ICU

I started in the ICU this week, and I am generally surprised by how similar it is to the rest of the hospital in terms of what RDs do. There are more patients on tube feeding than the rest of the hospital, but other than that, it's basically the same. It seems like a lot of end of life issues come up at this hospital. Some of the patients have no hope of recovery, but there was no plan in place previously about what to do in such a situation. In one particularly terrible situation, a woman is basically brain dead with no chance of recovery and her family has yet to come see her. She is apparently a pretty frequent visitor to the hospital, and Adult Protective Services has been called each time she has been in. She usually leaves the hospital and is placed in a home, but her common law husband comes and takes her home just after she arrives at the nursing home. She is disabled and her "husband" doesn't take care of her. Apparently on her last admission, she had roach eggs growing in her hair because he hadn't bathed her in so long. On this admission, in hopes of avoiding protective services, after she initially became ill, he waited an hour or so and bathed her before calling 911! He went on a vacation just after she was brought to the ICU, because he "couldn't handle it", and nobody has heard from him since. Her son claims he has no car, and won't come in to visit her. The doctor is in a hard situation, because there is family, so she needs their permission to do anything, but they aren't present, so she can't discuss options with them. The care manager has worked to have a ride provided for the son, but he still doesn't come in, so all in all it's a pretty terrible situation. It just highlights the need for everyone to have their wishes about end of life care clearly laid out, just in case.