heaven or hell and why health care is stupid!

this week, i met a 43 year old woman who was diagnosed with cancer in 1993. she had osteosarcoma (cancer of the bone) and survived after receiving chemo, radiation, and having a new femur bone constructed with titanium plates and rods (of course, not without complication - she had an infection and needed screws replaced and on and on). it's now 2011, years later, and she is back in seattle (from her native north pole, alaska) with recurrence of her disease and metastises to her lungs and trachea. despite chemo and radiation, she is dying. and she is scared. and angry. and a patient on my unit.

i'll spare you the many details on how poor her admission was carried out by my night time colleagues. wait, no i won't. i can't help but mention just one of the tiny mishaps because it is SO scary and ridiculous. when i was getting report from the night nurse who admitted the patient, i asked if the patient had a tracheostomy because i saw mention of it in a physician's note. now, a tracheostomy is a hole strategically cut in the trachea or windpipe to ease with breathing (in SUPER laymens terms). i didn't ask the nurse if the patient indeed had a wart on her left pinky toe - there are just some things you don't look at or assess, especially on a night shift. but come on, you should look at your patient's HEAD. you should notice if the patient is breathing through a hole in her neck or through her mouth! but the nurse couldn't answer the question. "oh my god, did you look at your patient?"

anyway, back to why healthcare is so stupid! the patient (i will call her M) uses 2L of oxygen delivered through little straws in her nose. we have all seen little older folks carrying their tanks to help them breathe. well, M uses this too, to help alleviate some of the terrifying feelings of suffocating. as tumors fill her lungs and surround her windpipe, she constantly feels as though she is gasping for air. without oxygen, her oxygen saturation is about 92%. this is not a bad oxygen sat; it's low, but not dangerous. in the hospital, at 92%, we put people on oxygen. but, for some assinine reason, medical insurance requires that people saturate at 88% to have their home supply of oxygen covered. what that means is, M does not qualify for home oxygen (even though wearing just 2L provides her some relief). M's husband is kind, devoted, and doting. he would do anything for M. and so, he has been stealing oxygen tanks from the hospital. kind of funny, kind of sad. if your loved one felt as though they were drowning, would you steal oxygen tanks? probably!

after some sleuthing and M's husband finally revealing the source of their illegal oxygen supply, i asked if i could help them set up home oxygen legitimately. that's when M tearfully admitted that without oxygen her saturation is not low enough to qualify. my response kind of surprised M and her husband. "i don't care if you qualify legally or not. gasping for breath sounds pretty miserable. i think you deserve to have a little oxygen wherever you are if it provides you just the tiniest bit of comfort." they looked at me curiously. i was happy to document that the patient desaturated down to 88% without her oxygen; it's the least i could do. after some white-lie computer charting and a call to social work, i had a portable oxygen tank delivered to the hospital, delivered to their hotel, and set up in their home town in alaska.

does it make ANY sense that we provide futile medical treatment covered by insurance to thousands of people? on a daily basis, there are folks in the ICU on my unit that we all know will not survive. and yet, they are receiving MRIs, CT scans, dialysis, and thousands of dollars worth of nursing and medical care. BUT... we won't provide oxygen (a natural gas) to a woman who wants to die more comfortably, without gasping for air?

M and her husband thanked me profusely, as if i had performed some miracle. no nurse before me had done them this favor. as i left the hospital that night, i wondered to myself... am i going to nursing hell or nursing heaven?