I'm sitting in a hospital bed tonight after my first chemo injection and I have nothing to do. So let's play a game of AITA.
Before I checked in, I had already decided to make a nuisance of myself over two things. The first is that I wanted to wear my street clothes instead of the dumb hospital gown. To my surprise, that was no problem. They didn't care.
The second was bound to be more contentious: I also didn't want an IV line installed. They're magnets for infection—and a pain in the ass—and none of my meds were going to be administered via IV. Nor did my case require a constant saline drip.
Needless to say, the nurse objected. The nurse's boss objected. The doctor objected. Procedure demanded a peripheral IV line. Beyond that, their case was simple: I was here under observation because the chemo meds can have severe side effects. If that happened, they wanted the IV line ready to go. My case was also simple: If anything goes wrong, you can install an IV in two minutes, which is faster than you can get drugs from the pharmacy. There was no danger in waiting.
To my surprise (again) I also won this argument—with a stipulation that if there were any problems I wouldn't object to the IV line. Naturally I agreed with that.
All that said, I understand that maybe I was being an asshole.¹ What do you think? AITA?
¹Despite this, I'm the nurses' favorite! This is only partly due to my natural charm and mostly due to the fact that I'm alive and friendly while practically everyone else on my floor is old and all but comatose.
One should never feel guilty about or second guess self-advocating, and when dealing with medical-industrial complex, is also simple common sense.
Seems reasonable to me. I don't believe that people should ignore the recommendations of trained medical professionals lightly, but at the same time, I've been around health care enough to know that not everything in standard of care came down on stone tablets.
It's ok to question and even direct your care as long as you know your limitations and listen to their arguments.
IV ports are torture. IV lines make it just about impossible to sleep, and you need sleep. Nurse, I need sleep!!! And if they do start pumping something into you, the pump grinds maddeningly all night. Grinds, that is, when it’s not beeping after an occluded line malfunction. Goes like, nurse starts the pump then leaves, Twenty minutes later, beep beep beep… occluded line. Beeps for a half hour, or longer, rarely shorter, before the nurse comes in to restart the pump. Over and over for your entire stay. Actual, honest to God torture.
Good docs listen to their patients, and can tell them what the parameters of good decisions are, rather than decide for them.
In my experience as a cancer patient, I've overridden my docs with regard to treatment every time (three different cancers), and it always worked out well. Standard operating procedure is usually wrong if you are non-standard in some way. So make your own decisions.
What you described sounds quite reasonable.
The footnote probably gives a big hint about why they ended up going your way with the IV line-- they know you're not one of the ones who's fighting everything every step of the way and throwing garbage reasons at them, but that you're overall on the side of getting effective treatment and have thought things through in terms *that make sense to them*. The trick there is being persistent enough that somebody with enough authority will sign off, without being confrontational or accusatory.
A long time ago I was set for outpatient hand surgery in our town's hospital, which would be strictly local anesthetic, and found myself that morning on a gurney with people around me talking in ways that didn't compute. I kept asking if they were sure about this, and it turned out I was in the line for generals. Luckily they took my questions seriously and when they went back over the orders they found that a sheet in the paper stack was misaligned and the typed X ended up on the wrong line. They were embarrassed enough to apologize *and* give me that long explanation as they wheeled me into the right areas.
My guess is that they only figured this out after they checked with the surgeon, who must have given a double-take and barked something like "what? who orders a general for a 10-minute hand procedure? are you kidding me?" But that's what I'd have gotten if I hadn't kept asking. So no, you're not the a-hole. It'd be a different story if you were acting like one, but there's no chance of that.
PS: You probably have good veins too, and that would have helped your case
Someone who has a seizure from experiencing surgery. Better to have everyone there than have an emergency while trying to do the procedure.
Unless they have the medicine there on the bedside, or an IV on you specifically would take longer than the meds' arrival, yeah.
Of course, with me, they're risking a seizure to install a line at all.
There's a "crash cart" with emergency medications in each hospital area, so it would actually take less than a minute to have emergency medications available. In a cardiac emergency, it's a lot harder to get a line into you.
As you correctly pointed out, you having an IV ready to go was for the staff’s convenience, not yours. It’s your body and they were right to honor your request
Nope. You're being rational, Kevin. Lots of SOP is just leftover practices that have been grandfathered in. There's been a spate of articles about it recently, too.
Kevin, I think you were being totally reasonable. I hope the time there passes quickly.
Not an asshole.
Even as costs for medical care go up; the unnecessary care we get -- like the drip line in place -- are hardly ever questioned. My 88-year old mother would, if her providers had their way -- be going off to two or three appointments a week, some weeks more -- when all she really needs is care for her macular degeneration. With only a small amount of encouragement, she began saying no to the excessive visits, and she's happier for it.
So no, you are not being an asshole. And if more of us spoke up and said no to unnecessary medical treatments, it would be a very good change.
If nature wanted you to have an IV line installed it would already be there.
No Assholes Here*.
* Of course, we're only getting your side of the story. So.
The dirty secret of our elder care industry is that dehydration is the first indicator of senior neglect. Many elderly patients end up in the hospital for non-specific complaints and then miraculously get better when rehydrated with a saline drip and fed a good meal.
Doctors cover for nursing homes by making saline drips routine.
Oh no, not the AH. I work in a hospital in a non-clinical role but have a lot of experience with patient complaints and staff communication issues. The definition of patient autonomy in the medical ethics literature is the right to choose among medically indicated treatment options, and refuse the ones you don't want.
People often don't understand that autonomy (in medical ethics) doesn't mean I can choose whatever treatments I want- a positive right- it means I can refuse treatments I don't want- it's a negative right.
There are two bad options and one good option when two parties draw conflicting conclusions. The two bad options are to impulsively adopt or impulsively reject the conflicting conclusion. The one good option is to be skeptical. Ultimately, both bad options require more effort to have a negative impact, and the one good option requires less effort to have a positive impact. The only variable is the magnitude of the impact.
Translation: Kevin, the nurses, the doctor, and the Harris-Walz campaign are all wise, aka non-assholes, but we can't say the same about the Republican party, Republican voters, voters who don't vote, most of the MSM, the chief justice of the most powerful nation on Earth, etc.
The one exception is when you need to neutralize an imminent threat that is real in lieu of imagined.
I'm laminating this post for the next time I have to be under the care of professionals. Most of my team of "...ologists" is made up of thoughtful Dr's, and nurses. There are some however who are "by the book". And some who's last foray into medical research was decades ago. Anyway good for you. Stay strong.
Tough call, it's semi-free hydration, kind of like a top off.
Definitely on your side, Kevin. I was recently an inpatient (major surgery—all is well) and developed one key practice: wear a sleep mask so when the parade of overnight interruptions proceeds, the automatic turning on of the overhead fluorescent lights is much less bothersome and it’s much easier to fall back asleep. Why hospitals have never heard of headlamps is beyond me.
Given my experience, pushback against actions which they can't easily justify - like a default, inactive IV - is fine.
I used to give medical institutions the benefit of the doubt, until I showed up as requested at Bldg 2 for a rectal ultrasound, was told they had no record of anyone with my name having an appointment, and that I should walk 1/4 mile to Bldg 5, which had no receptionist.
While searching building 5, I received a frantic phone call from Bldg 2 asking where I was, so I walked another 1/4 mile back to Bldg 2 - a clerk had switched my middle and last names.
In prep, a nurse asked me which end they would be scoping. Later, as they were wheeling me into the room for the procedure, I was asked, again, which end they would be inserting the scope, since "We wheel you into the room one way for the throat, the other way for the rectum."
They then wheeled me into the room the wrong way, and had to back out and turn me around in the hallway.
The last time I was in hospital, I was probably asked twenty times what my name was, what my birthdate was, and why I was there. The hospital staff was extremely determined to be sure that they had the right patient and the right procedure before administering anesthetic.
Same - I'm fine with teling them my name and birthday every few minutes.
In this case, they were asking which end the scope was going in because they did not know the answer, and they still screwed it up when wheeling me into the theater.
Your request was reasonable but you may have been accepting risk you didnt know about. Not everyone is good at starting an IV. The day staff may have had more competent people. The night shift may have had fewer, sometimes just one person, who is really any good at the procedure. They may not have been willing to tell you this since they wouldn't want to admit it's an issue. If your expected problem was not one that was expected to have a rapid onset then they weren't going to fight you knowing they could likely find someone eventually. If your veins are good it's not such an issue but if they are not it is.
Steve
You can refuse whatever you want, but if shit goes sideways and you don't have a line, that means people are going to be trying to get a line anywhere and they're not going to be as concerned about procedure as they would if they have time to find a vein without an actual emergency ongoing. So there's an increase in chance of infection.
If they can't get a line after a few attempts, they will start an intra-osseous line, into your bone. That requires a drill.
Not to mention, while you're having that emergency, you aren't receiving IV drugs through an IV that might mitigate any brain damage from lack of blood and oxygen.
So, you do you. You aren't being an asshole. You're just making it harder for everyone if an emergency situation occurs.
There's a reason everyone there wanted you to have an existing line. Saving your life and mitigating brain damage are the top two. It's not just to increase your chance of infection and to annoy you.
Until you address the part about why the meds arrive from the pharmacy faster than the iv can be installed, you're just trolling.
I'm a registered nurse who works in the emergency department. I'm not "trolling". In an emergency, we're not waiting for drugs from a pharmacy, we have them a few feet away.
But you know what isn't almost instantaneous? Starting an IV. Not everyone has nice easy-to-access veins. If a patient has had chemo treatments through an IV in the past, that almost always makes them a more difficult stick. Not to mention, if shit goes bad, you're going to be getting multiple IV lines. Not just to troll the patient, because we're trying to keep you fucking alive.
The best time to figure out that a patient is a hard stick and will require more time to start an IV is BEFORE they need an IV for life-saving treatment. And that is determined, when, uh, WE START THE IV. We like to do have this taken care of BEFORE an emergency.
Kevin specifically stated that the reason for the IV is due to "the chemo meds can have severe side effects. If that happened, they wanted the IV line ready to go".
So right off the bat, what I said matches, exactly what every single RN and MD told Kevin. You can pretend to know what you're talking about, but I don't have to pretend.
If shit goes bad (which is why Kevin was, uh, in the hospital) and you're having an anaphylactic reaction or cardiac arrest, every second you're not getting medications to mitigate you either losing your airway or being dead, is costing you brain tissue.
If Kevin started going into shock and needed to be intubated, we need to give a sedative and a paralytic agent as soon as possible to place an ET tube.
THROUGH AN IV.
If Kevin goes into cardiac arrest, we need to give Epi and other cardiac arrest drugs ASAP.
THROUGH AN IV.
This is why every single clinical person wanted Kevin to get an IV.
Not because we're "trolling" or whatever the fuck you think we're doing.
It's so we can do our job better to help the patient.
You want to not wear a gown? We don't care.
You don't want an IV? Sure, "advocate for yourself". You can refuse any treatment you want.
But let's be clear, you're just increasing your own risk of adverse outcomes for the very thing YOU'RE IN THE HOSPITAL FOR.
Yikes.
This!
The nurses like you because you had a logical reason for your objection, and seemed to understand the need for speed when and if the time comes.
Also, you probably weren't demeaning or abusive. All plusses.
I'm married to a nurse. A patient like you is likely to get better outcomes because you understand what's going on. She would like you too.
My wife, a retired cardiologist, offered another reason for the IV: insurance reimbursement rules. Some carriers will refuse inpatient reimbursement for "observation " if no IV is in place. Not sure how/whether that might have applied to your case, but hospitals do have to jump through some pretty strange hoops to get paid.
Seems reasonable to me. I prefer to be stuck multiple times than to have an IV left in.
The answer to the headline is yes, regardless of the rest of the post. The answer to the rest of the post is, it's impossible to say without actually being there because we don't know how these conversations actually went down and what the attitudes were of the people involved.
Not really an asshole, just a cranky old man.