I once had this morbidly obese patient present to emergency with some sort of abdominal pain. With that region, what you want to do is get a blood sample ASAP to know which organ is causing the problem. At the time I was a combat medic and about half the nurses and doctors I worked with were either medics prior to their degrees or had rotated through shock trauma platoons. I can all but throw an IV into an arm and have inserted at least a dozen in the dark by feel alone.
So I go in to get the blood sample and start feeling around their inner elbow for a suitable vein. I don't feel any vein at all. I check the other arm and nothing. I feel their wrists, nothing. I look at their feet because I don't want to go in blind and there isn't even a palpable vein there. Every suitable site had such a deep layer of fat over it that you couldn't do anything beneath it. So needing the sample, I trusted my skills and went in blind. Once, twice, three times before I gave up as a mercy and said I'd get the most experienced nurse on duty. She tried six times without success. We grabbed the on-duty physician, one of the best doctors I have ever worked with, and she tried and tried and tried and tried. Different needles, different sites, an ultrasound machine, she stuck this poor patient over 20 times. They were in such pain that they left against medical advice with an issue that could potentially kill them. Any other patient on that ward and I could go in and get an IV within 30 seconds regardless of conditions.
I had this other patient in a nursing home. They were maybe 800-1000lbs and would have been healthy enough to spend another 30 years out of a nursing home if not for their weight. They couldn't leave their bed because they couldn't move. Their body was breaking down because of their weight and immobility so without someone manually repositioning them every few hours they would begin to ulcerate and rot. They couldn't use the bathroom without two people rolling them over, putting a bedpan underneath them, and then wiping their ass because they could no longer reach it. The highlight of their day was me getting them coffee in the morning and every day will be groundhog day until some organ fails or a blood clot dislodges. A fate I wouldn't wish on 5% of my enemies.
Yeah, there should be better healthcare and any possible means of steering people toward better options than dying terribly after years with lifestyle diseases. When grandma is being amputated slice by slice due to diabetes, that's a horrific degree of suffering that could have been prevented and should be mitigated unless you're a fucking sociopath. At any point prior and after the diagnosis an intervention would have saved them from something they don't need to experience. Ignoring that is as stupid as anti-vaxxers.
Totally noncompliant with it and they had family bringing in food that they filled the room with. You can use implied consent to act in their best interest if there is some inability to advocate for themselves, but that patient was totally there cognitively and in their 40s. It was just one of those cases where their spouse died and there was no one else willing to be a caretaker. Even being fairly fit I couldn't solo-roll that patient so they would have required two around-the-clock caretakers to move them around on the bed.
I once had this morbidly obese patient present to emergency with some sort of abdominal pain. With that region, what you want to do is get a blood sample ASAP to know which organ is causing the problem. At the time I was a combat medic and about half the nurses and doctors I worked with were either medics prior to their degrees or had rotated through shock trauma platoons. I can all but throw an IV into an arm and have inserted at least a dozen in the dark by feel alone.
So I go in to get the blood sample and start feeling around their inner elbow for a suitable vein. I don't feel any vein at all. I check the other arm and nothing. I feel their wrists, nothing. I look at their feet because I don't want to go in blind and there isn't even a palpable vein there. Every suitable site had such a deep layer of fat over it that you couldn't do anything beneath it. So needing the sample, I trusted my skills and went in blind. Once, twice, three times before I gave up as a mercy and said I'd get the most experienced nurse on duty. She tried six times without success. We grabbed the on-duty physician, one of the best doctors I have ever worked with, and she tried and tried and tried and tried. Different needles, different sites, an ultrasound machine, she stuck this poor patient over 20 times. They were in such pain that they left against medical advice with an issue that could potentially kill them. Any other patient on that ward and I could go in and get an IV within 30 seconds regardless of conditions.
I had this other patient in a nursing home. They were maybe 800-1000lbs and would have been healthy enough to spend another 30 years out of a nursing home if not for their weight. They couldn't leave their bed because they couldn't move. Their body was breaking down because of their weight and immobility so without someone manually repositioning them every few hours they would begin to ulcerate and rot. They couldn't use the bathroom without two people rolling them over, putting a bedpan underneath them, and then wiping their ass because they could no longer reach it. The highlight of their day was me getting them coffee in the morning and every day will be groundhog day until some organ fails or a blood clot dislodges. A fate I wouldn't wish on 5% of my enemies.
Yeah, there should be better healthcare and any possible means of steering people toward better options than dying terribly after years with lifestyle diseases. When grandma is being amputated slice by slice due to diabetes, that's a horrific degree of suffering that could have been prevented and should be mitigated unless you're a fucking sociopath. At any point prior and after the diagnosis an intervention would have saved them from something they don't need to experience. Ignoring that is as stupid as anti-vaxxers.
That's fucked.
With the last patient, surely there'd be a caloric restriction plan if it's a nursing home.
Totally noncompliant with it and they had family bringing in food that they filled the room with. You can use implied consent to act in their best interest if there is some inability to advocate for themselves, but that patient was totally there cognitively and in their 40s. It was just one of those cases where their spouse died and there was no one else willing to be a caretaker. Even being fairly fit I couldn't solo-roll that patient so they would have required two around-the-clock caretakers to move them around on the bed.
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