The Buck Stops Here
Recently I had a horrible experience with a rescued pit bull puppy (stay with me, here; it relates to nursing, I promise). She was an adorable miniature brindle pittie mix with a history of “cured” Demodex mange. She was a tail-wagging handful but very sweet. Until she wasn’t. Her mange returned, and her temperament changed; she became a snarling, snapping aggressive growling dog who finally bit me. I informed her rescue organization, and we mutually agreed that euthanasia was best. The rescue owner came and retrieved the puppy. Her vet refused to euthanize her. Why? She hates to put down an animal whose aggression is caused by medical reasons. The rescuer was swayed by this, having spent a great deal of time, energy, and affection on the puppy; I continued to maintain that a biting dog is not adoptable regardless of the reasons for it (what, I asked, if the mange is cured but recurs?). I had had the opportunity to take the puppy to a different vet to have her euthanized and declined because that vet did not like her and I feel, with unfortunate recent experience, that an animal should at least be put down by a human it trusts.
So a situation has developed around this dog that is all too familiar to those of us who care for humans: no one wants to take responsibility. We all have good, although different reasons, but at base the dog has become a hot potato, passed around in hopes that someone else will solve the problem. How often do we see this in medicine? The nursing home passes off the desatting DNR patient to the paramedics, who bring her to the ER as quickly as possible, and the ER staff stabilize the patient as quickly as possible to transfer her to the floor before she deteriorates further. No one appears to make any decisions regarding code status. No physicians will do it without family input. The patient is kept alive and often miserable. Hot potato.
What of abuse and neglect? Mental illness? Drug abuse? These unfortunate people are handed around through emergency rooms, law enforcement, mental health agencies, hospitals, treatment centers, and social workers, often with no good resolution. Hot potato.
People don’t like dealing with unpleasant situations, particularly ones in which we have to accept responsibility for the outcome of someone else’s life. The rescue organization, in the example of my erstwhile dog, basically accused me of having no idea how hard it was to do this, and I said I was in fact acutely aware of it. I see it every shift I work: “Here…you do it; you take care of it.” I took care of an extremely elderly lady a few months ago who stated, clearly in her right mind, “I really want to be left alone to die in my bed. I’m tired of being hauled in here in the middle of the night and stuck with needles and having those damn catheters. What ever happened to dying of old age?” I felt she had a point, but her family refused to concur with her wishes. I never was clear on why the lady couldn’t make her own decisions, but my point is that she was a hot potato, she knew it, and she was sick of it.
As nurses, we have limited ability to stop the buck, stop passing the potato. But we do have the capability to realize when this is happening and use the power we do have to intervene in care planning and requesting consults. “Hot potato” patients are miserable, and we can help in some ways—according, of course, to our scope of practice and state Nurse Practice Acts. I wish I had used my power while I still had it to put this biting dog down, but I didn’t. I regret it.
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