Stay and wait, or go home

I had a patient, a haemodialysis patient.
I like to call him Mr. Ice-coffee, because he likes it.
Sometimes he can only be waken up by being called Ice-coffee.

He, I think, is a cute poor country man.
He lives alone, no families that we can contact because he said they never care about him.
But he has funny sense of humor.
He always laughs and talks very loud because of deafness.
He only gets grumpy when no one listens to him.

He recently got diagnosis of prostate cancer and bone mets.
They found accidentally his NOF is fractured, but he has been walking on it for long time.
Because X-ray show it is not a new one. And he has been walking finely.
The renal team referred to Orthopedic for some intervention.
He, then, waited a week for some test--not cleared.
He got upset, and wanted to go home because of sleepless in hospital.
We tried and tried, but he one day took taxi and got home.

The renal team doctor called him from home to ask him to come.
Because he is a haemodialysis patient, it is very easy to chase up their address.
And renal team always has strong sense of responsibility of dialysis patient's health status.

He came by flight doctor.
Unfortunately he lost his mobile on the way to hospital.
And then, he started to wait again.
Sunday night he was fasted for "just in case".
Because orthopedic team want to do some procedure (uncleared) on monday.
Although, he usually like to use swear words when he gets anoyed but he never means so.
Because he is always very good to those very gentle and patient nurse, and like to joke with those words, such as "bloody good you are" etc.
He, we believe, has brain cancer now also because he's mood is very unstable recently.
What made him worse is, another patient in his room is an alcoholic withdraw man.
We can imagine what happened that night.

Monday, he finally decided to go home again.
I tried almost whole morning to keep him down and stay.
But, he still choose to go.
Orthopedic team sent a junior doctor after I called them.
And, the Dr let him go after Mr Ice-coffee sighed the risk form.
When finally renal team doctor came, she was very unhappy.
I, then, went down with security guard to look for him as renal doctor asked.
We didnt find him.
We guessed he has already Taxi to the city and took bus to his country home.

What's the problem?
What we can do better for him?

  • Cant Doctors take time to chat with patient, siting down with them, especially for people who recently diagnosed cancer?
I remember a week before, he was upset already and wanted to go home in the evening. We called the one of the residence doctor of renal team who was the renal cover that evening. She sat with him, and asked for a period of private time for chatting with him. And, he did come down. And, he spoke out he has been painful for weeks all over his body which he never told anyone. And that night, he had pain relieve and he had sleeping tablet. And he said, next day, that was the best night he never had in the hospital. He was very happy.
  • Whose choice, health care provider's or patient?
We cant say people is dying soon because he/she has cancer. But, what we, as a health care provider, should really respect is people's own choice. Mr. Ice-coffee is 0ver 80, has bad heart problem, DM, and has been passing blood urine since diagnosed. And now, bone mets etc. He is those country man, like freedom. And he still can walk around by himself independently. What he wants? If I were him, I will to go home and enjoy my rest of life as like nothing happened. We have good palliative care for hospital patient. What can we do for those who is still ambulant? Also, comfort care. SO, going home, to my perspective, is the best way.
  • What is the nurse the role in this case, helping Doctors or helping patient?
We nurse always act between every one. We cant make finally decision that patient should have what or what because of our limitation of authority. What we can do is to organize any people who involve in this case to talk to each other and make a good plan. It is not easy job, because all the doctors are busy, while patients are sometimes too sick or unstable to chat with. But it is very important.

I believe Mr. Ice-coffee is very happy now.