Not when I'm swimming...jeez

Pulling out my Dr.A stories today....

Another elderly pt of his was failing. I consulted with my coworkers, and called the pts Dr. He didn't care..."there's not much we can do, it's what we expected."

Okay fine, fair enough, we knew one day this would happen.

Again, consult with my coworkers, decide to call back to get orders for pain relief and to make breathing easier.

Dr.A: "How did you get this number?" (It's on the list at the nursing station)
"Well I'm still swimming" (in my head: dont answer if you dont want to talk on the phone)
(Ask for orders) "No, I don't think so"
"I'll be there in an hour or two. Don't call me again."

So, this was quite upsetting, the most I had ever been at work. Told Dr. on call as I thought we would have a code on our hands as of course the level of care was not signed by Dr.A. (even though we knew the pt would die soon??)

Dr. on call said I could file a complaint, and I fully planned too. Unfortunately the day totally got away on me and now I am sure it's too late.

"I

Dr. vs. Dr.

Good thing there are some Dr's willing to change the plan of care on others Dr's pts.

Back to Dr.A and his elderly pt with the harsh cough and a set of lungs filled with gurgles and crackles and wetness. (Not normal)

Dr.A 'assesses' pt, writes "chest clear" (? Dr.A actually listening to chest)

Later Dr on call orders xray, which shows plueral effusion, and thankfully starts antibiotics. Pts chest remains full of adventitia.

This lasts a week or so and it becomes obvious pt is not going to be with us much longer. Dr.A, paged twiced, does not answer. Dr on call again to the rescue to order pain medication and talk with next of kin about Level of Care. Thankfully Dr on call did this so we would not have to perform CPR on this frail and elderly lady when she passed about 12 hours later.

Try some water

When it comes to palliative care, there is generally a standard of care, a path that each patient follows. The patient shows X sign, we do X intervention...so on and so forth, it is pretty basic.

Or it is unless you are a patient of Dr.A. Then it all changes. In Dr.A's opinion you likely aren't even dying. In your chart under Dr's Progress Notes will likely be written "Pt improving. More responsive today." The day Dr.A writes this the nurses will have noticed and reported to Dr.A that you are no longer opening your eyes and still do not have a gag reflex.

To this Dr.A will say "Try giving pt more water." When nursing staff object as the pt is not swallowing, Dr.A will reply "It will take a lot of water to kill the pt."

And the nursing staff all gasps and is horrified...news of the new order spreads.

The consensus is "it's not going to be me who tries giving him water...I'm not going to kill him."

Thank goodness nurses have minds of their own and do not follow Dr's orders to a T.