Sat noc 2330: Just another day in the trenches as an OR nurse
It was a disaster from the start. Our star neuro surgeon suddenly decided he needed to do surgery. It apparently early in the afternoon. The patient was already said to be “a little addled” but pleasantly confused. Then he became irritable and over the next two hours became withdrawn, then somnolent. By 2200 he was unarousable. The neuro team did an assessment and decided he needed a “decompressive craniotomy.”
Why, why, why. Why would you do a craniotomy on a patient with liver cancer that has metastasized to the pancreas, both lungs and brain, especially when the patient has made it perfectly clear he did not want treatment and had made himself a DNR.
So what happens? Well, first you waste a whole bunch of blood products from the Red Cross, then you continue to bleed until the stress and declining hemoglobin causes a strain on an aged heart.
So here’s the rational to coding this patient:
His disease process didn’t cause this.
We intubate, push meds, do CPR (break some frail, cancer-stricken ribs), shock numerous times, push through all the algorithms until all of the residents and interns have had their fill…
And he dies a terrible death. Like the cancer that ravished his body wasn’t enough. He was someone’s father, uncle, husband.
Merry Christmas… I want to cry.