Live on the Verge of Death

Posted by Nicki Baker at Thursday, September 01, 2011

I’ve worked at Select Specialty in Ypsilanti a couple of times in the past when I filled in as a technician and I’m excited to be spending my second rotation there. Select is a long-term acute care facility located on the campus of St. Joseph Mercy Hospital and cares for patients with complex medical needs who require an extended hospital stay. Many of them are on ventilators, PEG tube feedings and IV antibiotics. They’re currently at capacity, caring for 36 patients.

I generally start the day by checking INRs for patients on warfarin. Select has a combination of electronic and paper charts, so I can get lab values from the computer but have to go to each patient’s room to check the MAR to be sure they were given the warfarin dose they were supposed to have received the previous evening. Based on the patient’s INR trends, I decide whether to continue them on their current dose or to make a change. Since I’ve been there about a week now, I’m starting to see the impact of the changes I’ve made. It’s really fun and gratifying to see patients become therapeutic or to be moving in the right direction based on decisions I’ve made. I’m also enjoying writing orders for warfarin and lab draws, which pharmacists at Select do per established protocols.

Antibiotic stewardship is another of pharmacy’s responsibilities at Select. Checking culture results and making sure all antibiotics have reasonable stop dates is part of the student’s job. I’m glad that I’m getting a chance to work with antibiotics a bit more since it’s an area I need to improve in.

Working with this population really makes you appreciate your health and the health of your loved ones. A lot of the patients are very old an ill, but some of them are younger and trying to recover from falls, accidents or infections. Many of them will improve and be transferred to a skilled nursing facility, inpatient rehab or even be discharged home, but for others, this will be their last stop. It’s difficult to see some of these people struggle, but even more difficult to watch their families make tough decisions. I guess what these patients are going through could best be described as living on the verge of death.

It appears difficult for physicians to let these patients go, even when it feels like the time has come. It seems to be against their nature, like they're admitting defeat. As healthcare professionals, we've devoted ourselves to preserving and extending life, so being ok with letting a patient pass away feels contrary to what we've been taught.

Still, the respiratory therapists, physicians and PAs, occupational therapists, nurses and pharmacists at Select take great care to do what’s best for patients and families. Some really amazing stories of recovery have come out of this place. A woman who nearly passed away from a terrible case of H1N1 stopped by to visit yesterday. It was obvious that she had a real connection with the staff who cared for her during her stay at Select and she was doing great.

This blog is becoming a blab. More later!