Bad day at work

**Warning, venting out dealing with a dying pt.**

I love the work I do at the hospital, most days. I get to be a part of helping people remain safe and independent, I help them get back home, I learn new things everyday, I love the medical aspect of my job. Yes I do deal with sick and sometimes dying patients, but even with the dying pt's I learn so much. Today was not one of those days were I felt like I learned something, today was a day where I questioned the morality of doctors and a pt's family member. There are some docs I like, some I don't, and some I wonder how they got through medical school. My first pt. I was to work with today was 91 y/o and obviously very near the end of life. I am no doctor, but just looking at the labs you could tell that death was close. So, I think "stupid doc just checking off everything on the order sheet." it is a common occurrence. I check the chart only because it is what I am supposed to do only to realize that this was not an order from the check list, but a hand written order for both occupational and physical therapy. This is written in the same order stating "no medical intervention, no matter the intensity demise is eminent." WTH!!!! It is specifically written that this pt. is in fact dying!!! Why do you order OT? How is that ethical, how is that medically appropriate. Now I never intended to work with this person. Medically they were not even close to being appropriate. Why waste my time just for me to realize that the doctor in an ass and has no clue what I do or what the purpose of OT is. So am I supposed to go into this pt's room and state "Mr(s). I am sorry you are dying, but the doctor wants you to so some therapy." Yea I don't think so. Do as you must, write what orders you will...I will not see your dying pt. Now on to the family of the same pt. I know dealing with death is not easy. No one wants their loved one to die, but there comes a time when you must let go. Your family member as demented as they are is crying/screaming to be allowed to die. I can hear them through the closed door asking God to take them home. How do you take that to mean that they want every thing, including intubation, to be done to save their life. This poor pt. had NO independence prior to coming to the hospital, their body and mind were worn out and broken. I know it is not my choice as to what they want but clearly they are asking you to let them go. LET THEM GO--yes you will hurt, yes you will be sad, but they will be free from the wrecked and worn out body and mind. I can only imagine how difficult it must be when it is your family member asking to die, but I hope if I am ever in that position I can let them go peacefully. I actually had to leave that unit for a bit b/c my heart was breaking for the pt. I feel for the family but I think it is cruel to put someone in that condition in an unfamiliar place with unfamiliar people, run countless medical tests-which are invasive, when the honest truth is that no matter what the pt. will die. Take them home, let them be comfortable, let them go.

Sigh--days like today suck!!! Also if I have to deal with one more alcoholic going through DT's I will rip my hair out. There is nothing I can do until detox is over. Even then I really don't care to work with someone who won't help themselves!!! One more vent for the day--in the hospital system OT's work in 5 different areas, 3 of those areas are based within the hospital, 2 are based outside the hospital. I swear if the women from the out pt. hand clinic complain out us OT's at the hospital not working hard and in not so specifically saying what we do is not OT I think I will scream. Yea your right, I can't make a dynamic splint and I don't know the precautions for carpal tunnel surgery or tendon repairs, but that is simple because I have NEVER worked with hand pt. nor do I want to work with hand pt's. That being said, should I assume what they do is not OT because they can't tell me off hand what cardiac enzymes are indicative an MI, or at what INR level a pt. is not safe to be out of bed, or how about tell me if it is safe for a pt. with a ventric. drain to get up and out of bed. Yes we are both OT's, yes we do very different work and treat very different types of pt's...but that is the beauty of being an OT!!! And if you complain one more time that you just can't seem to figure out how to use our spreadsheet I swear I will shake you....I'm sorry, someone who can construct one of the most difficult and intricate dynamic splint and then type a protocol/exercise program can surely add or delete a pt. from a spreadsheet....seriously there is one button you need to remember!

What a day. I hope that tomorrow is better.