I cried like a ridiculous child the other day at work...because i have never in my life felt so helpless for myself and for my pateint! This particular patient had a living will which denoted a healthcare surrogate should he become incapacitated and stated his wishes regarding "life saving" techniques. Let me say that i HATE PEG tubes...putting them in...cleaning them...feeding people through them...because USUALLY we're just prolonging their misery...and USUALLY it was the family's decision to place the peg tube! So I was bumbling through my patient's chart...and i was admittedly looking for a reason to cancel the surgery! As i bumbled i came across his living will which stated VERY clearly that he did NOT wish to have a feeding tube under any circumstances....RED FLAG! I really didn't want to do the case in the first place...but HELLO HE DOESN"T WANT IT!!!! I was already told that the healthcare surrogate had signed the consent form...I am disgusted that a healthcare surrogate can override a patient's living will and do anything that they want!!!
I informed the surgeon of the living will...and umm...he didn't care. he gets paid either way right? and nobody starves to death on his watch!
Patient rolls into preop holding along with the healthcare surrogate and some other family member...patient is in fact fairly incapacitated...myself and my manager introduce ourselves to the healthcare surrogate and begin talking with her...i ask her if she knew the patient had a living will...umm...of course she knew, how else did she get free reign over his quality of life!!! So i show it to her. I ask her to read the part about feeding tubes...she obviously doesn't quite understand...she gets that one must have nutrition to stay alive and that is what the feeding tube does...she just can't understand that the sentence "I do NOT want a feeding tube placed....." means that she shouldn't let us put in a feeding tube. I reiterate this and reword it and do everything but get down on my knees and beg her not to let us put the feeding tube into the patient. She still wanted to proceed. I left. I cried and threw a pity party for me and my patient and how morally and ethically and just plain old wrong this was. I called our risk management departent to no avail, the healthcare surrogate legally has the right to do this. I came back to the preop area...all puffy faced and red eyed...finished preparing the patient and took him to endo. I cried when I read the time out...I cried as I helped place the peg tube...I cried when we were done...and I cried when I dropped him off in PACU...I simply could not keep it together. How could this woman know and see it in black and white that this patient did not want this...and yet she still wanted it!!! HOW?
My coworkers informed me that my problem was that i still care....is this what healthcare has become? nurses should be automated little robots, carrying around their computers, not caring what the patient wants, simply performing tasks, focusing on legalities instead of patient wishes?
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