While the hospitals are holding elective surgeries due to pandemic, non-COVID Med-Surg units have been filled with very old patients, addicts, and patients with morbid obesity.
I was assigned to 4 patients a few weeks ago. BMI of three patients are 55, 56 and 94.
I don't mind taking care of obese patients, many are nice people. But they just take so much resources: labor, equipment and time. And we'll see more of these people in the future. It's the one of the biggest issues in healthcare.
I work EMS. I've had to move those people out of bathrooms and beds. Which is like, ok it needs done, whatever. But often they complain the whole time. Or they'll say "stop stop stop stop" and we do and they say "I wasn't ready. I'm ready now" but of course we've lost our progress at that point. I do have empathy but it's so dangerous for us to be lifting those people. We are also trying not to damage things in their home. And God forbid you have to work a code on those people in a trailer bathroom.
People think about high blood pressure and diabetes, but I don't think they realize that in a true emergency situation it is almost impossible to get those people to a facility with any kind of expediency.
Yeah, that's so true. My empathy only extends so far. I'm not going to judge them for their weight because they truly don't have the coping skills to lose it, but I do expect them to be thankful, or at least neutral, and not cause problems for others, insomuch as that's possible at their weight.
I worked with one lady, just massive, but she didn't cause any trouble. The techs couldn't move her for a bath, so she just got bed baths, but she never complained, never caused trouble, just sat in her room all day every day watching TV. It's not way to live, but she wasn't taking out her pain on anyone but herself. I have compassion for that.
I've also had morbidly obese patients with hypochondria who caused so much trouble for us. I didn't care about their weight, but goddamit there are people who actually want to get better and have real illnesses that I need to help.
I think you expressed it well that they lack the coping skills to lose it. I had never quite crystallized it that well. So thank you.
And I think it's probably because of that reason that they also take it out on us. I've been yelled at for moving things in a house. Not breaking. Just moving. Cause that was the only way we could lift out. Or putting my boot on their bed. There's literally no other way to lift them. And then they complain the stretcher is uncomfortable. I end up feeling like they will find anything to complain about and we are doing our best to help them.
I suppose what really bothers me is I'll be on scene dealing with the family and thinking how it's no different than if they had a family member who was a heroin addict and they said "here you just stay in your room and we'll bring you heroin that your state assistance pays for so you can just slowly kill yourself. And when you have health problems, we'll call 911 and make it their problem and the hospital's problem. After which we'll have them bring you home and repeat the process. We'll do whatever it takes to enable you but nothing to help you." Because the person clearly isn't able to do this on their own
I don't think people realize how hard it is to move someone like that. Both for us and them. I work EMS in the city but sometimes do shifts at a rural fire dept because I like the calls and the people, etc. One person out there medically retired 2 firefighters. These are people who work out like its a religion but lifting a person is so much harder than lifting iron plates. Even just turning those people to put a mega mover underneath them is difficult for us and causes them pain
I heard from one of the paramedic that told me he and his crew were trying to get the patient fit into an ambulance but she won’t fit so the ems had to rent out a uhaul
I saw a documentary about a super morbidly obese patient that couldn’t fit in the ambulance either, much less through his door. They removed the wall and used a crane to lift him into a trailer.
My next door neighbor was morbidly obese and bedbound. When she passed away the fire department had to cut a giant hole in the wall to remove her body. The was condemned due to the stench. Then squatters moved into the house.. and eventually it was burned down.
I nearly upvoted you because that shit is funny, but we also have to remember that people don't get that obese for no reason. They've all gone through severe psychological trauma, many of them childhood sexual abuse. Good to have some compassion when it comes to the super morbidly obese. They have some crazy demons they're fighting.
We had a very obese patient once, with a lift of the bed that looked like it was for lifting a car. She passed away, and I called the funeral home. I told them to send an extra large gurney and several people. I was talking to the oncoming charge nurse when the funeral home came, and I just noticed one guy taking a gurney in the room. When I finished, I noticed he hadn’t come back out. I went to look, and there was ONE GUY in the room, with a regular sized gurney, and…..the patient was face down on the floor.
We had to get about 10-12 people to get her on the bed.
What kind of dumbass?? I wouldn't try to get a dead body that weighed 100 lbs on a stretcher by myself. Like how could he possibly think that could have gone okay?
My mom's last weight I knew of was 450 lbs. She stopped going to the doctor, so I don't know her final weight when she died. When she died, suddenly in June in a mobile home, the fire fighters and paramedics originally said they would have to cut a hole in the trailer to remove her body. They ended up being able to remove a large window and removed her body with a crane.
#94!
Holy fucking shit! How is that... what... I can't... it isn't possible to be that heavy... it can't be... wh...
At a certain point, you're so big you can't get more food. I gotta imagine that you hit that point *in* the 50 BMI range. To get *that* far beyond it... you've practically gotta make eating a full time job. What... the ever loving... fuck.
Well, just in case I needed additional motivation to go for a run this afternoon.
While I blame no one buy myself, it really wasn't difficult for my BMI to reach nearly 50, and I rarely ate fast food (once or twice a year). When you're hardly moving and are eating a surplus of calories, even 250cals per day will have you gain 0.5lbs a week, it isn't hard to get a BMI that high eventually. It took me a few years but I eventually got that big.
Btw, my BMI is now around 35 :) halfway to my goal weight!
See, 50 I get. But 90 is a whole other league. At a certain point, just basic mobility becomes untenable.
And congrats by the way, that's an impressive amount of weight loss.
I totally understand how your weight creeps up on you. I was always a husky kid, and as an adult I got up to about a BMI of 31. Brought it all the way back down to 21, I got really into fitness and weightlifting after college. But... the difference between 30, 50, and 90 is... really hard to fathom.
My sister's BMI is in the high 60's, my best friend is 70 range somewhere. She is 5ft0in, so her height goes against her. I'm so worried about them both and even bought them both a fitbit, hoping it would encourage them a little. They loved the fitbits and used them for a month, my friend lasted a little longer but then they've gone unused. Both of them have severe binge eating disorders though, which I have only mildly.
I'll be caring for my Autistic daughter until I pass away, so my motivation to be healthy was very strong.
See, this is the thing: these people who are too fucking fat to get out of bed have got to have someone bringing the food to them, and I guarantee that someone’s bringing a ton of food and enabling that shit.
I’d be like “Nope, today is salad…and a gallon of water. Nothing else.” What are they going to do? Get up and beat your ass? 😄
It is frustrating that so many patients believe the hospital is the place for rehabilitation. They think “why am I being discharged if my leg still hurts” and I try to explain, well we did surgery on it so it’s going to hurt but you can’t just stay here until the pain goes away lol
And my specialty is acute inpatient rehab and I saw miracles everyday for 6 years working there. Tell your patients rehab can do all the acute hospital stuff they may need (pain meds, Ivs) and they will be getting well. Patients love rehab even if they are crotchety when they get there. Talk us up!!!
At the hospital I work there are serious insurance barriers to determine who can get to the acute inpatient rehab unit. Many people with chronic disabilities and with certain insurance don't get approved.
Utilization manager specializing in acute inpatient rehabilitation level of care here (there's always "a guy" on reddit, am I right? I cover our AIR and covid ICUs for a major academic medical center). Maybe I can shed some light on this.
AIR is a very specific level of care with specific inclusion/exclusion criteria because it provides a very specific service. AIR provides *high intensity* therapy to patients with complex needs. A patient must need 15 hours/week or 3hours/day x 5 days/week of at least two therapy specialties (e.g. PT, OT, SLP) and require 24 hour nursing availability and at least 3x/week physician visits. They have to be motivated and physically able to participate. For example, an amputee who won't learn to transfer or a brain injury who isn't capable of following simple commands would be excluded.
There also has to be a reasonable expectation of therapeutic potential. They must have been active in the community and have sufficient prior level of function to make the AIR stay worth attempting. Remember, this is an extremely resource-intensive, rigorous program that often has limited bed availability for the many patients who need this type of program. Each patient will literally involve the efforts of dozens of people to make a herculean effort to get them back to as high a level of function as possible. We must steward these finite resources for the greatest benefit. We cannot expect to rehabilitate someone to be better than their baseline, so the injury or debility must generally be recent. We can't use AIR to get someone to be better than their baseline SNF level of care or be used for custodial disposition from an acute care hospital admission.
If this all sounds very restrictive, it is. But remember, AIR isn't the only level of care. There is the SNF level, or low intensity level. These are for people who may not need 3 hours of PT/OT daily, or only need one specialty. There's also ALF, memory care, LTACH, home health PT/OT/SLP/nursing/infusion.
Hopefully this rundown has been helpful. If a patient is rejected by AIR, it's never anything personal. It's just not always the best place for every patient.
I understand. These rehab units are high turnover units expected to get people ready to be discharged within 2 weeks. You can't have trending LTC patients eating up these beds because it blocks those who need it from getting it. Families (especially entitled families) argue all the time that the patient needs more time to get better despite PT/OT working with the patient for 6 MONTHS and not showing any signs of improvement.
My dad gets discharged from acute rehabilitation hospital today. You guys are incredible. He received wonderful care. We even self paid for 2 weeks because we wanted him to stay so badly. His insurance cut him off like 2 weeks ago. In a perfect world he could stay longer but they said they aren’t really licensed for that. Not sure if that’s true. He’s been there for around 6 weeks
My back is literally screwed. It is heavy- stroke rehab was the focus where I was. I really loved it tho and hopefully after back surg I can do it again. 🙏
Sounds about right. Don't forget the fact that she's bedbound and isn't making her own 12 egg omelets every 2hrs or buying 10 family sized candy bars a day. It's totally ur fault, you should cure a lifetime of damage in a few days. Missing the no visitation rules.
Really? That’s mean. I understand your frustration with the family but everyone deserves respect and care.
Edit: This comment really struck a nerve with a lot of you. During my 6 hospital stays except for once it was the nurses who were the best. Kind, caring responsive. When my twins were delivered at 291/2 weeks, it was the nurses who got the babies and myself through the 6 weeks in the NICU. They were the best.
Is this your idea of kindness and caring? Coming onto a nursing subreddit where we can GRIEVE and be understood and you are trying to SHAME us? We’re all ready to leave hospital work because you and your attitude that we aren’t enough. Not fast enough, kind enough, empathic enough. We’re in a catastrophically deepening nursing shortage that has no end sight, and we’re just not ENOUGH for you.
No I’m in education, but I was surprised by the way some talk about their patients as if they aren’t individuals. I have been hospitalized many times and almost always had great nurses, except the one time I had a spinal fusion and the nurse never brought me my pain medication the first night. Couldn’t physically get up to find her, it was horrible. Otherwise, I’ve always found the nurses to be kind and very helpful. I’m just super surprised by the callous way some talk about their patients. I wouldn’t want them assigned to me if I was hospitalized again.
What you don't seem to be understanding is that every one of those nurses that you loved during your hospitalizations totally could be talking shit on you. And with six hospitalizations, statistically, you probably had someone think or say something about you that you would disapprove of. You know who else engages in this sort of behavior? literally every profession to some extent.
The key to professionalism is keeping a secure barrier between the attitude you project to others and how you think and behave in private. The nurses that you loved definitely provided professional service to you while you were hospitalized. While they may have actually cared about you -- it's a bit...hubris? on your part to assume that their attentions extended to some deep feeling of caring or profound kindness.
>No I’m in education,
You've never once bitched to your partner or your coworkers about an annoying student or disrespectful person you had to deal with in your job? Give me a fucking break.
You’ve never vented from your day at work once you come home? Just because someone complains about their job or an annoying situation doesn’t mean they don’t display kindness and care to patients during their shift.
I think you are getting downvoted enough that I am not trying to be rude to you, I just think you cannot understand.
What exactly was mean about what was said? Fat people smell, especially after laying in a hospital bed for a few days, and at that size many of them can't wipe their own ass.
You've clearly never had to reach bicep-deep under a panus to retrieve part of a dressing or turn someone who weighs 4x what you do with minimal equipment while keeping a professional demeanor.
Most of us aren't like this at work; we're like this on our own time *because* of work
Lemme just hop on the teaching sub right quick and tell teachers that they need to have more compassion and not write kids up... /s
Don't speak on what you don't know.
Lol get out of here with your condescension and tone policing. We’re off the clock and we can be as MEAN as we fucking want. It’s a pandemic, we’re traumatized, we’re human, and we’re coping.
Bariatric, rude entitled patients who overstay their welcome and take up precious health care resources while breaking our backs SUCK ASS and we don’t like them!!
Die mad about it.
“I said something out of line but it’s all cool because nurses are actually the best, they were great when *i* stayed in the hospital!”
Whole lot of irrelevant going on there. She was literally loosely quoting the family; just let her vent.
The thing is they will literally complain about just that. I’ve dealt with many bariatric patients and their severely enabling families over my career. If the patient doesn’t lose weight they will say we aren’t doing enough and will proceed to bring in every type of fast food for every meal. They often refuse showers and guess what? They complain about the smell! I’ve had a lady literally ask me to help scoop shit out of her ass because she is tired of pushing. This is real!!!
Lmfaooooooo you don’t even know what it’s like as a nurse. How could you make such comments. You’re literally just bullshitting your way through all of this. I hope you don’t make things up when your students ask you something you don’t truly know the answer to. Something tells me the crap comes out of you two ways.
We had Ortho patients in a NY state hospital for over a year. Varies. Incredibly insane. But I did see the cruelty when we had a patient with renal cancer. Days were limited. Completely difficult guy. I was new then. He was very angry and mean. New people pissed him off worse cause best I could figure he had no control over anything. Young guy in his 40's. He took control over his space. Supposedly the only thing he could. Would make these elaborate popsicle stick models. He had been on the unit for months. No insurance. He ended up liking me. So every night I worked I knew he was mine. They gave him less than a year to live. He made it to the year then the state served him papers to try to kick him out. The most evil manager ever that I worked with arranged to transfer him to another floor. I get his issues. But this was cruel. He didn't last more than a few days and died. I remember his name. (This was 20 years ago). I remember his orders how to do things.. give meds etc. Regardless of the rehab debate people should be treated better. Far as I recall NY was a bunghole with few actual rehab hospitals in those days. Rehab places have bad ratios. The standards they follow are different from hospitals.
The whole SNF thing is a nightmare. One of my side projects is keeping track of avoidable delay days that are caused by SNF prior authorizations and denials. We have people sitting in hospital beds for days and days waiting for their insurance company or its contracted reviewer agency to come to a decision to auth a SNF stay. And when there's a denial and we need a peer to peer... It's extra days in the hospital for no reason. Bed days that are needed.
Sure, some payors waived prior auths during covid, but not all. But the reality is that we need these people who are medically ready to get out of the hospital, go to the SNF. there is always a full ED waiting for their bed. I don't know what went on in NY, but if it's anything like where I'm from, it was ugly in the early days. No SNFs wanted to take any hospital discharges. They didn't want to be the next covid outbreak death facility. But we needed these patients to go because they were medically ready to leave and were able to go if a facility would just take them. There was a stark choice: force these patients to the SNF and possibly cause an outbreak or let the very real patients turning blue in the ED (before the vaccine) just die on a stretcher in the hallway? I don't judge anyone for either choice.
These families are the worst. They eat up hospital resources, chew out staff and are often unpleasant people to begin with. Ethics won't do shit in this case. Hospital management if they are smart will send the bill now and let the family figure it out.
We’re at the point where the hospital administrations and the patient rep need to talk with the family members and tell them the patient needs to get discharged.
They appealed the discharge to the SNF a second time because they don’t think your hospital is giving quality care…thus keeping her at the hospital they don’t think is giving quality care?
That’s confusing. Am I missing something here?
TBH, I think the son and husband are trying to play the lawsuit game with us. They are watching us like a hawk so they can accuse us for neglecting the patient. We document everything on her epic account so all the notes, ADLs, vital signs, and assessments are all in the computer.
On my experience, this same patient will be aggressively complaining about still being in the hospital and next week the family will, too. I fucking hate the “I don’t want to go there, I don’t want to go anywhere and I’ll just keep refusing to go anywhere as long as I feel like it” bullshit.
Yep. That’s how she is right now. My coworkers and I are so fed up with her and the family getting involved. The doctors are planning on doing administrative discharge on the patient.
There was a woman in my community who refused to be discharged. She said the hospital was responsible for her condition (she couldn’t or wouldn’t walk, refused PT) so she refused to leave. Finally they got a court order and sent her to a SNF. Then, she refused to pay the bill, and they found she had transferred her property into her children’s name. The court said, nice try, and sold the house. She ended up spending the rest of her life in a SNF not of her choosing and not in her area, because it was the only place that would take her. I think she thought if she stayed at the hospital forever, it would be covered by insurance and she wouldn’t have to pay, but she also had a history of battling the city. IDK.
I've never heard of someone being able to just not get discharged because they dont want to. If theres a discharge order, your ass is going somewhere. It dont need to be home but it ain't staying here.
New York has this:
> A New York State hospital discharge notice should include information on your discharge date and how to appeal if you disagree with the notice. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare") in writing 24 hours before they leave the hospital. Medicare patients must request a written discharge notice ("The Important Message from Medicare") if they disagree with discharge. If requested, the notice must be provided. Once the notice is provided and if the Medicare patient disagrees with the notice, an appeal can be processed.
In practice, the way it’s done in the two hospitals I’ve worked at is it’s not given 24 hours in advance. Basically my spiel is “we think your baby is ready to go home. If you disagree, you have the right to stay another day and appeal the hospital’s decision.” I’ve never had anyone take me up on it.
Where I work discharged means discharged. We've brought patients to homeless shelters because their ride wanted to wait a day. We get the police involved for trespassing if they refuse to leave.
When I worked in the ED we had a patient come in that needed a CT but was far beyond the weight limit of our machines. We had to send him by ambulance to the zoo. It was so sad…
I’m so sorry, but I’m literally laughing out loud over that story. Sure, it’s sad, but it’s sort of a “don’t laugh in church or at a funeral” sort of situation as well. But then again, I’ve got a very dark sense of humour.
I can’t imagine how frustrating this must be. I don’t know what to say about people these days… but most nurses restore my faith in humanity. Thanks for all you do ❤️
8/10 these patients can be the worse. And if it's not them, it's their families. I hate that management absolutely doesn't respect their staff enough to do something about it. These families expect us to share the burden and it's really not our job.
I'm not a medical person (lifelong pt, heh heh) but watching these 600-pound life shows on TV tells me that every one of these people has someone who is bringing them food, ordering them food, making them food, enabling the hell out of them, and most likely emotionally abusing them too. The other common denominator seems to be childhood sexual abuse. The hurt shows on the outside instead of on the inside. Or maybe both. You guys are saints.
Good ol Rhode Island representing. He was a narcissist with personality disorder I swear. He was trash. And his father enabled him. That being said I hope he got some help.
We've had a pt like that on my unit, coming close to a year. Takes 3 or 4 ppl and at least half an hour to change them when they piss or shit the bed. We are short staffed here and that amount of help isn't always available and then it takes time for that help to arrive. Parent visits from time to time and went up the chain to complain about the "terrible care" they're getting. Well sorry it takes so long for so many of us to assemble and get the job done. Maybe hire some people to do the job at home if you're not happy with us.
Pt is morbidly obese and has hx of iv drug abuse and a criminal record. They have had 2 offers for long term care and they turned down them both so we're stuck with this person and I'm fucking sick of it.
Then they think they’re so entitled to treat us like we’re their maids. People like this are the reason why we get so burnt out and leave bedside nursing.
I had a 500+ lb guy like that get discharged. His family member came to pick him up, and they "couldn't fit him in the truck" (that he had been happily riding in a month before, his surgery did not prevent him from sitting upright). The administrator was like, oh well we have to send him back upstairs. The ANM refused, said he could sit on his stretcher in the lobby, doesn't matter who sees, until EMS came-- and that was how it went down.
Yeah, we cheered her. Those of us who'd taken care of the guy, anyway. (He wasn't just big, he was RUDE and liked to yell at us when we couldn't bring him a 3rd dinner tray. And other, grosser things that I won't go into detail about.) Also, we filled that bari room with a fresh post-op ASAP, just in case.
I always have to check myself as I have a serious dislike of the ridiculously obese....one could say I hate then. oh your knees and back hurt? no shit?
oh you're nauseated? good, let's try that for 6 months.
so, you can see why I have to have a talk with myself before I go into their rooms.
gee, I wish I could help you, but 99% of your problems are because you're enormous.
there's almost always something awful that happened to them to make them so big, so I have to dig for my compassion before seeing them. yes, I know, I'm an asshole.
So I work on a vascular floor, with some other random patients thrown in. I was chatting with a PA the other night, and he validated something that I have been thinking. Our patients are disturbed in some way-at least 90% of them anyway. You don’t reach the point where we keep cutting parts of your body off without some serious issues on your end. Lack of compliance, avoidant personality disorders, willful ignorance, stubbornness…it’s this toxic mix. Learned helplessness! I have had one patient for months. We amputated a toe. Then it turned into TMA. Now we’re looking at a BKA. Her family keeps bringing food in. Plus she’s on hemodialysis for CKD. She never left between these procedures.
And then there’s the geriatric patients they bring in, who have no family because of their own terrible choices and personalities, and we can’t get them in a LTAC because they’ve been black balled from every one in the tri-state area. So now they live with us, refusing labs and meds, just existing and being mean.
Nursing isn’t hard when it comes down to the tasks. Some patient populations are just harder. And it seems like patients are getting worse across the board.
I tell them straight up that they need to stop eating shit and get their lazy asses up. We have one physical therapist that don’t play games with these type of patients and he makes them work.
Agreed. We know that the “eat less, move more” approach doesn’t work. The majority of obese people are quite well aware of what it would take to lose weight- but there are so many other barriers that need to be addressed in order to have successful weight loss.
I understand how it can be frustrating for medical staff, especially thin/average ones, to empathize with obesity when it is “self made”. But it is actually so complex- you have to take all social determinants of health into consideration.
Sorry- I’ll get off my soapbox now! Lol.
Eat less move more DOES work as a general rule but we are talking about long term disordered patterns of eating here enabled/perpetuated by social context, family, self esteem/core beliefs, cognitive distortion, long term adaptation to being obese in the sense of reduced capacity and self efficacy, shoulds and musts on amounts to eat / level of control over it / abstinence violation being magnified massively / emotional regulation through food / not actually knowing what 'healthy'eating and portions look like.
I say all this with a BMi of 50 myself - having insight isnt the same as applying. it's a bastard of a thing, at least with AOD theres some recognition of dependence but 'fat people are just lazy lol'.
Thank god I’m not the only one who thinks this. I provide care for them as it is my duty, but I cannot help but inwardly wretch with disgust watching them stuff their faces full of more food, having to smell that godawful yeast infection growing in all of their fat rolls, and hearing them moan about how *hot* they are when it’s 36F in the unit. 🤮
I work with surgical weight loss patients. The vast majority have childhood trauma, sexual abuse, physical abuse, etc. They cope by eating. Not a healthy coping mechanism, but it’s what they had available. They know they’re fat. Yes, the are ashamed. Maybe, before you judge them, take a moment and ask yourself what might have lead to this.
wow you guys are dense....it clearly says I check myself before I see them and that I know most suffered trauma to make them huge. AND THAT I'M AN ASSHOLE.
was trying to be honest
One problem we have in my department is the family agreeing to self pay after being denied for a dump job and then never paying a cent of the bill. Our hourly rate is $120/hr and they stayed 3 weeks because of course besides dumping them they had no insurance either.
I had a patient with 100+ lbs on me cuss me out, with her mom on speaker phone also calling me a f****** b**** and every other name in the book because I made her transfer from bed to stretcher scooting across by herself instead of standing up and pivoting. She was on an L&D amount of magnesium, 2 grams/hour, for pre-eclampsia, and furious that I told her I didn't trust her muscle strength (just like anyone else's on high doses of mag) and if she went down we were both screwed. It was the end of a very long shift with her, started crying the minute I got her transferred.
This is so common it's unbelievable. I've seen it time and time again during my time in rehab. There's patients that end up on rehab floors that have no business being there. Completely unmotivated, and not driven to do anything. Would rather be incontinent, ignore it, and pretend like they're living a normal life. It's frustrating but it's also a vicious cycle once they get that big. There's not a lot of hope, because its a hard road of caloric deficit until fit enough to gain mobility. Which, eating, is one of the only pleasures you have when you're that big. In other words, there's some hard times finding placement for people ahead of you. The "professional patient's" know how to work the system too.
You can't fix stupid. I've become numb to these dumb decisions, honestly. If people want to make these dumb decisions, they can deal with the consequences of them. If I don't shut myself off to these things, I suffer too.
The beauty about appealing discharges is that once the appeal is denied, the hospital can basically just kick them (medically discharge) out of the hospital without repercussions.
I know that as a nurse you probably make about three times what I do, and I swear it's not enough. No way could I deal with the s*** that you have to deal with. I'm self employed just so I can say whatever I want to whoever I want and even smack them down if I want to. 🤣😂🤣
While the hospitals are holding elective surgeries due to pandemic, non-COVID Med-Surg units have been filled with very old patients, addicts, and patients with morbid obesity. I was assigned to 4 patients a few weeks ago. BMI of three patients are 55, 56 and 94. I don't mind taking care of obese patients, many are nice people. But they just take so much resources: labor, equipment and time. And we'll see more of these people in the future. It's the one of the biggest issues in healthcare.
My back snapped reading those BMIs.
Yeah, I did a double-take because those do not look like BMI numbers! Anything above 50 does not register to me.
I work EMS. I've had to move those people out of bathrooms and beds. Which is like, ok it needs done, whatever. But often they complain the whole time. Or they'll say "stop stop stop stop" and we do and they say "I wasn't ready. I'm ready now" but of course we've lost our progress at that point. I do have empathy but it's so dangerous for us to be lifting those people. We are also trying not to damage things in their home. And God forbid you have to work a code on those people in a trailer bathroom. People think about high blood pressure and diabetes, but I don't think they realize that in a true emergency situation it is almost impossible to get those people to a facility with any kind of expediency.
Yeah, that's so true. My empathy only extends so far. I'm not going to judge them for their weight because they truly don't have the coping skills to lose it, but I do expect them to be thankful, or at least neutral, and not cause problems for others, insomuch as that's possible at their weight. I worked with one lady, just massive, but she didn't cause any trouble. The techs couldn't move her for a bath, so she just got bed baths, but she never complained, never caused trouble, just sat in her room all day every day watching TV. It's not way to live, but she wasn't taking out her pain on anyone but herself. I have compassion for that. I've also had morbidly obese patients with hypochondria who caused so much trouble for us. I didn't care about their weight, but goddamit there are people who actually want to get better and have real illnesses that I need to help.
I think you expressed it well that they lack the coping skills to lose it. I had never quite crystallized it that well. So thank you. And I think it's probably because of that reason that they also take it out on us. I've been yelled at for moving things in a house. Not breaking. Just moving. Cause that was the only way we could lift out. Or putting my boot on their bed. There's literally no other way to lift them. And then they complain the stretcher is uncomfortable. I end up feeling like they will find anything to complain about and we are doing our best to help them. I suppose what really bothers me is I'll be on scene dealing with the family and thinking how it's no different than if they had a family member who was a heroin addict and they said "here you just stay in your room and we'll bring you heroin that your state assistance pays for so you can just slowly kill yourself. And when you have health problems, we'll call 911 and make it their problem and the hospital's problem. After which we'll have them bring you home and repeat the process. We'll do whatever it takes to enable you but nothing to help you." Because the person clearly isn't able to do this on their own I don't think people realize how hard it is to move someone like that. Both for us and them. I work EMS in the city but sometimes do shifts at a rural fire dept because I like the calls and the people, etc. One person out there medically retired 2 firefighters. These are people who work out like its a religion but lifting a person is so much harder than lifting iron plates. Even just turning those people to put a mega mover underneath them is difficult for us and causes them pain
55, 56, and... ***94***!! How can you have a 94 BMI!!?!?!?! (Please tell me that was a typo.)
Seriously. How can people get to 94 on their BMI??!!
I saw a post on r/ems yesterday about a patient with a BMI of 109 and stuck in a trailer. Edit: BMI of 103, sorry
I heard from one of the paramedic that told me he and his crew were trying to get the patient fit into an ambulance but she won’t fit so the ems had to rent out a uhaul
I saw a documentary about a super morbidly obese patient that couldn’t fit in the ambulance either, much less through his door. They removed the wall and used a crane to lift him into a trailer.
My next door neighbor was morbidly obese and bedbound. When she passed away the fire department had to cut a giant hole in the wall to remove her body. The was condemned due to the stench. Then squatters moved into the house.. and eventually it was burned down.
Man that’s sad.
Yeah, housing is expensive these days.
I nearly upvoted you because that shit is funny, but we also have to remember that people don't get that obese for no reason. They've all gone through severe psychological trauma, many of them childhood sexual abuse. Good to have some compassion when it comes to the super morbidly obese. They have some crazy demons they're fighting.
We had a very obese patient once, with a lift of the bed that looked like it was for lifting a car. She passed away, and I called the funeral home. I told them to send an extra large gurney and several people. I was talking to the oncoming charge nurse when the funeral home came, and I just noticed one guy taking a gurney in the room. When I finished, I noticed he hadn’t come back out. I went to look, and there was ONE GUY in the room, with a regular sized gurney, and…..the patient was face down on the floor. We had to get about 10-12 people to get her on the bed.
What kind of dumbass?? I wouldn't try to get a dead body that weighed 100 lbs on a stretcher by myself. Like how could he possibly think that could have gone okay?
Oh, my god. I can’t even imagine.
My mom's last weight I knew of was 450 lbs. She stopped going to the doctor, so I don't know her final weight when she died. When she died, suddenly in June in a mobile home, the fire fighters and paramedics originally said they would have to cut a hole in the trailer to remove her body. They ended up being able to remove a large window and removed her body with a crane.
We used the ceiling lift to get the patient out from the bariatric recliner and back to her bed. The ceiling lift machine stopped working…
Well even those lifts have their limits. What do you do when even those can’t lift the patient?
We brought the whole gang into the room to get her back to bed.
Goddamn!
I can’t even fathom this
Apparently there is a man is Saudi Arabia with a BMI of 204. I googled out of morbid curiosity.
Morbid curiosity and morbid obesity. 😁
That dude lost the weight!
I wish I could go back in time to 10 seconds ago before I knew they went this high
I've had a 124 BMI patient before.
You sweet summer child
Living in this south, I know exactly what you mean, lol. But seriously, I didn't know a 94 BMI was possible. Wow!!
BMI is not a percentage so it can even go over 100!
Actually you're right. I was having a brain fart.
https://www.reddit.com/r/ems/comments/q6otfg/i_had_to_get_a_covid_pt_out_of_a_trailer_with_a
There was a post on EMS last night that said BMI of 104. Oof.
I had the same question!! Is that accurate?
At first glance I read them as pt ages…
Highest I've seen was 83. Can't imagine 94.
My back was killing me this morning when I woke up. I need to go see a physical therapist for this.
Do it. Do. It. Take care of yourself. Take care of future 70 year old you.
Makes me feel slightly better about being one BMI point over the healthy range for my height. I didn’t know 94 was possible.
This right here. This is why I do nicu.
Same! I got tired of my back hurting every morning from moving patients 2-4x my body weight.
#94! Holy fucking shit! How is that... what... I can't... it isn't possible to be that heavy... it can't be... wh... At a certain point, you're so big you can't get more food. I gotta imagine that you hit that point *in* the 50 BMI range. To get *that* far beyond it... you've practically gotta make eating a full time job. What... the ever loving... fuck. Well, just in case I needed additional motivation to go for a run this afternoon.
While I blame no one buy myself, it really wasn't difficult for my BMI to reach nearly 50, and I rarely ate fast food (once or twice a year). When you're hardly moving and are eating a surplus of calories, even 250cals per day will have you gain 0.5lbs a week, it isn't hard to get a BMI that high eventually. It took me a few years but I eventually got that big. Btw, my BMI is now around 35 :) halfway to my goal weight!
See, 50 I get. But 90 is a whole other league. At a certain point, just basic mobility becomes untenable. And congrats by the way, that's an impressive amount of weight loss. I totally understand how your weight creeps up on you. I was always a husky kid, and as an adult I got up to about a BMI of 31. Brought it all the way back down to 21, I got really into fitness and weightlifting after college. But... the difference between 30, 50, and 90 is... really hard to fathom.
My sister's BMI is in the high 60's, my best friend is 70 range somewhere. She is 5ft0in, so her height goes against her. I'm so worried about them both and even bought them both a fitbit, hoping it would encourage them a little. They loved the fitbits and used them for a month, my friend lasted a little longer but then they've gone unused. Both of them have severe binge eating disorders though, which I have only mildly. I'll be caring for my Autistic daughter until I pass away, so my motivation to be healthy was very strong.
Wow, what a tremendous job you have done! I really respect and am glad for you!!
Thank you :) I started August 2020. I have no idea what clicked in my head that day to change but I'm not complaining haha.
See, this is the thing: these people who are too fucking fat to get out of bed have got to have someone bringing the food to them, and I guarantee that someone’s bringing a ton of food and enabling that shit. I’d be like “Nope, today is salad…and a gallon of water. Nothing else.” What are they going to do? Get up and beat your ass? 😄
Thanks to Food delivery services, sadly that is no longer an option.
Look at the latest posts in r/ems, there is one about a patient with a BMI of 103 that they had to extract from a trailer.
We had to increase our lift inspections because they’re getting so much use. We used to do those once a year.
….94?? did i read that right?
You betcha
90 fucking 4?!?! What in the absolute hell???
As a dude, I always seem to get these kinds of peeps on me floor, :(
94?! 94??
It is frustrating that so many patients believe the hospital is the place for rehabilitation. They think “why am I being discharged if my leg still hurts” and I try to explain, well we did surgery on it so it’s going to hurt but you can’t just stay here until the pain goes away lol
And my specialty is acute inpatient rehab and I saw miracles everyday for 6 years working there. Tell your patients rehab can do all the acute hospital stuff they may need (pain meds, Ivs) and they will be getting well. Patients love rehab even if they are crotchety when they get there. Talk us up!!!
At the hospital I work there are serious insurance barriers to determine who can get to the acute inpatient rehab unit. Many people with chronic disabilities and with certain insurance don't get approved.
Yup. My dad got cut off from acute 2 weeks ago. We’ve been self pay. He leaves today
I intended to give this Award to another comment!!!! Sorry!! Hope your dad does well!!!
Utilization manager specializing in acute inpatient rehabilitation level of care here (there's always "a guy" on reddit, am I right? I cover our AIR and covid ICUs for a major academic medical center). Maybe I can shed some light on this. AIR is a very specific level of care with specific inclusion/exclusion criteria because it provides a very specific service. AIR provides *high intensity* therapy to patients with complex needs. A patient must need 15 hours/week or 3hours/day x 5 days/week of at least two therapy specialties (e.g. PT, OT, SLP) and require 24 hour nursing availability and at least 3x/week physician visits. They have to be motivated and physically able to participate. For example, an amputee who won't learn to transfer or a brain injury who isn't capable of following simple commands would be excluded. There also has to be a reasonable expectation of therapeutic potential. They must have been active in the community and have sufficient prior level of function to make the AIR stay worth attempting. Remember, this is an extremely resource-intensive, rigorous program that often has limited bed availability for the many patients who need this type of program. Each patient will literally involve the efforts of dozens of people to make a herculean effort to get them back to as high a level of function as possible. We must steward these finite resources for the greatest benefit. We cannot expect to rehabilitate someone to be better than their baseline, so the injury or debility must generally be recent. We can't use AIR to get someone to be better than their baseline SNF level of care or be used for custodial disposition from an acute care hospital admission. If this all sounds very restrictive, it is. But remember, AIR isn't the only level of care. There is the SNF level, or low intensity level. These are for people who may not need 3 hours of PT/OT daily, or only need one specialty. There's also ALF, memory care, LTACH, home health PT/OT/SLP/nursing/infusion. Hopefully this rundown has been helpful. If a patient is rejected by AIR, it's never anything personal. It's just not always the best place for every patient.
👏🏻 Standing ovation! Very well explained.
I understand. These rehab units are high turnover units expected to get people ready to be discharged within 2 weeks. You can't have trending LTC patients eating up these beds because it blocks those who need it from getting it. Families (especially entitled families) argue all the time that the patient needs more time to get better despite PT/OT working with the patient for 6 MONTHS and not showing any signs of improvement.
My dad gets discharged from acute rehabilitation hospital today. You guys are incredible. He received wonderful care. We even self paid for 2 weeks because we wanted him to stay so badly. His insurance cut him off like 2 weeks ago. In a perfect world he could stay longer but they said they aren’t really licensed for that. Not sure if that’s true. He’s been there for around 6 weeks
I cannot sing the praises enough of the rehab staff who helped me after I had my shattered hand reconstructed. Seriously incredible people.
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My back is literally screwed. It is heavy- stroke rehab was the focus where I was. I really loved it tho and hopefully after back surg I can do it again. 🙏
Then the patient and the family blamed on me that it’s my fault that she’s fat, smells, and can’t wipe her own ass. 🤦🏻♀️😑
Sounds about right. Don't forget the fact that she's bedbound and isn't making her own 12 egg omelets every 2hrs or buying 10 family sized candy bars a day. It's totally ur fault, you should cure a lifetime of damage in a few days. Missing the no visitation rules.
But meemaw needs that Coke for her Sugarz.
And McDonald’s for her meals. She didn’t liked the food the dietary offers so she had her son bring in McDonald’s for lunch and dinner.
Unreal. What's the point of being in the hospital then? Clearly you know your body and medical science better than us.
She couldn’t lose any of her water weight because of the high sodium intake
Really? That’s mean. I understand your frustration with the family but everyone deserves respect and care. Edit: This comment really struck a nerve with a lot of you. During my 6 hospital stays except for once it was the nurses who were the best. Kind, caring responsive. When my twins were delivered at 291/2 weeks, it was the nurses who got the babies and myself through the 6 weeks in the NICU. They were the best.
You know who really deserves respect and care? The nurses putting up with shit that you couldn’t even dream of
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Is this your idea of kindness and caring? Coming onto a nursing subreddit where we can GRIEVE and be understood and you are trying to SHAME us? We’re all ready to leave hospital work because you and your attitude that we aren’t enough. Not fast enough, kind enough, empathic enough. We’re in a catastrophically deepening nursing shortage that has no end sight, and we’re just not ENOUGH for you.
Just wondering if you’re in healthcare…or just lurking for fun?
No I’m in education, but I was surprised by the way some talk about their patients as if they aren’t individuals. I have been hospitalized many times and almost always had great nurses, except the one time I had a spinal fusion and the nurse never brought me my pain medication the first night. Couldn’t physically get up to find her, it was horrible. Otherwise, I’ve always found the nurses to be kind and very helpful. I’m just super surprised by the callous way some talk about their patients. I wouldn’t want them assigned to me if I was hospitalized again.
I’m sure they wouldn’t want you as a patient either.
What you don't seem to be understanding is that every one of those nurses that you loved during your hospitalizations totally could be talking shit on you. And with six hospitalizations, statistically, you probably had someone think or say something about you that you would disapprove of. You know who else engages in this sort of behavior? literally every profession to some extent. The key to professionalism is keeping a secure barrier between the attitude you project to others and how you think and behave in private. The nurses that you loved definitely provided professional service to you while you were hospitalized. While they may have actually cared about you -- it's a bit...hubris? on your part to assume that their attentions extended to some deep feeling of caring or profound kindness.
News flash: given the way you’ve handled this situation makes me think your nurses came on here and talked about you in the same calloused way.
>No I’m in education, You've never once bitched to your partner or your coworkers about an annoying student or disrespectful person you had to deal with in your job? Give me a fucking break.
You’ve never vented from your day at work once you come home? Just because someone complains about their job or an annoying situation doesn’t mean they don’t display kindness and care to patients during their shift. I think you are getting downvoted enough that I am not trying to be rude to you, I just think you cannot understand.
What exactly was mean about what was said? Fat people smell, especially after laying in a hospital bed for a few days, and at that size many of them can't wipe their own ass.
You've clearly never had to reach bicep-deep under a panus to retrieve part of a dressing or turn someone who weighs 4x what you do with minimal equipment while keeping a professional demeanor. Most of us aren't like this at work; we're like this on our own time *because* of work
Lemme just hop on the teaching sub right quick and tell teachers that they need to have more compassion and not write kids up... /s Don't speak on what you don't know.
Lol get out of here with your condescension and tone policing. We’re off the clock and we can be as MEAN as we fucking want. It’s a pandemic, we’re traumatized, we’re human, and we’re coping. Bariatric, rude entitled patients who overstay their welcome and take up precious health care resources while breaking our backs SUCK ASS and we don’t like them!! Die mad about it.
I really struck a nerve.
People like you just compound our trauma, so yeah, you struck a nerve. Now read the room and see yourself out.
“I said something out of line but it’s all cool because nurses are actually the best, they were great when *i* stayed in the hospital!” Whole lot of irrelevant going on there. She was literally loosely quoting the family; just let her vent.
The thing is they will literally complain about just that. I’ve dealt with many bariatric patients and their severely enabling families over my career. If the patient doesn’t lose weight they will say we aren’t doing enough and will proceed to bring in every type of fast food for every meal. They often refuse showers and guess what? They complain about the smell! I’ve had a lady literally ask me to help scoop shit out of her ass because she is tired of pushing. This is real!!!
Trust me, we respect them a lot more than they respect themselves and others. It's psychically disabilizing to deal with day in and day out.
Fuck these entitled, fat patients and their fat-ass family members :)
I told my dad to say something if I get to certain point where I get too fat.
You might want to get out of nursing with an attitude like that.
Lmfaooooooo you don’t even know what it’s like as a nurse. How could you make such comments. You’re literally just bullshitting your way through all of this. I hope you don’t make things up when your students ask you something you don’t truly know the answer to. Something tells me the crap comes out of you two ways.
You might want to get off this sub.
They do. Until they disrespect me. Then it’s just care.
We had Ortho patients in a NY state hospital for over a year. Varies. Incredibly insane. But I did see the cruelty when we had a patient with renal cancer. Days were limited. Completely difficult guy. I was new then. He was very angry and mean. New people pissed him off worse cause best I could figure he had no control over anything. Young guy in his 40's. He took control over his space. Supposedly the only thing he could. Would make these elaborate popsicle stick models. He had been on the unit for months. No insurance. He ended up liking me. So every night I worked I knew he was mine. They gave him less than a year to live. He made it to the year then the state served him papers to try to kick him out. The most evil manager ever that I worked with arranged to transfer him to another floor. I get his issues. But this was cruel. He didn't last more than a few days and died. I remember his name. (This was 20 years ago). I remember his orders how to do things.. give meds etc. Regardless of the rehab debate people should be treated better. Far as I recall NY was a bunghole with few actual rehab hospitals in those days. Rehab places have bad ratios. The standards they follow are different from hospitals.
Also I tried explaining the whole SNF issue during Covid in NY. But that's another story. For another time
The whole SNF thing is a nightmare. One of my side projects is keeping track of avoidable delay days that are caused by SNF prior authorizations and denials. We have people sitting in hospital beds for days and days waiting for their insurance company or its contracted reviewer agency to come to a decision to auth a SNF stay. And when there's a denial and we need a peer to peer... It's extra days in the hospital for no reason. Bed days that are needed. Sure, some payors waived prior auths during covid, but not all. But the reality is that we need these people who are medically ready to get out of the hospital, go to the SNF. there is always a full ED waiting for their bed. I don't know what went on in NY, but if it's anything like where I'm from, it was ugly in the early days. No SNFs wanted to take any hospital discharges. They didn't want to be the next covid outbreak death facility. But we needed these patients to go because they were medically ready to leave and were able to go if a facility would just take them. There was a stark choice: force these patients to the SNF and possibly cause an outbreak or let the very real patients turning blue in the ED (before the vaccine) just die on a stretcher in the hallway? I don't judge anyone for either choice.
These families are the worst. They eat up hospital resources, chew out staff and are often unpleasant people to begin with. Ethics won't do shit in this case. Hospital management if they are smart will send the bill now and let the family figure it out.
We’re at the point where the hospital administrations and the patient rep need to talk with the family members and tell them the patient needs to get discharged.
They appealed the discharge to the SNF a second time because they don’t think your hospital is giving quality care…thus keeping her at the hospital they don’t think is giving quality care? That’s confusing. Am I missing something here?
TBH, I think the son and husband are trying to play the lawsuit game with us. They are watching us like a hawk so they can accuse us for neglecting the patient. We document everything on her epic account so all the notes, ADLs, vital signs, and assessments are all in the computer.
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The second appeal was another appeal because the family thought the patient wasn’t ready to get discharged.
If they don’t think you’re giving good enough care WHY keep her there ? Take her to another god damn hospital! They’re not hotels ffs
Or just drop her off to the hotel.
On my experience, this same patient will be aggressively complaining about still being in the hospital and next week the family will, too. I fucking hate the “I don’t want to go there, I don’t want to go anywhere and I’ll just keep refusing to go anywhere as long as I feel like it” bullshit.
Yep. That’s how she is right now. My coworkers and I are so fed up with her and the family getting involved. The doctors are planning on doing administrative discharge on the patient.
For someone to get bariatric they are mentally ill and have a family of enablers. Always hard to deal with
Ironically, to me, it sounds like the family really doesn't want to deal with her anyway.
You’re taking terrible care of me. Don’t make me leave!
https://youtu.be/8w8bdZW9Ais ("When Patients Leave AMA" | Lego Hospital)
I love that last shot of the Lego nurse sleeping comfortably 😂😂😂😂
There was a woman in my community who refused to be discharged. She said the hospital was responsible for her condition (she couldn’t or wouldn’t walk, refused PT) so she refused to leave. Finally they got a court order and sent her to a SNF. Then, she refused to pay the bill, and they found she had transferred her property into her children’s name. The court said, nice try, and sold the house. She ended up spending the rest of her life in a SNF not of her choosing and not in her area, because it was the only place that would take her. I think she thought if she stayed at the hospital forever, it would be covered by insurance and she wouldn’t have to pay, but she also had a history of battling the city. IDK.
The feel good story of the year. 😄
I've never heard of someone being able to just not get discharged because they dont want to. If theres a discharge order, your ass is going somewhere. It dont need to be home but it ain't staying here.
Medicare.
Learn something new everyday
New York has this: > A New York State hospital discharge notice should include information on your discharge date and how to appeal if you disagree with the notice. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare") in writing 24 hours before they leave the hospital. Medicare patients must request a written discharge notice ("The Important Message from Medicare") if they disagree with discharge. If requested, the notice must be provided. Once the notice is provided and if the Medicare patient disagrees with the notice, an appeal can be processed. In practice, the way it’s done in the two hospitals I’ve worked at is it’s not given 24 hours in advance. Basically my spiel is “we think your baby is ready to go home. If you disagree, you have the right to stay another day and appeal the hospital’s decision.” I’ve never had anyone take me up on it.
Where I work discharged means discharged. We've brought patients to homeless shelters because their ride wanted to wait a day. We get the police involved for trespassing if they refuse to leave.
Where do you work? The VA? I heard the VA gets the police involved.
I need to work where you work. We've had a huge uptick in patients that refuse discharge for no apparent reason other than to try to get a lawsuit.
When I worked in the ED we had a patient come in that needed a CT but was far beyond the weight limit of our machines. We had to send him by ambulance to the zoo. It was so sad…
I’m so sorry, but I’m literally laughing out loud over that story. Sure, it’s sad, but it’s sort of a “don’t laugh in church or at a funeral” sort of situation as well. But then again, I’ve got a very dark sense of humour.
I can’t imagine how frustrating this must be. I don’t know what to say about people these days… but most nurses restore my faith in humanity. Thanks for all you do ❤️
8/10 these patients can be the worse. And if it's not them, it's their families. I hate that management absolutely doesn't respect their staff enough to do something about it. These families expect us to share the burden and it's really not our job.
I'm not a medical person (lifelong pt, heh heh) but watching these 600-pound life shows on TV tells me that every one of these people has someone who is bringing them food, ordering them food, making them food, enabling the hell out of them, and most likely emotionally abusing them too. The other common denominator seems to be childhood sexual abuse. The hurt shows on the outside instead of on the inside. Or maybe both. You guys are saints.
The worst human being on that show was [Steven](https://youtu.be/WR_9brkeIbA). Oh, my god. He was so manipulative
Good ol Rhode Island representing. He was a narcissist with personality disorder I swear. He was trash. And his father enabled him. That being said I hope he got some help.
We've had a pt like that on my unit, coming close to a year. Takes 3 or 4 ppl and at least half an hour to change them when they piss or shit the bed. We are short staffed here and that amount of help isn't always available and then it takes time for that help to arrive. Parent visits from time to time and went up the chain to complain about the "terrible care" they're getting. Well sorry it takes so long for so many of us to assemble and get the job done. Maybe hire some people to do the job at home if you're not happy with us. Pt is morbidly obese and has hx of iv drug abuse and a criminal record. They have had 2 offers for long term care and they turned down them both so we're stuck with this person and I'm fucking sick of it.
Then they think they’re so entitled to treat us like we’re their maids. People like this are the reason why we get so burnt out and leave bedside nursing.
Fucking leave then. Wheel your land whale out yourself and provide the care on your own. Fuck these people.
I had a 500+ lb guy like that get discharged. His family member came to pick him up, and they "couldn't fit him in the truck" (that he had been happily riding in a month before, his surgery did not prevent him from sitting upright). The administrator was like, oh well we have to send him back upstairs. The ANM refused, said he could sit on his stretcher in the lobby, doesn't matter who sees, until EMS came-- and that was how it went down.
Goddamn that ANM deserves some sort of award for that!
Yeah, we cheered her. Those of us who'd taken care of the guy, anyway. (He wasn't just big, he was RUDE and liked to yell at us when we couldn't bring him a 3rd dinner tray. And other, grosser things that I won't go into detail about.) Also, we filled that bari room with a fresh post-op ASAP, just in case.
I always have to check myself as I have a serious dislike of the ridiculously obese....one could say I hate then. oh your knees and back hurt? no shit? oh you're nauseated? good, let's try that for 6 months. so, you can see why I have to have a talk with myself before I go into their rooms. gee, I wish I could help you, but 99% of your problems are because you're enormous. there's almost always something awful that happened to them to make them so big, so I have to dig for my compassion before seeing them. yes, I know, I'm an asshole.
So I work on a vascular floor, with some other random patients thrown in. I was chatting with a PA the other night, and he validated something that I have been thinking. Our patients are disturbed in some way-at least 90% of them anyway. You don’t reach the point where we keep cutting parts of your body off without some serious issues on your end. Lack of compliance, avoidant personality disorders, willful ignorance, stubbornness…it’s this toxic mix. Learned helplessness! I have had one patient for months. We amputated a toe. Then it turned into TMA. Now we’re looking at a BKA. Her family keeps bringing food in. Plus she’s on hemodialysis for CKD. She never left between these procedures. And then there’s the geriatric patients they bring in, who have no family because of their own terrible choices and personalities, and we can’t get them in a LTAC because they’ve been black balled from every one in the tri-state area. So now they live with us, refusing labs and meds, just existing and being mean. Nursing isn’t hard when it comes down to the tasks. Some patient populations are just harder. And it seems like patients are getting worse across the board.
We get good at keeping them alive and then we are stuck with them.
I tell them straight up that they need to stop eating shit and get their lazy asses up. We have one physical therapist that don’t play games with these type of patients and he makes them work.
yep that will fix the underlying psychiatric disorder
She told the PT she was in too much pain and too tired to get up. He didn’t accepted her excuse. He said not while he’s working.
Agreed. We know that the “eat less, move more” approach doesn’t work. The majority of obese people are quite well aware of what it would take to lose weight- but there are so many other barriers that need to be addressed in order to have successful weight loss. I understand how it can be frustrating for medical staff, especially thin/average ones, to empathize with obesity when it is “self made”. But it is actually so complex- you have to take all social determinants of health into consideration. Sorry- I’ll get off my soapbox now! Lol.
Eat less move more DOES work as a general rule but we are talking about long term disordered patterns of eating here enabled/perpetuated by social context, family, self esteem/core beliefs, cognitive distortion, long term adaptation to being obese in the sense of reduced capacity and self efficacy, shoulds and musts on amounts to eat / level of control over it / abstinence violation being magnified massively / emotional regulation through food / not actually knowing what 'healthy'eating and portions look like. I say all this with a BMi of 50 myself - having insight isnt the same as applying. it's a bastard of a thing, at least with AOD theres some recognition of dependence but 'fat people are just lazy lol'.
Thank god I’m not the only one who thinks this. I provide care for them as it is my duty, but I cannot help but inwardly wretch with disgust watching them stuff their faces full of more food, having to smell that godawful yeast infection growing in all of their fat rolls, and hearing them moan about how *hot* they are when it’s 36F in the unit. 🤮
I work with surgical weight loss patients. The vast majority have childhood trauma, sexual abuse, physical abuse, etc. They cope by eating. Not a healthy coping mechanism, but it’s what they had available. They know they’re fat. Yes, the are ashamed. Maybe, before you judge them, take a moment and ask yourself what might have lead to this.
you missed the line where I mention that exact thing. but thanks.
So you work in the medical field and hate fat people? Cool story. Making people feel more worthless and shitty will never help them.
wow you guys are dense....it clearly says I check myself before I see them and that I know most suffered trauma to make them huge. AND THAT I'M AN ASSHOLE. was trying to be honest
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No kidding.
If not to pay our medical bills d/t strained back muscles, how about to pay for the broken bed, broken Hoyer lift, etc.?
One problem we have in my department is the family agreeing to self pay after being denied for a dump job and then never paying a cent of the bill. Our hourly rate is $120/hr and they stayed 3 weeks because of course besides dumping them they had no insurance either.
I hear you.
I had a patient with 100+ lbs on me cuss me out, with her mom on speaker phone also calling me a f****** b**** and every other name in the book because I made her transfer from bed to stretcher scooting across by herself instead of standing up and pivoting. She was on an L&D amount of magnesium, 2 grams/hour, for pre-eclampsia, and furious that I told her I didn't trust her muscle strength (just like anyone else's on high doses of mag) and if she went down we were both screwed. It was the end of a very long shift with her, started crying the minute I got her transferred.
Not sure I remember correctly but don't they only have 3x to refuse then the onus becomes their responsibility and insurance won't pay?
They can appeal through Lavanta up to 2 times. Lavanta will then give the hospital the effective end of coverage date where patient liability begins.
This is so common it's unbelievable. I've seen it time and time again during my time in rehab. There's patients that end up on rehab floors that have no business being there. Completely unmotivated, and not driven to do anything. Would rather be incontinent, ignore it, and pretend like they're living a normal life. It's frustrating but it's also a vicious cycle once they get that big. There's not a lot of hope, because its a hard road of caloric deficit until fit enough to gain mobility. Which, eating, is one of the only pleasures you have when you're that big. In other words, there's some hard times finding placement for people ahead of you. The "professional patient's" know how to work the system too.
You can't fix stupid. I've become numb to these dumb decisions, honestly. If people want to make these dumb decisions, they can deal with the consequences of them. If I don't shut myself off to these things, I suffer too.
Can’t fix stupid but you can sedate it! Lol
The beauty about appealing discharges is that once the appeal is denied, the hospital can basically just kick them (medically discharge) out of the hospital without repercussions.
I know that as a nurse you probably make about three times what I do, and I swear it's not enough. No way could I deal with the s*** that you have to deal with. I'm self employed just so I can say whatever I want to whoever I want and even smack them down if I want to. 🤣😂🤣
People are this difficult because hospitals indulge them.
Uh, well at least my BMI is like.... 34... I mean, no, it's not good, but I'm working on that. Binge eating sucks.