Home Internal Medicine Critical Care Bed-Bound, Demented 89-Year-Old Successfully Resuscitated, Discharged to Wallow in Own Excrement at Nursing Home

Bed-Bound, Demented 89-Year-Old Successfully Resuscitated, Discharged to Wallow in Own Excrement at Nursing Home

Jake Ho
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119
Bed-Bound, Demented 89-Year-Old Successfully Resuscitated, Discharged to Wallow in Own Excrement at Nursing Home

GREENSBORO, NC – A team of physicians, nurses, and support staff is being lauded for its efforts in saving the life of Jasper Billings, 89, after he presented in septic shock last month to Our Lady of the Chronic Recurring Abdominal Pain Hospital after being transferred from his skilled nursing facility.

nursing homeMr. Billings, a non-verbal, bed-bound, double-amputee on dialysis, presented to OL-CRAP Hospital with a fever, low blood pressure, and multiple organs failing.  His family held steadfast to their policy of wanting “everything done,” and once again refused to talk about a DNR.  “Daddy has always been a fighter,” said son Joe Billings.  “We knew that his strength and the Good Lord’s will would overcome every obstacle.”

Mr. Billings was started on aggressive blood pressure support with multiple liters of IV fluid.  When his blood pressure didn’t respond, a central line was placed and a norepinephrine drip was started.  He was given broad-spectrum IV antibiotics, a blood transfusion, and sent to the ICU.

While there, Mr. Billings continued to receive aggressive management.  He ultimately required intubation and was placed on a ventilator due to respiratory failure.  Over the course of ten days, he began to improve.  The family asked for a feeding tube to be inserted into the abdomen since Mr. Billings couldn’t eat.

Support was slowly weaned as the patient’s organ failure and blood pressure slowly improved.  “I just know those tube feeds are what helped Daddy turn the corner,” Joe explained.  “He has always loved chocolate milkshakes, and that Jevity through the feeding tube looks just like chocolate milk.  He is getting his favorite snack around the clock!  We are going to continue those tube feeds as long as it takes for him to get his strength back.”

Intensivist Michael Johannson agreed to an interview.  “It just goes to show what early and aggressive intervention can do in these cases.  A man presented to the hospital at death’s doorstep, and thanks to the institution of a protocol focusing on measurable parameters, the patient is alive and was discharged in the same state of health he was in prior to falling ill.  Our goal directed care is the biggest reason that Mr. Billings can continue to enjoy his time lying on a stretcher at thrice weekly dialysis sessions, staring off into space while caregivers clean and attend to him, and the joy of having his decubitus ulcers debrided and redressed every other day.”

We attempted to reach Mr. Billings’ skilled nursing facility yesterday for comment, but were told that the patient had to be sent back to the Emergency Room at OL-CRAP due to fever and low blood pressure.

119 COMMENTS

  1. It does happen…so true and sad. Our hospital’s IR physicians would not put a G-tube in patients like these. If palliatve care & IR still can’t stop them… I would refer the case to bioethics… but GOC discussion really should have started in ED (better yet, SNF docs, PCPs, etc)

  11. This is an almost daily reality even in our very tiny rural hospital. We have one in here tonight who looks like death warmed over. Liver cancer, GI bleeding, Hepatitis, chronic pain issues. But? You guessed it! FULL CODE status. Oy vey.

  13. The sad thing is, because of fear of lawsuits/upset family members/poor patient satisfaction scores, I think many healthcare providers are truly afraid to have honest conversations with many families. Seriously. So many people are in denial and just don’t want to hear it. Until healthcare providers are allowed to be healthcare providers and not Burger King “have it your way” workers I fear this “do everything” mentality will continue and possibly become MORE widespread.

  24. It is appalling what we inflict upon people. I believe most of it could be stopped by one meaningful truthful conversation with gentle but descriptive detail what the slow boat thru hell is going to be like until sepsis wins. In fact, let a nurse do the talking. I am hardly the grim reaper but we are doing a great disservice by not having that conversation.

  25. It is so crazy…too bad it’s not like the good old days when a family wanted a full code and the patient was a dying 90 year old, they used to do CPR with one finger tip and then the whole staff would agree to call it. Families should stop thinking about themselves and think about what their loved one would want!

  31. I wish we could do a PSA to show people what doing everything means. And to show the reality of life after we stabilize people. By golly- we cannot let anyone go with a shred of dignity intact!

  50. Bravo! I see so many people who can’t understand to let nature take its course. My mom had ALZ. I took care of her at home until she was no longer ambulatory. The goal should be to keep one on their feet and then when that fails to let nature prevail. I kept mom on her feet until the last 4 months of her life. I had her placed. No feeding tube.

  51. This is satire but it is reality. Writing down you wishes doesn’t mean much when you are unconscious because the family’s wishes often supersede the written living will. Healthcare professionals are bound to respect the wishes of the family. As a healthcare professional, I believe it is wrong to prolong the life of people who already are bed bound and unconscious to the world around them. Futile medical care should be avoided however our society fears death and loss. It makes us see how little we actually can control in life and we have a difficult time making peace with these facts. I know futile medical care is not what I signed up for as a healthcare professional. None of us did but it’s our reality.

  52. Probably one of the most frustrating parts of my job. Many years ago when I began working with the ER I had a doctor tell me that we are allowed to treat dogs more humanely than actual human beings~so sad but true! Nobody gets out alive, so we should be able to get them out with some comfort and dignity!

  59. Satire or not this is so true & one of the reasons we are in a healthcare crisis. Most family members that are making these ‘do every thing possible’ decisions, are undereducated and/or unrealistic in their beliefs. Something is going to have to change the way these decisions are made. Way too many resources are used on pts that IF they survive, they STILL & NEVER will have any QUALITY of LIFE!

  66. I have an Advanced Directive, my parents have an Advanced Directive, my brother has an Advanced Directive. I suggest we fight this nonsense by educating patient’s families every opportunity we are allowed and offering them the paperwork and access to a notary (we have one on staff 24/7 at the ED where I work).

    Humans are, or I should say Americans are, lazy. If you don’t do everything short of signing the goddamn papers yourself, it simply won’t get done.

    And I, too, plan on getting a ‘DNR’ tattoo on my sternum, either at age 70 or if I have any co-morbidities that would qualify me for an Internal Medicine specialist as opposed to a good ol’ PCP. Humans aren’t built to be eternally bed-bound, tube-fed, and vasopressed.

    Dementia should immediately qualify a person for palliative care. Just give them Roxicet and Ativan as needed, then let nature take its course.

  69. Put your wishes in writing yes, but also talk to your family and make sure they know and accept what you want. In addition, spend time with elderly parents and relatives. That way, when something happens, your guilt won’t do the deciding. I’ve seen that so many times in my nursing career. It’s just so sad for everyone involved. The lay community doesn’t really understand what ” do you want us to do everything” means until it’s too late.

  70. Christi- collaborate with the SLPs in your building to talk to family members about appropriate use of feeding tubes. We have been reviewing tons of research showing that it does not increase length of life. If the SLP in your building doesn’t understand the research send them to me! I have created many SLP materials.

  72. I agree. The need to discuss appropriate use of feeding tubes is very real. I am a speech-language pathologist and treat swallowing disorders and people with dementia. The evidence about using feeding tubes in people with advanced dementia is clear. It does not improve length of life and the post feeding tube insertion sequelea is awful. So many people are sedated, because they try to pull them out. In people who are mobile, sedation increases fall risk and a whole mess of side effects.

  74. I have it in writing, and apparently I will tattoo DNR on my sternum. I swear to God you guys better not bring me back all gorked out or like Becky said, I will poltergeist the crap out of you :)

  76. Brutally funny as well as brutally accurate.

    I had a 92 year old nursing home patient with severe dementia on a FUCKING VENT and four point restraints because he would pull out his trach and kick at the staff in his state of constant, unrelenting terror. His family still insisted on full code when he arrested. Of course his ribs broke with my first compressions, and when his pulse returned after the second round of epi, I felt like crying.

    The man’s arms were covered with USMC tattoos listing all the WW2 battles he had fought, including Iwo Jima. He was once a badass, a proud Marine, and now he was reduced to a shit covered, helpless, terrified shell of a human being whose family wouldn’t let him go.They probably didn’t want to lose his social security and VA checks. I wanted to beat the shit out of each and every one of them.

  77. Beautifully put, gomer! As health professionals, I’m sure we can all share in the same excitement of the family as we aggressively invade and intercept the natural process of a dignified death again and again. You were a bit generous on the readmission time though…

  83. So…I thought that I was going to make a unique and pithy comment about how this particular piece of satire was too close to the truth but when I pulled up the comments, you guys had already made that exact observation…yuk, right? I’m NOT complaining about the satire; I’m complaining about our very real practice of heroically resuscitating bed-bound, demented patients so they can wallow in their own excrement.

  85. Sounds more like a patient family education issue. Quality vs. quantity of life. Some cultures insist that the patient remain alive even if thrice weekly dialysis treatments are needed. Ethically, we as nurses, have to treat the patient. Personally, I have a demented stroke survivor that lives with me. She has expressed all her wishes to me prior to her stroke. I am her health care surrogate and will abide by her wishes.

  89. As I was reading this, knowing it is satire, what I kept thinking was how to share this tastefully, not as comedic satire, but as education to those who need to see the other side. Unfortunately, what I’ve learned over the years, and currently as a LTC nurse, is that family members are ill-prepared and aren’t receptive to truth. A sad fact.

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