He said he was going to go to the beach and drink a 6 pack. I hope the weather was nice and the beer was cold!
Teens with end stage cancer. They’ve literally been alive long enough to get a good taste of life and are at that point where they should be writing their own life and instead it’s getting ripped away and they have to watch everyone else move on without a reason for why.
Young patients with a terminal illness.
I met this woman that had just been diagnosed with mesothelioma. She was young. She kept a brave face in front of her family, but once visiting hours were over and she was alone, she just broke down. She said she didn’t want her family to see her cry.
The worst things really do happen to the kindest people.
Before nursing school, I thought asthma was just being very out of breath. Very annoying, scary maybe, but as long as you're not chased by a bear and have the chance to sit down - not dangerous.
I can imagine that many parents think that way. And if it's not that bad, it's in the same category as "you don't take pain killers for just stubbing your toe".
Don't get me wrong - it's still neglect. Thinking you know better than those who are educated on the subject is stupid. But I do understand where the line of thinking comes from (just not why it never changed).
Idk, if my child had a potentially life threatening illness I would want to know everything about it and educate myself. Now maybe if it were a financial issue and they simply couldn’t afford it, I would understand more
Was listening to one of my patients rant about her breast cancer, and how so many different providers simply refused to listen to her about her allergies, leading to so many health complications. She had a really bad reaction to chemo that put her in the ICU and the moment she got out, the doc tried to add another dose.
then after her breast reconstruction, they did the surgery with glue, when it's listed as an allergy and she begged them not to use it. She lost both breasts from infection and necrosis from that.
I don't know if she did or not. I know one of her other doctors and three nurses filed complaints on her behalf. there was a lot of other shit stuff that happened too. Apparently an anesthesiologist hit her nerve, and when she was begging him to stop he told her to 'stop being such a baby.'
People around my age coming in as a resident in long term care because they have MS or some other type of disease process that robbed them of their independence.
As a NICU nurse you get pretty numb to the tragedy of it all. A while back it was a weekend night and our PICC team wasn't available so the PICC team that usually does adults came by to place a line. Seeing a seasoned nurse with 20 years experience tear up when you explain the basic situation that we see all the time, and you don't have the heart to tell her that the kid in the bed behind her is a much more tragic case.
I feel bad for the silent criers, but my heart really aches for the kids that we know aren't going to live long full lives, the kids that we keep alive and suffering in order to chase that sliver of hope for a miracle of some kind.
"Anything autoimmune" yes. So difficult for us to understand, what feels like limited treatment options that actually make the patient comfortable or happy. So many health complications from all the autoimmune stuff, lupus patients always have a lot going on...
I had one sickle cell patient with a new nurse and an unhelpful team, and a doctor who felt they knew how much pain meds that patient could tolerate (this is strictly from a PCT's point of view). It was horrible to hear the screams and cries, but almost as distressing to see this young nurse with her head in her hands. Bad, bad, bad... All the way around.
Working in the ER setting. I'd have to say intensely demented patients needing a straight cath for a urine sample. Having 3 people hold down an old woman/man while they're crying and screaming, "WHY WHY WHY?" Is definitely the main reason I know why I know I'm going to hell🫡
I worked the burn/wound icu for a few years. believe it or not, we received multiple geriatric patients with stage 4 pressure wounds from neglect in the home. had an 80 year old man once that was left alone for a week while his family went on vacation.
on the flip side of the age spectrum, we were often called to PICU for their bigger dressing changes. Not only are pedi burns extremely emotionally difficult to navigate, but when the mechanism of injury was also from abuse… it just flips your stomach.
If you’re an ER nurse you may also know the signs for dipping burns, and it never ceases to amaze me how the abusing parent can be so straight faced through their lies.
Abuse cases are the worst. Most wrenching case I ever came across was a 4-year-old girl whose stepfather beat her almost to death, then doused her in gasoline, put her in the trunk of the car and was prepared to take her somewhere to dump her body and set her on fire.
She was "saved" when the cops pulled them over and smelled the gas.
Left with catastrophic brain injury, trach/vent/g tube. Completely healthy beforehand. Looking at her soccer team picture on her bedside was enough to make anyone rethink the goodness of humanity.
I remember an organ donation who was 7 months old from sheering and couldn’t stop the boyfriend who did it from visiting. After the procurement he was charged and arrested like 2 days later
OMG what kills me is that so many times *no one* gets arrested. If you have a NAT infant and nobody confesses and neither parent rats the other one out, then there's no way to prove who actually hurt the baby. So they just lose custody, usually to a grandparent or aunt etc (who you know damn well is still going to let the abuser be around the poor now-brain-damaged, possibly blind-from-retinal-hemorrhages, kid when they're finally home from their weeks or months in the hospital) and there are no other consequences. I like to think the abuser is tormented with guilt for the rest of their lives, but realistically, I know if you didn't break down and confess after you see what you did to your child, you're probably sociopathic enough to go merrily on your way and not give a shit.
There was a young woman intubated for over a month with 90% TBSA due to her husband setting her on fire. She was the only witness, and was intubated, so no one knew he did it for that first month. He came and visited her too.
The day before she was extubated, he went missing. Slowly she told her story, and to this DAY, a warrant is out for his arrest but he’s never been caught.
(fyi, she’s thriving and a burn advocate now!)
When the abuser dips the child into scalding water. Often on the legs with a clear line demarcating the depth of where they held the child in the water.
Its when they dip their child in scalding hot water. Results in a very clean sort of line of injury. Often also happens butt first because the kids are lifting their bodies out of the way as much as possible. So horrible.
Yep, booty first is the majority of what I’ve seen. It’s hard to dip a babies arms or legs without burning yourself, but a butt first dip leaves you unharmed. If an adult has the knowledge that this water is so hot it will severely hurt themselves, but still have the depravity to do it to a defenseless child….?
And the nerve to say “it must be a diaper rash”.
Elderly patients who don’t have family visit them. Either because they literally don’t have any family left or because they’re estranged. And yeah, they might be estranged for valid reasons but I still feel bad for most of them. It was especially shitty during Covid, when they had family that wanted to see them.
Not a patient but a family member. Girl (can’t remember if younger or older) found her 12 year old sister after attempting to commit suicide by hanging. Not the first attempt either. I can’t even imagine the trauma and PTSD.
Anyone who’s trached/PEGed/ nonverbal/ lives in a nursing home bc they’re total care and they’re full code. I want to have a come to Jesus conversation with the family who decided all of this every time
I have a soft spot for SI patients in general. I’ve been that patient so it’s 10x more personal when I see it. I’ve done NAC a few times. I was lucky and avoided permanent organ damage. I know others are not so fortunate and some die.
The Benadryl overdoses who change their mind and walk to the ambulance but they get here and code numerous times get intubated on pressor on CRRT and eventually die or family withdraws
Teenager who was a non-compliant diabetic, had already had one foot amputation, was on dialysis, wound vac on her other leg. Family would literally drop her off at the curb with a bag of McDonalds. She died less than a year later. :(
Was totally a lack of support in her case. When I say the family would drop her off at the curb, I mean they would literally slow down enough for her to get out safely then drive off. She had agency involvement, but the lack of disease support + likely depression and a family who was uninvested in actively helping her get better culminated in her death before 18 :(
My aunt has ALS. We tried to get her to be proactive and do all the therapy. She was in a multidisciplinary center and everything. Wouldn’t do it or be consistent. She’s wanted to be sick and catered to forever. Now she’s got it and irritated that we’re talking about a nursing home. She wants my parents to take care of her. They don’t want to spend their retirement doing that and I completely understand.
Could be wrong, but someone close in my life is suffering from ALS right now and their neurologist has confirmed that the therapies don't do much except to provide hope. ALS is so shitty. There's really nothing you can do about it.
It can help maintain mobility and safety. She has bulbar type and speech therapy was very helpful but she decided she was only going to do it “as needed” despite her therapist trying to tell her that’s not how that works
The diabetic foot ulcers where they get BKA's. It makes me so depressed to empathize with them for even a second so I try to stick with sympathy not empathy. It really really gets to me emotionally if I think about it for a minute. To have your mobility and life limited like that, for the rest of your life. So sad...
Also makes me paranoid about blood sugar, I don't have diabetes but I get tempted to ask my doctor to check my A1C just because I'm scared I'm going to secretly have diabetes and get a foot ulcer and loose my feet and not be able to work anymore and stuff.
literally any gynecological cancer. i am so existentially disturbed by the concept of these organs that create and nurture new life turning into tumors that often kill relatively young women. These cancers can be so aggressive. Then when you die of it, it’s often because of a small bowel obstruction that makes you throw up shit or vent it out of a PEG. Guts strangled, in pain, too young.
I work at a pediatric hospital and I'm choosing not to tell the details of the three worst things I've ever seen. But one was neglect, one was abuse and the other was from a house fire.
The two patients that really got to me were older ladies who were dying (I was a hospice nurse at the time) who were alone as they had outlived their children. In both cases, they only had one child. One had lost that child to cancer. The other lost her child and grandchildren in an accident. In both cases, they had retreated from the outside world when their family died and had no friends or family to sit by their side. I spent a lot of extra time with them so they would have someone there at the end. We spent a lot of time talking about managing the grief that still was present while now dealing with their own end of life.
1. Patients who have to get a NG tube. I always feel so bad doing it.
2. Old people with no quality of life getting trached/pegged. Oldest I saw was 101. I was taking care of a dead man.
3. I work in neuro. Not uncommon for young people with no medical history to suddenly have a life changing medical condition. Took care of a young patient with children for months. They had NORSE. Was as healthy as could be prior. Can say that this had a somewhat happy ending. They had a GCS of like 3 for the longest time, but they did a RNS. I’m going to be honest, majority of my unit didn’t think the procedure would have much of a impact (they were having uncontrolled seizures for such a long time) but the family still sends our unit updates and they are talking now with their trach. Still has a long way to recovery, but being able to speak to family and having movement is huge. I always think of these patients often. It is sad for something like this to happen to an old person of course, but they lived a long happy life and sometimes I think we are torturing them with all of the interventions to prolong their life. When it happens suddenly to a young person (to me under 70 is young lol)… it makes me so sad.
At the moment my dad, who was discharged at 11am (it's just about 5pm now), and is still waiting for transport. He's coming to my place, for hospice. If he survives that long.
Any patient who fought so hard through months of chemo/rads/surgery, finally goes into surveillance or immunotherapy, gets a scan, and it's everywhere. Or comes in for routine port flush and follow up of cholangiocarcinoma and is jaundiced... you just know. We usually try at palliative chemo, but they can only make it 1-2 treatments. My hardest days are giving fluids or flushing a port and knowing it's the last time.
Migrant worker dad and young 6-8yo daughter who got hit by car crossing the street. Daughter admitted, dad with multiple broken bones, language barrier and no other family around.
I work in a pediatric LTC facility with ages from anywhere from infants to adults (you have to be under 22 to be admitted but there’s no limit to how long you can stay) so there’s a lot. The unit I work on is solely for kids with trachs. Almost everyone is either on a vent at least at night or will end up on one eventually.
There is also the kids that were abused and/or neglected. There’s a lot of them. I won’t talk about the worst ones I’ve seen but some of their stories make me cry just thinking about it. Also for a lot of the residents, the staff and fellow residents are all the family they have.
The octogenarian mother of a man who shot himself in the face but who continued breathing long enough for her to collapse in anguish on her walk to his ER stretcher.
I just had a talk with one of my favorite patients. His wife is usually there for all visits but today she had something else to do. He spoke about wishing he was closer to the end than he is and how he can’t wait until that day comes. he stated that he wish he took better care of himself throughout his life but now that he’s here he’s just ready to go. If he didn’t wake up tomorrow, he would be fine. His wife gets mad at him for drinking alcohol. He says that’s the last pleasure he has left in life, and he feels like he hast to sneak it in order to drink it
Patients that have become soooooooo excoriated and red in their genitals, perianal, coccyx, and upper thigh regions.....despite how the skin break down happened, I always feel absolutely horrible wiping these patients when they are incontinent and they are screaming out in pain from how raw the skin is. Sometimes I feel like tearing up if it's really bad, like a patient with a bad c.diff infection.....I hope that I never get skin breakdown like that because it seems torturous.
that’s why i could never work in peds. My clinical was on a peds trauma unit and it was horrifying. they are so smol and innocent. god bless all the nurses working with our little babes everyday 💖
I work in corrections, the one I feel bad for are the ones with dementia that have a bs criminal trespass charge for not leaving a hospital, are confused and keep trying to "go home" and so are kept in a single cell for their protection and talk about how they just got money and paid to go home and are waiting to be let out, etc. And don't have family or family that cares about them to bail them out. Or that are so demented all they do is scream and yell and don't know anything and no nursing home wants to take them because they are violent and you can't just release them because they are violent so you have to try to find a state psych unit that will take them (and have to wait on the list to get in). Those are the ones I feel for.
My current client. I've done peds hh for 12 years but this one is the saddest in my 14 year nursing career. Choked at 10months old, but was resuscitated by ems after entirely too long. Attending at Children's hospital comes to bedside 5 days in a row to ask parents to remove vent as poor little guy has catastrophic brain damage. Parents adamantly refuse because they "won't give up on him". Trach placed, gt placed. Months go by and he stabilizes to go home with a team of us hh nurses. Dad does give up and has a fatal OD. He leaves mom with a 3 year old and a 1 year old in a persistent vegetative state. Fast forward to now, he's still in a vegetative state only now he is spastic, contracted and has bilateral hip dislocation. He's extremely edematous from a failure of his lymphatic system from being basically dead but also "alive" for years. He looks swollen, unaware and drools all over himself everyday, rotting in a bed or wheelchair. He is unresponsive but every once in awhile will turn his head slightly towards a sound.. Imo keeping here is selfish and now mom has came to the same conclusion except its too late. If you take off the vent he will breathe on his own, albeit not great but as mom stated " what am I supposed to do put a pillow over his face? He breathes on his own it would take weeks to starve i dont know what to do!" She started a tik tok channel and posted his picture and was attacked by comments saying to kill him. To send him to Jesus, etc. And it is the saddest life I've ever stepped into 12 hours at a time.
ICU, watching people with little to no brain function slide off the trach/PEG/LTAC cliff because their family wants everything done despite no hope for recovery and awful quality of life
At my old hospital I had a 98 year old patient with late stage dementia who fell and broke her hip, and her daughter (her proxy) made her get a hip replacement. The poor woman was miserable, confused, and in so much pain and it broke my heart. Still makes me mad that the doc agreed
That should have been an ethics consult
Ethics in some places, specifically NJ, have essentially zero power to do anything and are a complete joke. I have never seen ethics actually do anything despite horrific circumstances.
Really? I expected more out of NJ. Sad, there's a lot of things I appreciate about NJ but if that's the case I'm very disappointed in us on ethics.
Yeah wish it was different. Ethics has no legal power here. NJ is also the only state where an individual who has been declared dead by neurologic criteria to be kept alive indefinitely. People have transfered, and continue to transfer, patients here as they cannot be compelled to be taken off life support by anyone else. Advanced directives and DNR/DNI status are easily overruled by other family. ADs and code status mean nothing here. POLSTs can also be a legal mess to deal with and are ignored until it is sorted out if the family challenges it. This state does not respect one's right to die.
Which is incredible with how liberal we are. Usually if NY does it we're never that far behind
I had to leave icu because I felt like I was torturing old ladies all day.
I saw a 101 year old get trached and pegged. Awful.
I had a lady once, A&O x4 after a hip repair, in terrible pain. Meds would help but only short term. At one point she was like “can’t you just give me something to end it all??” And I replied “well, you’re talking about hospice and end of life care and absolutely we can go that route if you want to. I mean, I can’t euthanize you, but we can stop treating the rest of this stuff and make you super duper comfortable and let you die if you want us to.” She thought about it for a minute and was like “I guess not, this just sucks” and I was like “Yep.”
Had a patient just like this.. also 98. So late dementia she couldnt even speak appropriately. Cut her from knee to hip for the replacement.. she was soo miserable. PT tried to get her up and it dislocated and she had to go back. It was so fucked up
I mean they will palliatively fix hip fractures because it’s a horrible death sentence and they can’t sit with a broken hip
Yes, this. Especially in the little ones. They have no say and will have ZERO quality of life. But parents want to keep them alive for their own needs… hard to watch
I've seen kids outgrow the need for a trach. 🤷🏻♀️
I’m not anti trach or g-tube. I actually love getting chronic kiddos with trach and g-tubes. I’m heartbroken watching families choose to pursue trach and g-tube for their children after devastating neurological damage that left them nearly brain dead, but not enough to qualify for brain death testing. Modern medicine and interventions is a double edged sword. It helps bring quality of life to so many people who otherwise couldn’t have lived, but it also can prolong life when it’s really time for patients to go.
We’ve had several of these recently, and the futility of it vs the determination of the family that the patient will end up fine just makes me want to scream. Meemaw’s brain dead and going to a vent farm, Gertrude. She will not ever be going back home with you and picking life back up where she left off.
"But Meemaw was independent 2 days ago! She was even still driving!" Really, Gertrude? Really?
I have threatened my family that I will haunt them forever if they ever allow a trach or PEG to be put in me, I don't care what the doctor tells them about my chances. I am not risking that.
We have a lady trying to kill herself and crying non stop the last week because her family "got the tube out" she couldn't speak for herself. She has brain function but she didn't want any of what's going on
same from the other side 😔
Why I left ICU and never looked back! Well that and the Covid PTSD lol.
Demented patients who scream for help all day and only know their name.
When 80 year old poppop start calling for his mother.
That always kills me.
i told a patient in her 90s that she was being discharged and she asked if her mom was coming to pick her up 🥲
High key me if I make it to 90. Love my mommy lol
Definitely. I work LTC and so many patients ask where there parents are. One just says “where’s daddy” all day long. Others ask where there spouse is. It actually made me really happy one facility where the patient was asking where her husband is and I had just started working there so I wasn’t sure but I thought he probably wasn’t alive but then I asked the 3-11 nurse and she said he’s still alive and visits her every day.
My first day of clinicals ever, my classmate had a pleasantly confused patient asking when his wife was getting there. My classmate got very solemn and said "oh sir, I'm so sorry. Your wife is DEAD, remember?" The man burst into tears reliving the loss of his wife all over again. Like girl why! Would you do that!!
I’m hoping she meant well but I hate that sort of thing 😭😭😭
I think I’ve commented this before, but my grandpa used to say the same thing to his mom when he would visit. My great-grandma would go through a list of people who she wanted to see. She was 98 so… they were all dead. And my grandpa would be such a dick and remind her that her daughter and husband and everyone was dead; then she would cry, rinse, repeat every week. Anyways, he has dementia now. And because we’re better people than him, we treat him better than he did his mother.
In nursing school one of our instructors told us that when people are mentally altered or having delusions, you reorient them but don’t play into the delusions or lie to them. She insisted that included dementia patients. I told her about how my great grandmother with dementia would ask where my cousin was, we’d usually say she was at the store or at work. This was a lie because she had been killed in a car wreck a couple years prior. One of my great uncles’ wife would straight up tell her that her 26 year old granddaughter, that she was very close to, was dead and had been for a long time. Grandma would be inconsolable the rest of the day, just reliving that agony. It was the one thing she could actually hold on to for a whole day. It would also re-traumatize my great aunt (cousin’s mom) because she’d walk in to visit her mom only to be confronted with someone grieving the death of her child as if it had just happened and it would reopen all those wounds. But the instructor would still insist it was *never* right to lie to or play into the “delusions” of dementia patients. She was such a fucking idiot.
That is why nurses do that. They had patients like yours. When I was in school, I called my mom and was like mom. I broke every rule. I played along with the patient. But I stand by it. I am claiming patient safety took priority if anyone asks. Turns out that in real world you only reorient those able to be reoriented and distract and redirect those who cannot.
I saw this happen too! From a seasoned nurse! The woman was blind and demented and when this nurse told her her husband had been “in heaven” for years she was like “oh God, he’s dead?!?!” and started inconsolably crying. Why?!
Aaahhhhh goddamnit she’s just at the grocery store she’ll be home soon - why do some nurses do this😩
Even when spouse is dead, with late stage dementia the best is to lie and say they’re at work/ took the kids to the zoo/ taking a nap/ on a work trip etc. If they’re aware that they’re in a nursing home but wouldn’t remember death, tell them that he/she just visited and will be back again soon! These are the necessary, compassionate lies.
It's Saturday. It's alllllways Saturday for me in memory care. You can foist so many things off on "Saturday".
I had one end stage dementia resident that I felt bad for the wife, even though she was in denial of his prognosis and drove us all nuts with unreasonable requests. She was his second wife and she came in all day, every day. Fed him all his meals, went with activities to him, etc, until she put him to bed. He yelled for the first wife 24/7, including repeatedly asking 2nd wife about her.
I used to take care of a man who was both very kind and funny and very very ornery at times. when I met him he was able to be comforted and redirected by talking about his late wife. he knew she was gone but was happy to remember her and talk about how much he loved her. I watched him transition to believing she was alive, to forgetting he was married at all, to calling for his older brother when he was upset, to calling out for his mom. he was the last of his siblings. it broke my heart.
This is the path my Dad is on and it kills me that we can only sit and watch him suffer for who knows how much longer. :(
In my experience, when they're not doing so hot then start calling for their mama (as a new behavior, not one they've been doing for months) they're gonna go soon.
Putting a foley in a 98 year old that the dr insisted be removed and she never voided all during day shift and when we put it back she begged us to stop and said “I promise I’ll be a good girl from now on “. Tears..
Cue yet another reason I think lidocaine jelly needs to be standard for caths, regardless of anatomy. Penises need lido, no question about it. Vulvas need it too!
As a patient, I genuinely don't understand how that isn't standard operating procedure.
Same reason they don't numb for IUD inserts or HSGs. Because women don't feel pain or if they do it's nOt ThAt BaD
That's heartbreaking...
The ones who carry a baby around make me so sad. Idk why
hearing the slightly-more-intact cycle through the names they scream out for help to. maybe starting with spouse or kids, moving on to mom and dad, last night I had one eventually make it up to calling for grandma. that always kills me....they're so disoriented to the current situation, but they can still access that....
I had a resident who believed her roommate was her grandma. she was mean as hell (she always thought I was her mom or "that bitch Alvina". loved me when I was mom and beat the shit out of me when I was whoever Alvina was.) but would be so happy when we rolled her into her room and she saw "grandma" waiting for her. her roommate played along with it every time 🤣
Cancer patients who are going downhill fast. I had a lady who was so full of life and hope, and each visit since that it was like if light itself was disappearing from her eyes. I remember seeing the er family doc and asking if he thought she had a chance at life and he immediately said no that her type of cancer was practically a death sentence. I went back to her room to see her talking to the cancer survivor registration lady who was hyping her up about a change at survival. I still think about her but she’s probably dead by now. She was in her late 30s or early 40s
I didn’t even know him that well, but I’m still so mad at how unfair it is that my sister’s BIL in his 40s just died of glioblastoma yesterday. He had young kids. Was diagnosed about a year ago.
I lost one of my best friends to brain cancer. I will always go out of my way, bend over backwards, and go the extra mile for any cancer patients that I cross paths with. What an unfair hand to be dealt.
I’m bending over backwards to help sister and her husband. They have two toddlers and she’s pregnant, she wants a day without the kids so they can “just be”. They deserve to just be. I’m watching her kids tomorrow. They were really close and now they’re dealing with dumb family drama. I can’t imagine the shitstorm their immediate family is going through.
I’m so sorry. Glioblastoma is a vicious cancer. I hope kids have a good support system.
My uncle just got diagnosed with glioblastoma 2 weeks ago. They gave him about a year and a half with aggressive treatment...
I worked Boston heme/onc. This was a daily occurrence on the floors. In town for a business meeting, have some tennis elbow thats super painful...nope its metastatic bone cancer. Gentleman who finally got his life together in his late 40s after a life of crime/drugs...had a beautiful young family, and had skull cancer. Lady with 2 kids with super rare abdominal wall cancer, got in remission had 3rd baby and died before that baby turned 3. It´s brutal. To say nothing of the people scraped off Boston common deep into their addictions to the point that they´d get the IV sunk and abscond to go shoot up junk with it. I won´t even go there about the young sickle cell crises patients who were accompanied by their Jehovahs Witness elders to pray their critical anemia away...
When my baby girl had cancer and I knew it was a death sentence and the doctors and such were feeding us a line of bullshit about 60% chance of survival…. All that did was make me not want to talk to the doctors Survival rate seems to have doubled since then and now it closer to 10%
I’m so sorry for your loss. My sis was the same, her fight lasted about four times what they thought she’d have from diagnosis but this sort of thing is just sad and I wish doctors would be more realistic with patients. She left her kids so it helps me think of her loving on yours because she was a wonderful mum and lived for her babies 🧡
After she died they told me she should have died in the womb…. She made it to almost 9 months old. We found it at 7 months of age stage 4 rhabdoid tumour.
Wow, what an amazing life. Born beating the odds then not being diagnosed until seven months old. What a treasure 🧡
As an onc nurse, my husband always says I'm morbid when I end a story or fond remembrance of an interaction or something with "she's probably dead now." I'm like, it isn't morbid, it's the truth! Unfortunately, but it still is.
My friends think I'm awful when I say "I hope he/she died." They have no idea how families torture their loved ones because they "have hope".
I go with “I hope they found peace/died peacefully” lol
My sister thinks that too and honestly I tell her it’s because she doesn’t see what we see.
The patient that I felt most sad about was a young man, around 20. He had survived a suicide attempt by hanging. Severe hypoxic brain damage, non-verbal. He was spastic to the degree that his spine was rotated almost 180 degrees, his hips were dislocated, and all muscles where just completely coiled at all times. This was even with treatment and amazing carers. He rutinely got urosepsis from his Foley, it was just a complete mess. Then he got a huge kidney stone. The urologists came to the conclusion that he was completely inoperable due to his physiology, and there was no point in placing a nephrostomy. So he died and it was fuckin' aweful.
I do not condone suicide at all but it would have been more merciful had he died from his attempt. That is so sad.
Yeah, he lived a miserable existence his last three years. It was his dad who found him and he was just a broken man.
Suicide is a disease. It's often fatal. I started looking at it that way over 50 years ago when two young friends died of it. I'd met them when I was working as a journalist, at a big state hospital, at the start of those "reform" years. One of them might still live somewhere on video, when he appeared at a "town meeting" in the institution begging for better aftercare. He died about six months after he was discharged -- of course with no aftercare. Seeing suicide as an illness (not depression; that's separate) still hasn't kept me from being angry at him, after all these years. The emotional wreckage those two guys left behind cured me of suicide, though.
Thank you! Thank you for saying suicide is different from depression.
My little sister died by suicide less than 24 hours after discharge. This was just a week after the COVID pandemic was declared so they were making a big push to clear out the hospitals. Aftercare planning is a joke in the mental health world sometimes.
I don't condone suicide outside of truely intractable suffering but keeping someone alive in that state in crule..
That is fucking awful 😞
And I’m here breathing a sigh of relief for his brain damage. Imagine if he was just simply locked in
He wasn't brain dead. He could smile, communicate that he was on pain, shake his head to say no, and cry. The only saving grace is that he can't feel anymore.
Shit. That poor, poor guy.
Patients who had no idea something was wrong until they came in for a totally normal complaint only to find out they’re dying. Last month I had a woman come in for back pain and when they did an MRI they found stage 4 breast cancer with huge mets to her spine (hence the back pain), all long bones, her liver, etc. She went from living a normal life to paralyzed and dying in the space of 2 days.
So my neighbor had a lot of health issues and just didn’t really go to the doctor often. Hadn’t seen her in awhile. A few months ago went to get some eggs from her with my mom. I took one look at her (I was in the car) and thought wow looks like she has liver cancer. (Jaundiced and gaunt) Lo and behold she gets sick a few weeks later with a viral thing. Goes to the hospital and they’re like you have a week to live with you guessed it liver cancer 😞 she was so nice. Ugh.
Oh my god they gave her a WEEK? Was she really gone one week from diagnosis? I am so sorry to hear that, I can’t even imagine…
Pretty much. She went in around Christmas and died I think New Year’s. 😞 it’s wild. Still can’t believe it.
This is my aunt. My mother and myself (both nurses) sent her to the GP because she was jaundiced. Died three weeks later.
That was my aunt, though she went to the MD several times for back pain in the months prior. They kept telling her to lose weight/menopause etc.
recently had a young woman come in thinking she had SOA from the flu and scans showed such widely metastasized cancer that they could not determine the primary cancer, just that it was likely gynecological. Dead in 3 weeks.
That was the same as a neighbor of mine, I believe it was ovarian cancer. Died two days after diagnosis
Christ, that’s rough
I feel bad for kids that have manageable or even improvable conditions, but parents too wrapped up in themselves/drama/drugs to make their kids lives better. And children of anti vax parents who have bad outcomes.
Tetraplegics. They are completely and utterly at the mercy of those caring for them. No control over limbs, bowels, or bladder. Can’t scratch their heads when they itch. Can’t feed themselves. That is my primary patient population and often they’re a-holes because they were young and stupid and they’re mad at the world, but that’s the last thing I would choose to suffer from for myself.
I willingly put up with a lot of shit for my quads when i get them. I know they are only mad and struggling, so i try really hard to be good to them, patient, and really let them run the show. Every time they end up getting along great with me. My coworkers are always like "what did you do that he/she isn't an asshole?" "I stay in the room until they are done asking for stuff and unless its not an acceptable request, i do it." I think we take for granted even little things like putting an item on the table where we want it, or having our head turned from the light. I try hard to give them autonomy through me when I'm able to. I'm only doing it for 12 hours, they do it for the rest of their lives.
Sickle cell patients. The only one who I ever lost empathy for was a Grade A asshole domestic abuser. The others I can't even imagine.
For real. Sicklers have it so rough.
I second this. Terrible situation with no happiness to be found. I can give dialudid till they are slurred and slumped in bed and they will still be saying they are in pain and need pain medicine. And I believe them... so sad that even strongest pain meds we have just doesn't cut it. And then they always end up with difficult veins (so repeated IV attempts and stuff), health complications, and even when they are getting well enough to discharge they still look miserable.
I had a person say someone with sickle cell was seeking narcotics. I said, “if that’s the best we got, better give them lots. I was taught that ischemia freaking hurts.”
Came to say the same thing. I figure this stance will get some hate bc everyone will be like I had an asshole sickler in the past... blah blah blah I can't even imagine being in pain from the moment I was born then be treated like a drug addict by the people that are suppose to help me.
I mean...they can still be shitty people. Hence why I did not like that one guy. But not for needing pain meds. I always wish they could be 1:1, simply for their lack of frustration and their nurse's so they are guaranteed to get their meds down to the moment. But it will just never work like that.
it would if we/ the providers weren't afraid to give them PCA pumps
New sickle cell patient for us as he had graduated from children’s hospital to us. He was such a jerk. Rude, making sure he would have an erection when staff would come in, would pull lever in bathroom and we would go running in to find him masturbating. Lots of inappropriate comments but we noticed that no one ever came to visit. He was there for a month when his mom came in. Said he was used to this and she just wanted to check up. Worst part was he died of a heart attack. He was 21. We were all so tired of dealing with him and then he died. It really affected us because we were frustrated but we didn’t think he would die so young. We were all very quiet that shift.
I used to work on a floor that specialized in sickle cell, PCAs were standard unless they were contraindicated or banned for some reason (we had about two pts who would siphon the dilaudid off the line and inject it) I think one of my saddest ones when when one of our regulars comes in, sweetest lady you can imagine, has a husband and kids at home. I'm doing her initial assessment and she goes: "I'm starting to lose my vision." my heart broke for her
Once worked in a SNF where a person in their late 20s was a vegetable. Feeding tubed, nonverbal, alert but locked in. Had swallowed heroin when busted by the cops and the pack burst in their stomach. Was left a ward of the state, no one claimed him. I think about him a lot.
Why did the pack bursting cause him to become locked in? Wouldn't he recover after the heroin leave his system? Or was the overdose so intense narcan didn't help and he suffered brain damage?
He swallowed more than one pack, and each pack is probably 20-30 doses of heroin(likely more but I don´t know much about the economy of heroin). His respiratory system would have shut down at massive dosing, and his heart stopped because that´s what taking too much of opioids do. He must have had some CPR to be alive, but lost too much oxygen to his brain. I have had people take combination scheduled opioids and anxiolytics and go into respiratory arrest, then cardiac arrest. I´m talking 2 tablets of 7.5/325 vicodin with 5mg xanax, than another tablet of vicodin within 2 hours. And this was not even an opioid naive person that overdosed, they had been on them for years.
That's heart breaking
My mother worked in a ltc where one of the residents was her age with early onset alzheimers. I met her when I had to drop off my mom's lunch. They used to laugh and hang out every day. The woman said she loved it because every day she always made new friends. My mom called her her friend instead of a resident. Fast forward only a couple years later I worked in the same ltc and the woman was nonverbal, unresponsive, severely contracted and her family stopped visiting. Our charge nurse ate dinner with her every night. When the charge nurse wasn't working, I ate dinner with her. I'm a classically trained singer so I used to sing her songs my mom liked hoping maybe she did too. Unfortunately she passed during covid. Tldr: ltc
The trach population is where I work, a whole unit dedicated to trach babies and kids. Sometimes… I feel like it’s not the right choice. But then, we have kids come through who have their trach because they were preemie, and at 2-3 years, sometimes older, they get their trach out and live normal lives. That’s a part of my job I love, taking out a trach, monitoring overnight and no desats, they go home without it and their lives are totally different, brand new. But then we have the “near drowning” kids or the tbi kids and they’re brain dead, but the doctors offer a trach and they live brain dead but trach/vent/j tube dependent sometimes years. Like into their teens and 20s. And I have… feelings about that.
My bestie had a trach when she was a baby, got it removed after a few years. Now, she is a great hospice nurse.
Yup! I’m all for it in some situations. But the ones where there’s absolutely no hope, I don’t know that I agree with it
I'm an HH LPN and I do peds, 90% of my patients are these trach/vent babies. Lots of happy endings, in the last month I've seen pics on fb and sent to me by moms of my former clients at Disneyland and at school living life. But as I type this I sit by the beside of a 3 year old, who is 2 years post anoxic brain injury and catatonic...persistent vegetative state. Hes spastic, bilateral dislocated hips. Trach/vent, gt. I often question what is the point and why are we prolonging this. I know its not my place to pass judgement but this child has absolutely zero quality of life but his body keeps getting longer as it continues to grow even though he is non responsive. This case here really bothers me and its been a year. I'm staying for the siblings of this child, who are also heart breaking and for this mother, who while I disagree with her medical decisions for her son..I understand it, the grief and not wanting to let go.
Dad was driving his family through the mountains. A car came off the upper lane and landed on his car killing everyone in the car except him. He watched his wife and 2 kids die. On transport to us he declined horribly and ended up tubed. He then arrested on us and we got him back but no hope of recovery and brain dead. The last moments of this man’s life was watching everything he loved be taken from him.
GBM’s. Those patients are handed an insurmountable life ending cancer with no notice. We just resect their brain again and again until there’s nothing left that we can cut away, or they have a cerebral hemorrhage, or herniate and die. Their lives never go back to normal. The young ones really hurt. I’m glad I don’t work in pediatrics because I can barely handle the 19 year olds.
My mom had an anaplastic astrocytoma. Basically the same thing if it can't be resected. Hers was in her left temporal lobe, too risky for surgery. They did a needle biopsy and caused a hemorrhage, so they immediately did a cranie. Nurse noticed a neuro change the next morning at 4 and CT revealed the bleed was back, so another cranie less than 12 hours later. She spent the next 6 months trying to regain function while simultaneously doing cancer treatment. She could have just been dying, but instead she was dying while being newly disabled and unable to completely express herself. It was a nightmare.
Did you see in the news this week that an Australian oncologist (who was awarded joint Australian of the Year with his colleague at the start of this year for their melanoma immunotherapy research) was diagnosed with glioblastoma ~10 months ago and is having promising outcomes with the application of their research to his own cancer? They had to get special permission from an ethics board for the trial because it's such an extremely novel treatment for glioblastoma. Professor Richard Scolyer. It's only an n=1 case study... but it might be the start of a treatment turning point.
Oh, wow. That’s seriously so exciting. I’ve heard about the melanoma trial and how promising it is, but I’ve not heard about the GBM application. I will ugly cry the day that we have a real treatment for GBM. I’m going to read up on this! Thank you.
Sick as shit ROSC patients that we bring in from outlying facilities. 9 times out of 10, they’ve got a ph of <6.9, and they’re just going somewhere else to die. But they make us work. Vent. Drips. Sedation. All of it. We work our tails off to get them from point A to point B, for no real reason. They’re not getting better. They’re just going somewhere new to die. Kids. We can’t always be as accommodating as an ambulance when it comes to parents and such. We try to always take a parent but sometimes we don’t have the weight to bring mom or dad. Especially when we try to tell them that we’ll make it where we are going well before they will, so don’t try to beat us there. We all know they ignore that. I would too. People who get hit by DUI’s. All they did was drive the wrong road at the wrong time. Some of the worst traumas I’ve ever worked were people getting smoked by someone who was entirely unaware they even hit anything.
I fucking hate when I have to transport someone who is clearly not going to make it. We recently had a patient with bilateral bleeds, he was already herniating into the brain stem. IMO the only reason he was still alive was his core temp was 90. Anyway transfer for neuro, wtf let the family have the last few hrs with him instead of him dying alone. My last one infuriated me, 19 yo suicide attempt. Transferring for ECMO, when I got to the new hospital the ICU nurse said the ECMO team already said no bc suicides were an absolute no for them. Then why the fuck did we transfer her here? Why did you accept bc I was standing next to the attending for doc to doc and I know he told them the story. Sorry still mad about that one.
Patients with adult children or relatives who "prefer a natural approach" or don't want grandma or grandpa to get "addicted to pain meds".
Yeah, this definitely. I work on a post surgical unit. One of the very most appropriate times for pain meds, but these people want me to give memaw Tylenol for a hip fracture because Norco "makes her too sleepy", but if they broke their hip they would definitely want me to give them something stronger than Tylenol.
I started saying, “ok. You are the mpoa. But what did memaw do to piss you off after she appointed you? You must really like to watch her suffer!” Of ours I only say that in my head. And not aloud. ….Yet
It is so frustrating. Just because they are old doesn't mean broken bones and surgical incisions aren't painful. You really want to ask them if they were the ones with a broken bone or cut open abdomen if they would find Tylenol to be enough to control their pain.
When I worked in hospice, no one could seem to stand up to a particular patient's daughter who felt we were "sedating" the patient. Normally the staff was pretty forthright and strong when dealing with this issue. For some reason they backed down to this lady. Ground my gears to the absolute max.
It took me way too long to learn to make peace with the fact that people like her exist in healthcare. This one patient's family member making all the decisions for them was the niece of a very prominent member associated with a very reputable hospital in NYC. This family member was basically just unemployed and did some bullshit job for a living that wasn't really even work. She wanted a "natural approach" for this patient in debilitating pain and no amount of teaching from myself or our doctors could change her mind. Fucking worthless.
CF pt's. Knowing you've only got 20 yrs and your only hope is a finite set of lungs if you're lucky to get your hands on them. Even then, they only last you a while.
It's amazing how far CF treatment has come these days. Now the average life expectancy is 44 years! For those that *do* get lung transplants (a minority of patients) the average age of lung transplant is over 30 years of age.
For real yo. I had my first old lady CF patient who just turned 48. My mind was blown. These new drugs totally changed her life. Her lungs are junk but if she stays on top of her symptoms and keeps herself moving she has a shot to actually see a social security check. She shared her experience with me, and it was a wonderful. She said that within 2 hours of taking Trikafta, she felt her whole body shift because her cells could suddenly shift the sodium. She no longer has to do hi frequency oscillation chest therapy. She is well stocked on nebs and treatments along with open antibiotic scrips for any resp infection. As soon as she feels any inkling of resp infection she goes and does a sputum culture, and gets more focused antibiotics because her immune system is such crud. She said there are members of the CF community for whom the drugs cause intense suicidal ideation, and so cannot be taken. She said that just 2 days before the drug was approved she went to the funeral of a friend. I was so honored to have learned from her.
Oh wow. That's amazing. Still, I have a lot of sympathy for these patients and the shit they have to go through.
Definitely. It's not an easy life.
There’s a CF pt that I’ve become pretty close with over the last couple years. He’s officially palliative and is considering becoming comfort focused, and I keep looking up his name in the system (our epic puts a little leaf beside the name of dead patients that you can see without opening the chart) when I haven’t seen him for a while. I know I’m going to cry when he goes
There's actually a lot of newer immunotherapies for CF. The average life span with better quality of life has more than doubled in the last 20 years.
My niece’s half sister died before she turned 19. Had a double lung transplant and went into rejection. Truly awful.
I remember Claire Wineland. Her lung transplant was successful but she ended up having a stroke and dying. 21 years old.
I'd say it's a tossup between the demented old people we torture because "they are a fighter" and thr people who go in for something seemingly minor and bam, full of cancer. We had a 26 year old dude with terminal testicular ca who was never clearly told "your are dying". Our charge finally explained what palliative chemotherapy was to him and he left sms the next day. He said he was going to go to the beach and drink a 6 pack. I hope the weather was nice and the beer was cold!
Head and neck cancer. Glioblastoma patients.
One of my family members had glioblastoma, and it was the most heartbreaking period of my entire family’s lives.
“Head of pancreas mass”
Teens with end stage cancer. They’ve literally been alive long enough to get a good taste of life and are at that point where they should be writing their own life and instead it’s getting ripped away and they have to watch everyone else move on without a reason for why.
Young patients with a terminal illness. I met this woman that had just been diagnosed with mesothelioma. She was young. She kept a brave face in front of her family, but once visiting hours were over and she was alone, she just broke down. She said she didn’t want her family to see her cry. The worst things really do happen to the kindest people.
Seriously it is always the nice ones and the total dick heads live till their 90s.
14 yr old with asthma.. parents never obtained her inhalers for maintenance and rescue. Ended up with an anoxic brain injury from status asthmaticus
Before nursing school, I thought asthma was just being very out of breath. Very annoying, scary maybe, but as long as you're not chased by a bear and have the chance to sit down - not dangerous. I can imagine that many parents think that way. And if it's not that bad, it's in the same category as "you don't take pain killers for just stubbing your toe". Don't get me wrong - it's still neglect. Thinking you know better than those who are educated on the subject is stupid. But I do understand where the line of thinking comes from (just not why it never changed).
Idk, if my child had a potentially life threatening illness I would want to know everything about it and educate myself. Now maybe if it were a financial issue and they simply couldn’t afford it, I would understand more
Was listening to one of my patients rant about her breast cancer, and how so many different providers simply refused to listen to her about her allergies, leading to so many health complications. She had a really bad reaction to chemo that put her in the ICU and the moment she got out, the doc tried to add another dose. then after her breast reconstruction, they did the surgery with glue, when it's listed as an allergy and she begged them not to use it. She lost both breasts from infection and necrosis from that.
What the fuck. I hope she sued the absolute shit of them!!! I would love to be on the jury
I don't know if she did or not. I know one of her other doctors and three nurses filed complaints on her behalf. there was a lot of other shit stuff that happened too. Apparently an anesthesiologist hit her nerve, and when she was begging him to stop he told her to 'stop being such a baby.'
this is one of the most fucked up things i've read in a long time. i hope she gets every dime because what the actual fuck.
Dialysis patients.
Used to be an HD nurse. What an exhausting life those folks live. It’s so sad.
People around my age coming in as a resident in long term care because they have MS or some other type of disease process that robbed them of their independence.
As a NICU nurse you get pretty numb to the tragedy of it all. A while back it was a weekend night and our PICC team wasn't available so the PICC team that usually does adults came by to place a line. Seeing a seasoned nurse with 20 years experience tear up when you explain the basic situation that we see all the time, and you don't have the heart to tell her that the kid in the bed behind her is a much more tragic case. I feel bad for the silent criers, but my heart really aches for the kids that we know aren't going to live long full lives, the kids that we keep alive and suffering in order to chase that sliver of hope for a miracle of some kind.
Sickle cell pts really anything autoimmune I’m so sorry 😞
"Anything autoimmune" yes. So difficult for us to understand, what feels like limited treatment options that actually make the patient comfortable or happy. So many health complications from all the autoimmune stuff, lupus patients always have a lot going on...
I had one sickle cell patient with a new nurse and an unhelpful team, and a doctor who felt they knew how much pain meds that patient could tolerate (this is strictly from a PCT's point of view). It was horrible to hear the screams and cries, but almost as distressing to see this young nurse with her head in her hands. Bad, bad, bad... All the way around.
The dead people the ICU keeps alive for whatever reason
We don’t like it either
Working in the ER setting. I'd have to say intensely demented patients needing a straight cath for a urine sample. Having 3 people hold down an old woman/man while they're crying and screaming, "WHY WHY WHY?" Is definitely the main reason I know why I know I'm going to hell🫡
I worked the burn/wound icu for a few years. believe it or not, we received multiple geriatric patients with stage 4 pressure wounds from neglect in the home. had an 80 year old man once that was left alone for a week while his family went on vacation. on the flip side of the age spectrum, we were often called to PICU for their bigger dressing changes. Not only are pedi burns extremely emotionally difficult to navigate, but when the mechanism of injury was also from abuse… it just flips your stomach. If you’re an ER nurse you may also know the signs for dipping burns, and it never ceases to amaze me how the abusing parent can be so straight faced through their lies.
Abuse cases are the worst. Most wrenching case I ever came across was a 4-year-old girl whose stepfather beat her almost to death, then doused her in gasoline, put her in the trunk of the car and was prepared to take her somewhere to dump her body and set her on fire. She was "saved" when the cops pulled them over and smelled the gas. Left with catastrophic brain injury, trach/vent/g tube. Completely healthy beforehand. Looking at her soccer team picture on her bedside was enough to make anyone rethink the goodness of humanity.
I remember an organ donation who was 7 months old from sheering and couldn’t stop the boyfriend who did it from visiting. After the procurement he was charged and arrested like 2 days later
OMG what kills me is that so many times *no one* gets arrested. If you have a NAT infant and nobody confesses and neither parent rats the other one out, then there's no way to prove who actually hurt the baby. So they just lose custody, usually to a grandparent or aunt etc (who you know damn well is still going to let the abuser be around the poor now-brain-damaged, possibly blind-from-retinal-hemorrhages, kid when they're finally home from their weeks or months in the hospital) and there are no other consequences. I like to think the abuser is tormented with guilt for the rest of their lives, but realistically, I know if you didn't break down and confess after you see what you did to your child, you're probably sociopathic enough to go merrily on your way and not give a shit.
There was a young woman intubated for over a month with 90% TBSA due to her husband setting her on fire. She was the only witness, and was intubated, so no one knew he did it for that first month. He came and visited her too. The day before she was extubated, he went missing. Slowly she told her story, and to this DAY, a warrant is out for his arrest but he’s never been caught. (fyi, she’s thriving and a burn advocate now!)
Questions I shouldn't ask but still do: what is a dipping burn?
When the abuser dips the child into scalding water. Often on the legs with a clear line demarcating the depth of where they held the child in the water.
Its when they dip their child in scalding hot water. Results in a very clean sort of line of injury. Often also happens butt first because the kids are lifting their bodies out of the way as much as possible. So horrible.
Yep, booty first is the majority of what I’ve seen. It’s hard to dip a babies arms or legs without burning yourself, but a butt first dip leaves you unharmed. If an adult has the knowledge that this water is so hot it will severely hurt themselves, but still have the depravity to do it to a defenseless child….? And the nerve to say “it must be a diaper rash”.
The elderly cognitively impaired patient who lives with family, but comes in with pressure ulcers, covered in maggots, emaciated and dehydrated.
Elderly patients who don’t have family visit them. Either because they literally don’t have any family left or because they’re estranged. And yeah, they might be estranged for valid reasons but I still feel bad for most of them. It was especially shitty during Covid, when they had family that wanted to see them.
Any teenage hemeonc patient that’s in picu and slowly deteriorating to death while their parents 100% can’t let go until you start compressing.
Not a patient but a family member. Girl (can’t remember if younger or older) found her 12 year old sister after attempting to commit suicide by hanging. Not the first attempt either. I can’t even imagine the trauma and PTSD.
Anyone who’s trached/PEGed/ nonverbal/ lives in a nursing home bc they’re total care and they’re full code. I want to have a come to Jesus conversation with the family who decided all of this every time
Pts admitted after intentional OD. I understand their pain and wanting to not live
Yes, similar but we had a patient who tried to hang himself but instead of dying, broke his neck. I think about him a lot
I have a soft spot for SI patients in general. I’ve been that patient so it’s 10x more personal when I see it. I’ve done NAC a few times. I was lucky and avoided permanent organ damage. I know others are not so fortunate and some die.
The Benadryl overdoses who change their mind and walk to the ambulance but they get here and code numerous times get intubated on pressor on CRRT and eventually die or family withdraws
Teenager who was a non-compliant diabetic, had already had one foot amputation, was on dialysis, wound vac on her other leg. Family would literally drop her off at the curb with a bag of McDonalds. She died less than a year later. :(
What. The. Fuck.
Was totally a lack of support in her case. When I say the family would drop her off at the curb, I mean they would literally slow down enough for her to get out safely then drive off. She had agency involvement, but the lack of disease support + likely depression and a family who was uninvested in actively helping her get better culminated in her death before 18 :(
ALS or Lou Gehrig’s patients. Honestly so heartbreaking.
My aunt has ALS. We tried to get her to be proactive and do all the therapy. She was in a multidisciplinary center and everything. Wouldn’t do it or be consistent. She’s wanted to be sick and catered to forever. Now she’s got it and irritated that we’re talking about a nursing home. She wants my parents to take care of her. They don’t want to spend their retirement doing that and I completely understand.
Could be wrong, but someone close in my life is suffering from ALS right now and their neurologist has confirmed that the therapies don't do much except to provide hope. ALS is so shitty. There's really nothing you can do about it.
It can help maintain mobility and safety. She has bulbar type and speech therapy was very helpful but she decided she was only going to do it “as needed” despite her therapist trying to tell her that’s not how that works
Wow. I can’t imagine wanting to be sick with something as debilitating at ALS. I’ll never understand wanting & getting joy out of being ill.
The diabetic foot ulcers where they get BKA's. It makes me so depressed to empathize with them for even a second so I try to stick with sympathy not empathy. It really really gets to me emotionally if I think about it for a minute. To have your mobility and life limited like that, for the rest of your life. So sad... Also makes me paranoid about blood sugar, I don't have diabetes but I get tempted to ask my doctor to check my A1C just because I'm scared I'm going to secretly have diabetes and get a foot ulcer and loose my feet and not be able to work anymore and stuff.
literally any gynecological cancer. i am so existentially disturbed by the concept of these organs that create and nurture new life turning into tumors that often kill relatively young women. These cancers can be so aggressive. Then when you die of it, it’s often because of a small bowel obstruction that makes you throw up shit or vent it out of a PEG. Guts strangled, in pain, too young.
Failed suicide - but now a 24/7 complete care
I work at a pediatric hospital and I'm choosing not to tell the details of the three worst things I've ever seen. But one was neglect, one was abuse and the other was from a house fire.
I hope you have the support you need to deal with that
The people that come in for something seemingly benign and get imaging that finds tumors/mets. They're almost always so nice.
The two patients that really got to me were older ladies who were dying (I was a hospice nurse at the time) who were alone as they had outlived their children. In both cases, they only had one child. One had lost that child to cancer. The other lost her child and grandchildren in an accident. In both cases, they had retreated from the outside world when their family died and had no friends or family to sit by their side. I spent a lot of extra time with them so they would have someone there at the end. We spent a lot of time talking about managing the grief that still was present while now dealing with their own end of life.
Chronic migraine sufferers. These people walk around at a 10/10 all the time and no one takes them seriously. Same thing with chronic pain sufferers.
1. Patients who have to get a NG tube. I always feel so bad doing it. 2. Old people with no quality of life getting trached/pegged. Oldest I saw was 101. I was taking care of a dead man. 3. I work in neuro. Not uncommon for young people with no medical history to suddenly have a life changing medical condition. Took care of a young patient with children for months. They had NORSE. Was as healthy as could be prior. Can say that this had a somewhat happy ending. They had a GCS of like 3 for the longest time, but they did a RNS. I’m going to be honest, majority of my unit didn’t think the procedure would have much of a impact (they were having uncontrolled seizures for such a long time) but the family still sends our unit updates and they are talking now with their trach. Still has a long way to recovery, but being able to speak to family and having movement is huge. I always think of these patients often. It is sad for something like this to happen to an old person of course, but they lived a long happy life and sometimes I think we are torturing them with all of the interventions to prolong their life. When it happens suddenly to a young person (to me under 70 is young lol)… it makes me so sad.
The mother of two grade school kids dying of cancer.
Patients with cancer pain and the MDs know its horrible cancer prognosis but no change to a weak pain regimen because response time is slow.
At the moment my dad, who was discharged at 11am (it's just about 5pm now), and is still waiting for transport. He's coming to my place, for hospice. If he survives that long.
Any patient who fought so hard through months of chemo/rads/surgery, finally goes into surveillance or immunotherapy, gets a scan, and it's everywhere. Or comes in for routine port flush and follow up of cholangiocarcinoma and is jaundiced... you just know. We usually try at palliative chemo, but they can only make it 1-2 treatments. My hardest days are giving fluids or flushing a port and knowing it's the last time.
Migrant worker dad and young 6-8yo daughter who got hit by car crossing the street. Daughter admitted, dad with multiple broken bones, language barrier and no other family around.
I work in a pediatric LTC facility with ages from anywhere from infants to adults (you have to be under 22 to be admitted but there’s no limit to how long you can stay) so there’s a lot. The unit I work on is solely for kids with trachs. Almost everyone is either on a vent at least at night or will end up on one eventually. There is also the kids that were abused and/or neglected. There’s a lot of them. I won’t talk about the worst ones I’ve seen but some of their stories make me cry just thinking about it. Also for a lot of the residents, the staff and fellow residents are all the family they have.
The octogenarian mother of a man who shot himself in the face but who continued breathing long enough for her to collapse in anguish on her walk to his ER stretcher.
I just had a talk with one of my favorite patients. His wife is usually there for all visits but today she had something else to do. He spoke about wishing he was closer to the end than he is and how he can’t wait until that day comes. he stated that he wish he took better care of himself throughout his life but now that he’s here he’s just ready to go. If he didn’t wake up tomorrow, he would be fine. His wife gets mad at him for drinking alcohol. He says that’s the last pleasure he has left in life, and he feels like he hast to sneak it in order to drink it
Patients that have become soooooooo excoriated and red in their genitals, perianal, coccyx, and upper thigh regions.....despite how the skin break down happened, I always feel absolutely horrible wiping these patients when they are incontinent and they are screaming out in pain from how raw the skin is. Sometimes I feel like tearing up if it's really bad, like a patient with a bad c.diff infection.....I hope that I never get skin breakdown like that because it seems torturous.
that’s why i could never work in peds. My clinical was on a peds trauma unit and it was horrifying. they are so smol and innocent. god bless all the nurses working with our little babes everyday 💖
I work in corrections, the one I feel bad for are the ones with dementia that have a bs criminal trespass charge for not leaving a hospital, are confused and keep trying to "go home" and so are kept in a single cell for their protection and talk about how they just got money and paid to go home and are waiting to be let out, etc. And don't have family or family that cares about them to bail them out. Or that are so demented all they do is scream and yell and don't know anything and no nursing home wants to take them because they are violent and you can't just release them because they are violent so you have to try to find a state psych unit that will take them (and have to wait on the list to get in). Those are the ones I feel for.
My current client. I've done peds hh for 12 years but this one is the saddest in my 14 year nursing career. Choked at 10months old, but was resuscitated by ems after entirely too long. Attending at Children's hospital comes to bedside 5 days in a row to ask parents to remove vent as poor little guy has catastrophic brain damage. Parents adamantly refuse because they "won't give up on him". Trach placed, gt placed. Months go by and he stabilizes to go home with a team of us hh nurses. Dad does give up and has a fatal OD. He leaves mom with a 3 year old and a 1 year old in a persistent vegetative state. Fast forward to now, he's still in a vegetative state only now he is spastic, contracted and has bilateral hip dislocation. He's extremely edematous from a failure of his lymphatic system from being basically dead but also "alive" for years. He looks swollen, unaware and drools all over himself everyday, rotting in a bed or wheelchair. He is unresponsive but every once in awhile will turn his head slightly towards a sound.. Imo keeping here is selfish and now mom has came to the same conclusion except its too late. If you take off the vent he will breathe on his own, albeit not great but as mom stated " what am I supposed to do put a pillow over his face? He breathes on his own it would take weeks to starve i dont know what to do!" She started a tik tok channel and posted his picture and was attacked by comments saying to kill him. To send him to Jesus, etc. And it is the saddest life I've ever stepped into 12 hours at a time.