nursing home

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

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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.

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  • Avatar
    Winnie

    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)

  • Avatar
    Yvonne Fever White

    Sadly, spot on.

  • Avatar
    Gary G

    as per usual, no note of dementia even mentioned in the chart…

  • Avatar
    Haley Carlson

    Kristina Gray

  • Avatar
    Valella Jo West

    OMG, this is satire but too often true.

  • Avatar
    Brittany Leigh Crandell

    It’s just to worst to see these patients. Breaks my heart. It’s like they expect them to get up and walk our of the hospital afterwards. It’s practically what the admissions team sells them anyways.

  • Avatar
    Brittany Leigh Crandell

    Hahahahahaaaaaa.

  • Avatar
    Brittany Leigh Crandell

    Hugs. I know it’s terror on your soul. Just know he didn’t blame you for doing your job.

  • Avatar
    Brittany Leigh Crandell

    Please share your articles

  • Avatar
    Brittany Leigh Crandell

    Ain’t no lie there sister

  • Avatar
    Pam Miller

    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.

  • Avatar
    Roma Sitta

    A centurion was trached at mercy not too long ago I believe

  • Avatar
    Robin Fahringer Mitchell Machajewski

    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.

  • Avatar
    Robin Fahringer Mitchell Machajewski

    One does NOT have a feeling of “saving a life” in these type of situations. Happens all the time, tho.

  • Avatar
    Robin Fahringer Mitchell Machajewski

    Oh, but they didn’t want to “give up” on him. :-/ Poor guy.

  • Avatar
    Robin Fahringer Mitchell Machajewski

    I feel like I’m going to hell for laughing at this…. SMH.

  • Avatar
    Jimmy Ruiz

    So are you allowed to have dinner?

  • Avatar
    Jimmy Ruiz

    So are you allowed to have dinner?

  • Avatar
    Jeannie Gilman

    I can’t laugh at this. Too real, and too tragic.

  • Avatar
    Jeannie Gilman

    I can’t laugh at this. Too real, and too tragic.

  • Avatar
    Robert Schuchmann

    Living at any cost, shame on us.

  • Avatar
    Stephen Bailey

    Scary that as a society that this is “ok” apparently

  • Avatar
    Susan Wellnitz Rutherford

    Wish this one was just satire… its a lil too real though. I have several at the long term care facility I work at that could be this patient!!!

  • Avatar
    Susan Riggan

    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.

  • Avatar
    Mara Hemmerly

    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!

  • Avatar
    Jennifer Stoner

    ER Nurse too..I know :(

  • Avatar
    Elizabeth Leeman

    triple like!

  • Avatar
    Nyki Maddigan Ŧ

    I’m sure he gets a pneumonia vaccine every admission.

  • Avatar
    Nyki Maddigan Ŧ

    Yep. And when you ask someone who is struggling for air- they beg for a tube.

  • Avatar
    Nyki Maddigan Ŧ

    DNR tattoos don’t work. We will still Crush your sternum.

  • Avatar
    Nyki Maddigan Ŧ

    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!

  • Avatar
    Gomerblog

    Double like

  • Avatar
    Gomerblog

    Well said

  • Avatar
    Andrea Kit Knettel

    Sadly this isn’t so much satire as it is what we do everyday.

  • Avatar
    Pat Costello

    Why

  • Avatar
    Kathee Johnson

    I have actually seen DNR’s tattooed on sternums—believe it or not, that isn’t enough. It has to be on paper, or a loved one has to tell ED staff.

  • Avatar
    Marta Holmes

    Excellent illumination of an unfortunate reality.

  • Avatar
    Peggy Jewell Holstine

    Wonderfully articulated. Remember, satire is best as thinly-disguised truth. That is why MAD Magazine continues to thrive after all these decades. Thanks again.

  • Avatar
    Monica Liley

    Nothing like the torture of the old to satiate selfish family members of the me my I ilk.

  • Avatar
    Katesel Strimbeck

    Families can over ride what’s in writing.

  • Avatar
    Katesel Strimbeck

    I’d share on my FB page but my non medical friends wouldn’t get it. Only thing you left out wax the PT OT and Speech consults. He needs rehab now.

  • Avatar
    Annie Hamilton

    Were their Core Measures and vaccination screens completed? Let’s talk about what really matters.

  • Avatar
    Ellen Deffenbaugh

    Funny, tasteless, and true all at the same time. I love Gomerblog. The hospital acronym is a particularly tasty touch.

  • Avatar
    Storm Hawk Rising

    I think that within 24 hours of discharge the nursing home tried to refer him to my geropsych unit for an increase in aggression.

  • Avatar
    Lee Harper

    Just too true to be funny.

  • Avatar
    Elizabeth Morgan Pezzano

    My mom was on both. I think she had Roxy on Monday and died on Tues or We’d (in nursing home under hospice). So appreciative.

  • Avatar
    Gwen Cossette-Marks

    My mom put everything in writing. And we, being good kids, respected that. Its about the sick person and not anyone else.

  • Avatar
    Elizabeth Morgan Pezzano

    Same here. ALZ runs in our family. Hoping assisted suicide or euthanasia is legal by the time I get it.

  • Avatar
    Elizabeth Morgan Pezzano

    It does not matter. Push comes to shove and he dang families start fighting. I was fortunate that we were all on he same page.

  • Avatar
    Elizabeth Morgan Pezzano

    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.

  • Avatar
    Anna Sahadeo

    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.

  • Avatar
    Brandi McCracken Klunk

    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!

  • Avatar
    Conni Errickson Miller

    This one is not really a satire because I see it happen way too often.

  • Avatar
    Conni Errickson Miller

    I have to laugh because I tell my family the SAME EXACT THING!!!!

  • Avatar
    Brad Miller

    Oh, you must work in my ICU.

  • Avatar
    Jill Guizlo

    Rachel-do you have any easy to read articles or information pages you can suggest we share with families?

  • Avatar
    Sharon Henderson Wacht

    I could not tell if this was real or not. I see this happening at our facility and I’m sure we will get our share during the holiday’s as nursing homes cope with staff taking holidays off

  • Avatar
    Cheryl Zirger

    Sadly true

  • Avatar
    Betty Hilliard

    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!

  • Avatar
    Christian Jacobus

    Agreed, this isn’t a satire it’s a documentary.

  • Avatar
    Pamela Hall Duerr

    Damn. My pet peeve and the reason I’m going to hell.. For resuscitating all those poor old patients…
    I even tell family we’ll break every rib…

  • Avatar
    Tina Lekic

    Do fake compressions on these poor old souls if you can get away with it. Man I hate cracking ribs. …

  • Avatar
    Tina Lekic

    Story of my life right here. We don’t let our elderly die with dignity, and doctors never stand up to these people.

  • Avatar
    Jennifer Stoner

    Hahah

  • Avatar
    Laurence Sekansky

    Usually they have funny articles, this one is unfortunately true. Makes me sad that we do all this crap to people.

  • Avatar
    Lauren D Kasperski

    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.

  • Avatar
    David Parnell

    Can I see you new tattoo?

  • Avatar
    Kele McGrath

    Amy Jarmon remind you of anyone?

  • Avatar
    Janice Wilson

    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.

  • Avatar
    Rachel Wynn

    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.

  • Avatar
    Susan Smith Popham

    Slooooow code

  • Avatar
    Rachel Wynn

    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.

  • Avatar
    Norman F. Retener

    Hitting nail squarely on the head.

  • Avatar
    Jennifer Stoner

    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 :)

  • Avatar
    Theresa Skrobe

    This is what constitutes many of our ER patients and ICU admissions. Sad.

  • Avatar
    Steven Welsh

    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.

  • Avatar
    Lauren Wolf

    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…

  • Avatar
    Jeannie McCain Schooler

    Some families can’t be educated.

  • Avatar
    Mark Ciagne

    What I don’t understand is why health care is so expensive in the United States…

  • Avatar
    Helen Aanstoos

    Good business for the makers of Depends….

  • Avatar
    Andrea Miller

    Kristine Leigh Free I can name ‘OL CRAP hospital.

  • Avatar
    Sean Peakin

    Thank God my hospital isn’t the only one that this happens to on a regular basis….

  • Avatar
    Darin Adair

    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.

  • Avatar
    Marie Martin Philipp

    Sad, but true…

  • Avatar
    Andrea Miller

    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.

  • Avatar
    Becky Pierce

    Daily occurrence

  • Avatar
    Stephanie Hancock Rezac

    There’s some truth in all good humor.

  • Avatar
    Gwen Cossette-Marks

    All I can say is if you don’t want those kind of measures, PUT IT IN WRITING!

  • Avatar
    Christi Benefield

    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.

  • Avatar
    Becky Collins

    I will poltergeist the crap out of my family if they let this happen to me.

  • Avatar
    Becky Collins

    I will poltergeist the crap out of my family if they let this happen to me.

  • Avatar
    Stella Fitzgibbons

    Too true to be funny–happens all the time, and the worst part is the allegedly loving family standing there telling him how proud they are that he’s “going to be fine.”

  • Avatar
    Stella Fitzgibbons

    Too true to be funny–happens all the time, and the worst part is the allegedly loving family standing there telling him how proud they are that he’s “going to be fine.”

  • Avatar
    Wendy Harmon

    Yep, I see it several times a week. sigh.

  • Avatar
    Wendy Harmon

    Yep, I see it several times a week. sigh.

  • Avatar
    Sanda Vujnić

    Beth Ginsburg

  • Avatar
    Sanda Vujnić

    Beth Ginsburg

  • Avatar
    Cindy Withrow

    No

  • Avatar
    Cindy Withrow

    No

  • Avatar
    Theresa Skrobe

    Indeed.

  • Avatar
    Theresa Skrobe

    Indeed.

  • Avatar
    Jeff Siegler

    Christian Jacobus, even though its satire, sad but true.

  • Avatar
    Jeff Siegler

    Christian Jacobus, even though its satire, sad but true.

  • Avatar
    Kate Brennan

    Michelle Amy

  • Avatar
    Kate Brennan

    Michelle Amy

  • Avatar
    Melanie Nordlinger

    Nailed it. Sad but true.

  • Avatar
    Melanie Nordlinger

    Nailed it. Sad but true.

  • Avatar
    Melanie Nordlinger

    Nailed it. Sad but true.

  • Avatar
    Melanie Nordlinger

    Nailed it. Sad but true.

  • Avatar
    Mari Hoover

    Unfortunately this is true

  • Avatar
    Mari Hoover

    Unfortunately this is true

  • Avatar
    Amy Groves Bradley

    I know this is supposed to be funny, but I found it rather sad because it is so very true.

  • Avatar
    Amy Groves Bradley

    I know this is supposed to be funny, but I found it rather sad because it is so very true.

  • Avatar
    Andrea Clinton

    just because we can, does that mean we should?

  • Avatar
    Andrea Clinton

    just because we can, does that mean we should?

  • Avatar
    Pau La

    This sounds exactly like my last night shift….I thought this was supposed to be a satire page?!

  • Avatar
    Pau La

    This sounds exactly like my last night shift….I thought this was supposed to be a satire page?!

  • Avatar
    Sarah Kohrmann

    We see it all too often

  • Avatar
    Sarah Kohrmann

    We see it all too often

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