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Toni Talks about PT Today

My Cat Died

Published April 15, 2008 1:59 PM by Toni Patt
My cat died last night. He was old. He lived a full kitty life. He died last night in my lap and I gently petted him. I could have taken him to the vet but all that would have happened is he would have been put to sleep. I couldn't do that to him. He died at home in familiar surroundings, not in a cold, unfamiliar vet clinic. As soon as I picked him up I felt him curl up and relax. It probably took less than 15 minutes. 

That is how my cat died: at home and in peace. It's sad that we don't give our elders the same consideration. Many will die in the hospital either alone or with strangers. It won't always be peaceful.  It probably isn't how the person wanted it to happen.  Once an elderly person enters the medical system our society doesn't allow for much choice in how one dies. As soon as someone is admitted to the hospital, the focus is on keeping him alive at all costs. Many years ago my grandmother died in a hospital. She had a massive stroke. She went to the hospital. They didn't hook her up to anything.  Instead she passed quietly in her bed.  That could never happen today.

Living wills aren't a guarantee. If a family member says so, health professionals will ignore it. I've seen this happen several times. Family members have told me their parent didn't want to be kept alive but they can't let go. Even if a patient can voice an opinion on how things should proceed it will be ignored. I can't count the number of times I've gone to see a patient only to be told to go away. These patients have made a decision about their care. They don't want any. They want to be left in peace. I'm not advocating letting people just lay in bed. I am saying that some of those patients have made decisions about how they want things to end.  

Being a PT in a SNF is a challenge. The mechanism by which a SNF makes money is based on the amount of care a patient receives. The more care provided to the patient, the greater the amount of money received. Amount of care is measured by the total number of minutes the patient receives care. So a SNF wants everyone to receive as much care as possible. 

This weekend I worked in a SNF. I had a patient refuse. I was supposed to see him for 35 minutes. He told me he didn't want to do therapy. He knew he was dying and just wanted to be left alone in bed. I was caught in the middle. On one hand I'm supposed to provide 35 minutes of care but doing so meant encouraging him to do something he didn't want to do. ICUs are another place where this happens. Doctors want their patient s up no matter what. Sometimes it seems the therapy is worse than the disease.

I don't have an answer for this. Sooner or later we will all meet a patient like that gentleman. I have two ICU patients right now that fit that bill. One is a 77 year old new quad from an MVA. Assuming she survives what kind of life will she have? She is A and O X 3. I wonder if anyone has asked her what she would like to have done.

The other one is a 15 year old with severe anoxic brain injury. The chart said he was without oxygen at least 10 minutes. I can work with him.  Maybe I can make him a little better. Better is a relative term.  Better than what? He is high risk for just about every complication a patient can develop. I'm not sure how much help I'm really providing.  

Ultimately these decisions fall to the physicians. When my time comes I want to go quietly surrounded by things I care about. I hope there is someone around to watch over me, like I did for my cat, to make sure it can happen.



A cold sterile world is often the last place people see before moving else where.  

Grandma died at home in bed, where she belonged, thank God.  

Grandpa did the same, others wanted him to go to the hospital, he refused, he knew it was close and he chose where he wanted it to end.

A 77 y.o. quad!?!  You'd think the staff would realise she is old enough to decide what to do.

snf's and minutes - what a crock.  We young whippersnappers are telling these folks what they have to do.  Some have simply told me "make me do it".  Patient bill of rights supercedes RUG levels any day.  

And this I have told many managers so they simply send in another therapist to get the minutes - which I seriously doubt was gotten by the regular methods.

jason, PTA April 18, 2008 1:00 AM

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