This blog reflects on my placement in a gen surg ward (cardio). I was given an 88 yr old female, post hemicolectomy patient to treat. She is independent with her ADLs and lives at home alone. On day 1 post op, she was alert and willing to participate with physio, treatment on that day was ambulation, SMI and education about the benefits of SOOB. She was very cooperative with us. On Ax, she has moist cough and some inspiratory crackles and wheeze. The next day, she refused and said to us, she knows the benefits of ambulation but unwilling to participate saying that she's unwell. We tried convincing her but in the end stopped trying. Over the next few days she continued to refuse ambulation but is willing to do breathing exercises, I tried getting another student to get involved but we all came to the same outcome. My supervisor then decided to approach the patient herself, and the patient ended up behaving rudely and not wanting to participate. We explained to her that she is at risk of getting lung infections and she said, ' I know, Let that take me'. I was shocked with that statement, and all I could say was, 'It's not good to think that way'. She continued saying that to me and also to her family. She was independent prior to surgery and has no other medical conditions and to see her giving up just like that it's just something really hard for me to digest. Her stay in the hospital was a long 3 weeks and my treatment with her in that duration was getting her to SOOB for most of the days, nebulise, deep breathing exercises and chest physio to clear secretions. Patiend ended up passing away after 3 weeks post op.
How do you deal with patients who are willingly giving up on life?. I couldn't reply to all of her 'giving up' statements as I don't know what to say to her, all I could say that 'I have to do my job'. The way she delivers all of her statement was in good spirit, she was a cheeky and lovely patient. We did joke a few times saying 'what if He doesn't want you?'. Reflecting on this experience, I don't think my approach will be any different in the future.
What will your approach be for these patients?
1 comment:
I remember that, it was sad because she was so good the first day. Its hard when pts have given up on life, the only thing you can really do is try to stay positive when trying to treat them and try to encourage them to participate in treatment. You've just got to keep going back to see them everyday as you did and they may have a good day when they feel like participating.
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