You won't make any money by sueing me

According to Hippa each individual employee can be sued individually for violating the HIPPA law.

I just finished joking with Milo in maintenance, and he said he wanted to wash the carpet in the RT CAVE. He said he would be back in a few minutes to put up a "Wet Floor" sign and a matt outside the department so nobody slips and falls.

"Don't bother with that," I said, "I need some time off work."

He said, "Yeah, but I can be sued if I don't do that. You can sue me if you slip and fall."

"Oh, I won't sue you, I'll thank you."

"Yeah, but if you were a selfish bastard, you'd sue me and you'd win."

I said, "What would I get out of you. I mean, I'm sure you don't get paid much better than me, and I can tell you that all someone would get out of me is a big debt."

"Yeah, getting money out of me would be like trying to get blood out of an embalmed body."

Good point, Milo.

Yes it is true that I hate HIPPA. It is also true that I don't remember names anyway, so it's almost impossible for me to violate it.

But if I did, and someone sued me, what the heck do they expect to get, considering if I did violate HIPPA I'd be fired on the spot. How much does anyone expect to get from an in debt and unemployed RT.

Better yet, if you want to find out if someone is worth sueing, drive to their house. If you see toys in the yard, you know they don't have any money.

Well, I have toys in my yard. So sue me. You won't get any money out of me.

Are we prolonging life, or delaying death???

What I am going to write about tonight is something we need to have a major discussion about. Because I am convinced there is no solution to this conundrum. It's a conundrum because this terminally ill 93-year-old do not resuscitate (DNR) patient was placed on a ventilator last night.

In talking to her daughter, she led a wonderful life. She never held a job in her life, but her husband had a good job, so she didn't have to work. Instead, she stayed home and took care of the kids.

She has four kids, and all of them became successful in their own right. She was so proud that all her children turned out so well. And she's even more proud of her 12 grandchildren and three great-grandchildren. The flowers all over her room are a testament to how much she was loved.

When she was diagnosed with pulmonary fibrosis (PF) at the age of 88 she decided to make herself a DNR. Yet, even before the PF diagnosis she had become a regular fixture in the hospital with fluid overload, whereas her doctor said to me once, "Even a slight weight gain of 1-2 pounds quite often put her into pulmonary edema."

She was also a lifelong smoker. As a matter of fact, she smoked about a pack of cigarettes a day since the mid 1940s, when she started because it was in fashion to do so. As one of the negative and unexpected consequences of smoking, she has slowly developed emphysema, which has now progressed so that she has become a CO2 retainer.

Considering her grim prognosis, her doctor and family had decided to make her a comfort measures only patient, which justified placing her on a non-rebreather to keep her oxygen levels up despite the fact she was a retainer. But, despite the high levels of oxygen needed, she did not stop breathing (despite what believers in the hypoxic drive theory might contend. but that's a discussion for another day.)

The family had already been informed that their mother probably wouldn't live much longer without getting her lungs cleaned out, and that the best way of doing that was via a bronch. Yet, if the bronch were to be done, their mother more than likely would have to be intubated. But with her extensive medical history, she probably would need to stay on the vent at least over the weekend.

After a brief family conference, the family made the difficult decision to go ahead and allow the surgeon to do the bronch and risk the vent.

While the anaesthesiologist used a minimal amount of sedatives during the procedure, the patients sats consistently stayed low even on 100% FiO2, and the patient was not breathing over the vent when provided the opportunity. So the choice was made to send the patient upstairs to critical care, and to call RT to set up a vent.

As you know, when someone has to go to surgery they wave their right to a ventilator, at least temporarily. Even while a bronch is a simple procedure, it involved placing a tube in her throat, and the doctor peeking around her lungs with a bronchoscope.

As I was setting up the vent, the surgeon told me the right lung was completely filled with pneumonia, and he suctioned copious amounts of thick brown pneumonia not just from the right lung but from the left lung too.

The poor lady. My initial impression was that I'd keep her on the vent a few hours and wait for her to wake up and hopefully extubate her by morning, as I would any other post-op patient. But then I learned the story I just reported to you.

The problem with this case, as the Internist reminded me when he arrived on the scene to manage the ventilator, is that this patient is not weanable. He said, "How do we wean someone off the vent to respect a DNR order when she was on 100% to begin with. I know she's a DNR, but how do we ethically get her off the vent?

This lady was a true medical and ethical conundrum.

Did the family make the right decision? If they did nothing, there mother probably would have died soon. If they did the bronch, it might be possible to resolve the pneumonia, but still, the chance of her ever leading a normal productive life is gone. She is frail and has a terminal illness.

While the family assured me that they perfectly understand modern medicine cannot stop the inevitable, it might buy her some time, "so she can make it to her grandson's wedding in June."

Still, as one of the doctors said to me afterwords, "Are we prolonging life, or delaying death?" That is the question up for debate. What do you think? What would you do?

Here's my advice for hospital patients

Based on my own experience as an in-patient earlier this week, I've come up with a few bits of good advice for anyone going to the Emergency Room, or who might be a potential hospital in-patient.

1. Know your rights as a patient
2. Make sure you have someone with you.
3. If you think a therapy might be ridiculous, you may be right
4. Know you have a right to refuse therapy.

As you know from reading earlier posts on my blog, there are a lot of frivolous doctor orders pertaining to respiratory therapy. Knowing this, I ask nurses all the time if they get stupid orders, and usually they tell me they do, but can never think of anything off hand.

With no disrespect to doctors, I know they have a tendency to write orders out of habit and not necessarily because they are all necessary. Now that I've been that patient, I saw first hand what some of these frivolous orders are.

After I was told I was going to be admitted, and after I was stoned on phenergin, my ER nurse approached me carrying a foley kit. "The bad news is we don't have a male working who can put this in."

"I...don...crrrr..." slipped from my lips. I was trying to tell her that I didn't care who put the damn thing in, it wasn't going to happen.

Thank God I followed patient rule #1, because my wife was sitting right there and refused for me. She made sure the nurse was aware that we had a pact that the only time anyone would stick a foley in me is if I end up on a vent.

I like to call it a DNC order: DO NOT CATH.

"Why do you need to put a foley in him," my wife asked. "He can get up and pee."

"I don't know," the nurse said, and tossed it aside.

My wife added, "Just make sure you keep good track of your pee."

That was the end of that. In retrospect, I think this RN wanted me to refuse; that she knew it was a dumb order, but out of respect for the doctor she couldn't come right out and say it. I suppose this was not unlike me when I know a patient doesn't need a treatment.

Later that night, after I was admitted to the floor, a nurse woke me from a sound sleep. "I have to put these on you."

"What?" I said, groggily.

The RN said, "Sequential compression devices (SCS) to prevent you from getting clots."

"What do I need those for?" I know what they are for, but why do I need them?

"It's protocol to prevent clots." Clots? I can flip myself over no problem. And I didn't get clots when I slept in my own bed just last night.

"Okay," I said, "I'll try it." Why the hell am I agreeing to this? This is ridiculous.

Those damn things made my legs sweat, were excessively loud, and were extremely annoying. Not only that, but they made it nearly imposible for me to sleep on my side, which is how I like to sleep. These are coming off as soon as that nurse gets back in here.

"Why do I need these things again?" I said when she checked on me a half hour later with a syringe in her grasp. I proffered my arm.

"We have a standing protocol that all patients have to get these to prevent clots." She inserted the syringe into the IV.

"Every patient has to have these?"

"Yes."

"Well, that's ridiculous.

"I know." She's agreeing with me. That's it. She knows it's a stupid order.

"I thought it was just respiratory therapy that got stupid orders." Okay, shut up man; you're crossing into grumpy patient category.

She didn't say anything, finished her work on my IV. The machine beeped momentarily as she pressed a few buttons, and then she stood by the side of the bed.

What? Are you waiting for my order. "Then take these things off. I'm a young guy and I don't think I have a problem with clots."

"Okay," she said, and pulled the blankets from over my feet without hesitation. She's not argueing with me. That's reassurance enough. I heard the rip of the valcro as she stipped those things I couldn't remember the name of off.

I felt fresh air upon my ankles. Ah, that feels good. I rolled over and within a few moments was having pleasant dreams again.

"Do you think I need those things," I said to my wife when she arrived after breakfast the next morning.

"No," she said, "but I know sometimes doctors write orders just out of habit."

"I kind of figured that."

"You know you almost agreed to a foley last night? You were lucky I was here."

"Thank God for you."

She told me she remembered a time when she was working in OB when the doctor ordered a cath on a lady. She approached the doctor. "Why does this patient need a foley?"

"Oh," the doctor said, "I just wrote it out of habit. I'll DC it."

Dr. Tree said nothing about me not having a foley when he checked on me that morning. I wondered if he even knew he ordered it.