Saturday, October 20, 2007

Channeling Oscar

You know Oscar? The cat in the nursing home who cuddles up with people who are about to die? I’m starting to feel a bit like him. So far, as part of my fellowship I’ve charted on two people. The first one was clearly actively dying, although I thought it would be a few days before he was gone. After visiting with him and his nurse, and discussing the situation with G., she told me to write up the note and recommendations. Before I could get to it we had our weekly didactic. By the time I got back to my desk, he had passed.

Then there was last week. It was very exciting, we had a new consult, and G. suggested I “take the lead.” The first time we went to see the patient (delirium over dementia, hospitalized for pneumonia) was not conscious and his daughter had gone for the day, so we had an extensive talk with the (adult) grandson. Mostly we got background on the patient’s living situation, his character and values, and the course of this present illness. On Wednesday I said I wanted to go up and visit with the patient and family, and we agreed it was OK for me to go by myself. This time the daughter was there, and we got more clarification of goals and desires regarding level of treatment. I also consulted with the nurse, who happened to be an old friend of mine, which made it a lot easier. After a while, I went back to our “little tin shed,” discussed with G. what our recommendations should be and worked on the note I’d started the day before. I had even come up with a few recommendations of my own. I left feeling pleased with my progress and competence.

On Thursday, I looked up the patient’s chart from home (I have remote access and our records are almost all electronic) and found out he’d died at 0500 that day!

Made me feel a bit odd, especially since he didn’t appear to even be actively dying. I did notice that our recommendations had been implemented, and I felt like my conversations with the family had been helpful for them and the hospital staff.

If it happens again next week, I don’t know what I’ll think!

1 comment:

Thomas Quinn, APRN, CHPN said...

I've just been catching up on your blog--haven't been here in a few months. I'm really enjoying watching you grow--thank you for sharing. I'm hoping to start a new job soon in a place that doesn't have a palliative care program. Your last two posts have helped me label some of my panicky sense of incompetence.

Keep up the good work!