There is a new nurse at mom's SNF. He seems overly interested in getting morphine on board and Xanax and calls me every time mom is struggling. It's a fairly straightforward matter of draining the fluid off her lung and then she's comfortable and can breath. But each time the fluid builds up, instead of getting it drained he talks about her need for morphine. I thought it was just me that found him overly pressuring about it but when my son met him tonite he said he wanted him off my mom's care. Hes very nice but I feel he's either new or possibly a problem..
So anyway, after seeing her doctor today when I came out of the SNF and she asked how it was going, I voiced my concerns and questions. When I went in this evening to visit with my mom she was up and coherent! They hadn't dosed her! I can't tell you what a roller coaster ride this feels like. I mentioned the nurse that seems so gung ho w the meds to her Dr, and idk if she said something to the staff or if mom just had a good day but they didn't dose her with the Xanax and she was fine. We went to the cafeteria, in her wheelchair, and had a nice conversation and everything. This is what makes all these decisions so difficult! When I arrive at the SNF and she's unconscious and the nurse is pushing for morphine and Norco and Xanax and telling me how they're trying to make her more comfortable, and then when she's not dosed she's up and okay. She has never, ever complained of pain. I realize she has cancer, and she's 96, and she does get anxious. But it was a relief to know that the idea that she was being overmedicated wasn't all in my head. Thanks for 'listening'
We all have to remember I think, that family members can be difficult to work with for a variety of reasons, but when you add that they are getting conflicting and confusing input from each nurse on each shift, it can add to the stress dramatically. And when the Dr asked, I realized that by me verbally telling them who helps, and who might be steering the boat off course, it wasn't to get someone in trouble (which was my first thought) it was just to keep a 5 star facility just that. Just always have to be mindful of how we word things. Meaning well and doing well aren't always the same thing.
I'll get thru this, as will Mom. But it sure helps to have this sounding board
Where is her own GP in all this? One person - one medically qualified person, that is - taking ownership of adjusting her px and responsibility for her comfort shouldn't seem too much to ask, is it?
I'm not liking the sound of your nurse any better than I did. As my mother used to say "I'm sure he MEANS well..."
One thing I know is this ; you can't pilot a boat from the shore
Mom is at a stellar SNF, but each decision is only as good as the person making it. The overzealous nurse came from radiology and is not young, just I think, very into exploring his new job, and his closest male buddy is a Hospice guy. He is frustrated with me because I don't seem on board with the heavy drugs to comfort Mom.
So she had the fluid removed and she breathes easier. She gets some anxiety and they use Xanax. The Xanax makes her more sedated and vocal. So they give her some more. She is unable to open her eyes or sit up but now she calls out a lot, cries, and says she wants to go home, but can't answer any questions. She can shake her head yes or no when asked if she wants water or is pain. Never in pain. Always a no.
Now I am left with this horrible thing to watch. Either anxious and unable to be calmed without the Xanax, or unconscious and unable to be calmed with the Xanax. WHERE IS THE COMFORT THEY KEEP TALKING ABOUT??
I'm just at the point of screaming. Now they want to add Vicodin. For what? Narcotics wind her up. I think they just need to be clear about their goals! Either help her to the other side or don't, but this no mans land is misery.
I think the nurse wants to see the pain controlled and likely feels the continual draining isn't in your mom's best interest. This is neither right nor wrong - it's an opinion that has more than one side. His intentions are good but you may not agree with the approach. Talk with the doctor about how long to keep up the draining.
Consider your mom's wishes. How long does she want to continue this treatment. That should be the main consideration. Some people want everything done and others want to quit fighting and simply control the pain. I hope that she is still able to have input.
Take care of yourself, too, during this tough time.
Carol
Personally, I tend to think that when a person is on hospice, the incentive to treat something is removed because there really is no hope to prolong that person's life. The thinking is that they can just give the person some medications to ease their pain & suffering, and make the road "out" as smooth as possible. Nobody likes to see their loved one having difficulty breathing. In your subsequent posts, you say that your mother is indeed on hospice and 96 years old, routinely draining 1.2 liters of fluid from her chest. Adding that to the equation makes more sense to me for why the hospital is doing what it is doing---your mother is very ill, and a thoracentesis could lead to a hospital admission, which nobody wants to be responsible for primarily due to Medicare rules for reimbursement. The hospital won't get paid for her admission. It is sad, but it's true----admission & re-admission rates are scrutinized by Medicare, and physicians & hospitals don't get paid for them. They don't want to do something, have something go wrong & have to admit a 96 year old woman on hospice that is a SNF resident. So, they figure they'll transfer her to the hospital that misplaced the drain in the first place and let them deal with an admission/re-admission. Have them not get paid for a re-admission of a patient that was previously in their care.
Getting back to the matter at hand----the nurse was probably just trying to make your mother comfortable. And, with orders for morphine & xanax from hospice, that's what he was able to do. Your subsequent posts actually turned into another topic altogether, in which it seems like you are more accepting of your mother's passing rather than torturing her with more thoracenteses, drains, etc.
As far as the medications are concerned the side effects of many drugs are totally unpredicable especially in the elderly so it is often necessary to experiment to find what works best.
I hope the Dr that said the tube could be removed meant herself not Mom. it would be dangerous to do that ones self. It is a simple process but should be done with safeguards in place in case it is actually in the lung rather than the two layers of pleura surrounding the lung. Reinsertion has to be done under expert X-ray control so the radiologist can see exactly where it is being placed and there is sufficient fluid in the pleura for the two layers to be separated enough to safely introduce the tube. It is possible that the closest hospital does not have the necessary equipment or trained staff to do the procedure. What you have heard is a refusal to do it but they may mean they can't do it because they lack the equipment and expertise. When you are so stressed it is often confusing to really hear what you are being told especially if it is conveyed through a third party.
My SIL went and convinced the doctors to drain the fluid and hold the morphine--she lived several more months in relative comfort.
My mom had a brain bleed near the end of her life. The neurosurgeon at the hospital told us he could fix the problem with surgery. My moms neurologist heard this conversation and pulled me aside and told me he wanted me to think about what he was going to say. He said to me the surgeons could operate but should they? would this operation really better her quality of life? This was a heart wrenching decision to make but the best advice I was ever given. Good luck and God Bless.
The supervisor of Nursing should also observe this over zealous nurse to see what he is doing both with and away from patients.
I'm an oddball, but I believe we can rush in fear to adding drugs - one cannot wait forever, but surely one can see through the next procedure, when it sounds as if it may correct an error - and comfort by companionship and minimal sedation and pain meds, keep telling your mom that this next intervention will make things better, whether she looks as if she can hear or not - pray and trust and help her hope through this attempt to rectify, and revisit the issue of drugs another time. Sometimes the drugs can ease anxiety and mask symptoms.
I know how challenging all these choices, conversations can be, when the risks seem so high. I saw morphine help a lady with a severe cancer, and had to be somewhat convinced - yet I've also seen times when compassionate extra company, hand holding, resting together, can help an elder calm down, and if you have the alternative procedure planned, this seems good to try, for when things turn around, small signals grow into recovery, and that's amazing too.
If the new nurse is young and enthusiastic that's probably what his problem is - youthful enthusiasm and a gung-ho spirit aren't really what you want in hospice. Maybe suggest he be guided by calmer and more experienced older colleagues? If you think he's jumping the gun, don't hesitate to tell him so frankly but not angrily.