Refusal
We had a call to take a patient from a nursing home to the ER for "abdominal issues." We went through the typical motions; go upstairs, get the story from the nurse, ensure that paperwork is in order, ensure that the nurse called the ER, and go to get the patient. We were sharply interrupted from this routine when we entered the patients room and she began to shout "I'm not going! I'm not going! I'm not going!"
The story was that she had a colostomy recently, and when the wound was checked that day, it appeared that it was opening, and about to become an abdominal evisceration. (basically when your insides get on the outside...which, obvious to normal humans; is not good)
We greeted her politely, and I asked her where she was, what day it was, etc. And to me, she was of sound mind. I told the nurse that if she continued to refuse, we could not take her. The nurse said "OH, she'll go!" At one point, there were at least six staffers in her room trying to convince her to go. She was still vehement about not going. Once they gave up, I went into the room and sat down.
"So, how have you been?" I started. I figured that if I could get her to say anything other than 'I'm not going!' that I could maybe convince her to go. I learned she'd been married for 32 years, had two cats, where she used to work, what her husband did for a living, and that they told her she would probably go home in October. Rapport building is good stuff. I asked her why she didn't want to go to the ER. She admitted that she got dizzy when she was moved. I assured her that we would do all we could to prevent that.
I told her, which usually works, that if I were her, I would go to the hospital. "I know you're afraid of getting admitted, and not getting back home when you want to, but if you don't address this now, your recovery will be seriously delayed. If this doesn't get fixed, you will get a horrible infection that could kill you."
When sugar coating things doesn't work, I try frankness. But this lady wasn't buying any of it. "I feel fine." she insisted. "Yes, you may feel fine now, but you are not fine." I insisted back.
Meanwhile, staff were appearing out of nowhere: nurses, doctors, administrators. I told them I had done all I could, not listening to reason did not make her incapable of making decisions and refusing. I could not legally take her. One nurse said that she always refuses stuff, like dressing changes, "But we do them anyway." Dressing changes and taking someone to a different hospital are two totally different things, I assure her. I can tell they are getting irritated, but after that moronic statement, I am too. I told them we could give ten more minutes to get her to say 'yes.'
"Until she says 'yes' to transport, I cannot take her."
For the next ten minutes, they ran around making phone calls to various people. I told my dispatch what was going on, and then I went back to the patients’ room. We had another nice chat that unfortunately yielded nothing. She still refused completely. I was hoping that the nursing home could find somebody she trusted to tell her that she should go. A doctor, a nurse she liked, the surgeon, her husband, anybody. Alas, all of their phone calls led to nothing.
She happily signed my refusal, although, I told her that just because we were leaving, didn’t mean that the nursing home was giving up on her.
We left with the facility reeling, and the patient happily watching TV while slowly developing a deadly infection.
The story was that she had a colostomy recently, and when the wound was checked that day, it appeared that it was opening, and about to become an abdominal evisceration. (basically when your insides get on the outside...which, obvious to normal humans; is not good)
We greeted her politely, and I asked her where she was, what day it was, etc. And to me, she was of sound mind. I told the nurse that if she continued to refuse, we could not take her. The nurse said "OH, she'll go!" At one point, there were at least six staffers in her room trying to convince her to go. She was still vehement about not going. Once they gave up, I went into the room and sat down.
"So, how have you been?" I started. I figured that if I could get her to say anything other than 'I'm not going!' that I could maybe convince her to go. I learned she'd been married for 32 years, had two cats, where she used to work, what her husband did for a living, and that they told her she would probably go home in October. Rapport building is good stuff. I asked her why she didn't want to go to the ER. She admitted that she got dizzy when she was moved. I assured her that we would do all we could to prevent that.
I told her, which usually works, that if I were her, I would go to the hospital. "I know you're afraid of getting admitted, and not getting back home when you want to, but if you don't address this now, your recovery will be seriously delayed. If this doesn't get fixed, you will get a horrible infection that could kill you."
When sugar coating things doesn't work, I try frankness. But this lady wasn't buying any of it. "I feel fine." she insisted. "Yes, you may feel fine now, but you are not fine." I insisted back.
Meanwhile, staff were appearing out of nowhere: nurses, doctors, administrators. I told them I had done all I could, not listening to reason did not make her incapable of making decisions and refusing. I could not legally take her. One nurse said that she always refuses stuff, like dressing changes, "But we do them anyway." Dressing changes and taking someone to a different hospital are two totally different things, I assure her. I can tell they are getting irritated, but after that moronic statement, I am too. I told them we could give ten more minutes to get her to say 'yes.'
"Until she says 'yes' to transport, I cannot take her."
For the next ten minutes, they ran around making phone calls to various people. I told my dispatch what was going on, and then I went back to the patients’ room. We had another nice chat that unfortunately yielded nothing. She still refused completely. I was hoping that the nursing home could find somebody she trusted to tell her that she should go. A doctor, a nurse she liked, the surgeon, her husband, anybody. Alas, all of their phone calls led to nothing.
She happily signed my refusal, although, I told her that just because we were leaving, didn’t mean that the nursing home was giving up on her.
We left with the facility reeling, and the patient happily watching TV while slowly developing a deadly infection.
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