Nursing Home Nightmares

We received a call to one of the local nursing homes. Orlando seems to have more than its share  and I always hated calls to them. The level of care and the quality of care was almost universally less than it should have been. We were always faced with difficult and complex problems that rarely fit into any set of standing orders. Like the patient who had been seizing for an hour before they finally decided they should call us. Or the patient who had not had a bowl movement in a week and the staff had waited until the patient stomach was so distended it was causing them to have difficulty breathing  and only then to call us. It had come in as a difficulty breathing. Yeah a little O2 was going to fix that one. 

This one came in as a patient not breathing. It was that 3 am hour that I always hated in a 24 hour shift. I knew this one would be something nursing home staff always seemed to wait until the middle of the night to call. We arrived to find a coded emaciated patient in their 80's. I took one look and asked the staff if this patient had a Do Not Resuscitate order. They said no. As we began to work on the patient I asked them again to check their records I had a feeling that this patient just had to have a DNR. They again said no this patient did not have a DNR. They appeared perturbed that I had asked. 

So we worked the code and this time we brought the patient back. The patient had a heartbeat and was breathing on their own when we delivered them to the hospital. I was out at the truck refilling the drug box and airway kit when my partner came out. He told me that the patient did have a DNR after all. When the hospital had notified the family and they had been furious, sad and god knows what other kinds of emotions when you are told your loved one would continue to suffer. The amount of pain we were part of putting that family through still haunts me. I know, all we can do is go by the orders we have but we are part of the system. I did not report it because there was no one or nothing to report to. It was just another one of those wide awake nightmares we all seem to have in EMS.