Fish Count

I’ve been working for a company that provides NP’s to care for nursing home patients for the past month. I also get to follow my patients to hospice when they get to that point. End of life discussions are even more of a daily occurrence for me now. It’s much better to be able to have these types of discussions about death in the nursing home, rather than the ER after all hell has broken loose.

One of my younger patients was sent to the ER the other night in severe pulmonary edema. I read the ER report and went through her labs and was not convinced she really needed to be intubated. She was speaking in full sentences, her PO2 was 82 and her CO2 was 39. She was returned to the nursing home today at 1658. Yes, two minutes to five and the medics rolled her gurney through the door. Well I was going to get off on time today. I wrote admission orders, DC’ed a bunch of crap she didn’t need or use and went in to see how she was doing after her ordeal.

She is a morbidly obese diabetic (is there any other kind), with CRI, Cardiomegaly, CHF, COPD, HX MI and CVA, and is the ripe old age of sixty. Plus, she has no family and a boyfriend who visits infrequently. I spoke to her about the hospitalization and about changing her meds to keep it from happening again. She agreed with the changes. While I was talking with her I suddenly noticed her facial features changed and she looked like she was going to cry. I followed her gaze to a small bowl where a beautiful magenta Beta was floating silently.

Damn, I thought. The staff had sent this poor lady to the ER and never bothered to feed her fish. He died while she was in the hospital. She had had the fish for several years and it was really the only living thing she was attached too.

You may laugh at this but when you are trapped in a nursing home and your only pet is a fish, and it dies because others could not be bothered to feed it, it can cause a good degree of emotional upset. To top it off the male nurse happened to pop-in while I was talking to her about it and laughingly said, Oh, I guess we forgot to feed your fish, I guess you’ll have to get another one.

This poor lady was just about to loose it. I gave her a hug, told her I would see her in the morning and left.

What is wrong with people?

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