Wednesday, December 10, 2008
1900 hrs. -- I'm at the hospital on a consult for a prospective hospice patient. At the nurse's station, I sit near Mrs. L's primary physician as I study her chart.
"So, what do you do over at hospice?" asks Dr. S.
"Well, my primary duty is to take care of after hours emergencies", I reply."
"HAH!", laughs the doc. "What emergencies could hospice patients possibly have?"
I keep silent. A little anger is rising up within me. There is no way to respond to his thoughtless remark without betraying my feelings. I get up and go into Mrs L.'s room.
Earlier in the day, Dr. S. had ordered a Dilaudid drip for the patient. Running at a rate of 1 mg. per hour, it clearly is inadequate for Mrs L's pain. She's in agony. Her poor husband, sitting by her side, is suffering nearly as much as she. I immediately return to the nurse's station.
"Dr. S., could you please write titration orders on the IV Dilaudid so we can get her comfortable? The hospice won't be able to get her into an inpatient unit until tomorrow and her pain isn't under control yet."
The doc's eyes widen considerably. I instinctively know that he's hesitant -- no, he's afraid to increase the rate of the drip. "Noooo... I can't do that", he finally answers and gets up from the desk and walks briskly away.
Watching him leave, I raise my voice, "Why did you order Dilaudid if you weren't going to use it for her pain?"
He disappears into the elevator. Shit.