Thursday, August 6, 2009

Oxygen part 14

The family/care team meeting went well. Yes, there was tension over some of the things that have gone wrong. And the patient was very clear about feeling threatened by the staff. We are almost all agreed that she needs to get out of the acute care bed. The only person who disagrees is the patient herself.

She feels she should stay until she can get out of bed by herself.

I have sympathy with that, even if I disagree.

As things stand now, she will go to a transition unit in a different facility. She will be able to have physio and see what level of independence she can manage before any decision is made about her options.

The whole situation tires us out. Last week we alternated hospital days - going together on the weekend. Right now the situation at the hospital is complicated by the patient's roommate. She is a well-spoken wasted woman who is experiencing strong fantasies and fears. The other day she thought a stingray was on her hand. We can't visit without having her ask us, very politely, if someone couldn't spare a few moments to help her. We have to keep telling her that we are not staff, and she must ring her bell. She inists that she doesn't have a bell. Or she says she is too afraid.

We keep the curtain drawn between the beds, but she chimes in on our conversations. And two days running she has soiled herself and been imagining the excrement is something else. Today it was dogfood, because she had been listening to me tell the patient about the feeding arrangement we have made for our cat and dog.

The situation made me think about proactive nursing and about Art Frank's call for generosity in health care. Too much to go into here (I am exhausted), but worth a few minutes later.