I usually don't talk about my work because of all the patient privacy rules and regulations. I can't ever figure out what one can say and what one can't say. So, to avoid any unintentional mishaps, I just don't say much about it. And I try not to think about what could have been, be it good or bad. Today though, the "what ifs" and "could've beens" have taken hold and I am so very upset that I have to say something or I feel like I will explode.
I've been seeing this one patient for over a year now. I see her every week like clockwork. We get along great. Actually, we adore one another. So, when something happens, it upsets me just as it would if it were my own grandparents. This patient’s spouse is still living, but the spouse tends to stay away when I'm there so I can whip the house into shape my own way. So, I don't have much experience with this particular spouse. I see this individual in passing, we exchange pleasantries and I go on about my business.
My patient has dropped hints before that everything may not be perfect. The spouse gets frustrated when the patient spends money, or goes to the ER. But, my patient has never indicated that anything was seriously amiss and I've never, having been there weekly for a year, felt any tinkling that anything was wrong.
Last week, my patient got up in the middle of the night and fell. The patient has huge bruises on the arm and was worried it might have been a mini-stroke. When I asked why the patient didn't go to the ER, the reply was that the spouse didn't want that to happen. I told the patient (I know "the patient" is getting annoying, but I'm trying hard to preserve anonymity here) that whether the spouse liked it or not didn't really matter. The patient needed to be checked out. The patient finally agreed and went to the neurologist yesterday. So, I felt moderately better about that.
But, when I got there today something just seemed off. The patient seemed really upset. We went into the bedroom and I was walking around the bed and noticed this rope- not twine, not cloth, but 2 inch thick rope- tied to the foot of the bed. I looked over at my patient and asked what the rope was for. The patient's eyes filled with tears and a mumbled "I don't know" whispered across the bed to me. My heart seized in my throat as I started scrambling to figure out how to get her to talk and what we needed to do. When something isn't right, you just know.
About that time someone knocked on the front door. It was opened and I heard my supervisor's cheery greeting. I sighed with relief when I heard her and plopped down on the bed next to my patient. My supervisor came in and I shot my patient a "either you bring up the elephant in the room or I will" look. My patient took a deep breath and told the story.
Apparently, the spouse put the rope there sometime between my visit Friday and today, with the intention of tying the patient to the bed. The patient hasn't been tied to the bed yet, but was terrified. And who could blame the patient? I’d have been terrified out of my mind were I to suspect that my spouse wanted to tie me to the bed at night and leave me there like that, by myself all night long.
While the spouse has always been pleasant to me, there have apparently been issues from the days before I started working with them and from what the patient said, the spouse has a temper and has a tendency to "beat" the dog and yell and scream at the patient when no one else is there.
All I could think as the story unfolded was my god, there are guns all over this house. Then, the fact that I had been there every week for over a year and never noticed anything just kept looming in front of me again and again.
We've called in adult protective services and a social worker. Hopefully we can convince the patient to leave. No one should have to live in fear in their own homes. Ever. Thankfully, things hadn't digressed to physical abuse. But that rope... that's a reality check of just what could have happened. Just because something seems peachy-keen doesn't mean it is. I can't believe it took seeing the fear in my patient's eyes and that massive rope tied around the leg of the bed to remind me of that.
I feel like I really let my patient down. I've gone over and over again every little conversation I've had with the spouse, every conversation I've had with the patient thinking, "Maybe I was just too stupid to see the signs." Did I miss something? I just don't know. But, I never would have suspected that things were as the patient described. Those hints just didn't seem like hints until staring at that rope today.
And the fact that no one else noticed anything off doesn't really make it any better. If anyone should have seen it, it was me. I was there. I talked to my patient, sat with my patient, worked beside my patient. Every week, for 16 months. My patient could have been seriously harmed and I feel responsible because I didn't see it coming and perhaps I should have.
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It's difficult to discern from your post whether your patient was elderly or not, but there are a staggering number of elderly abuse and neglect cases every year in the U.S. These cases almost always involve elderly people that have diminished mental or physical capabilities, that can't easily take care of themselves and are abused by their families or caregivers.
Common sense is as rare as genius. ~Emerson
okay, i know any comment that starts off with "once on an episode of..." is going to be hard to take seriously, but bear with me here.
once, on an episode of scrubs, a woman was admitted that had been found unconscious on the floor of her apartment, and no one really knew what had happened. she kept dropping hints that all was not well, but no one picked up on it until she was about to leave, realizing that she had in fact tried to kill herself and no one noticed.
i know it's not exactly similar, and certainly the timeframe is drastically different, but i think what i'm trying to say is that sometimes when you're really close to a situation, as seems to have been the case here, it's hard to step back and put pieces of a puzzle together, especially when you don't even realize there's a puzzle there. so while it's good to acknowledge that maybe (and it's a big maybe) you could've done something, i wouldn't be too hard on yourself. just keep it in mind for the future if anything seems iffy with another patient. lesson learned.
PS--the spouse is a total douchebag! sorry, i just had to get that out of my system.
--stacie
A friend of mine used to be a caregiver/social worker for disabled (usually mentally, sometimes also physically) people who lived independently, and one of her clients had what was believed to be a seizure and heart attack caused by a pill overdose two days before a psychiatric appointment to evaluate his progress.
At the time she had more than the legal caseload of clients and didn't have time to check on everyone every day. This particular client hadn't used his credit card to buy groceries, though she knew he was supposed to. Alarms went off that he might miss his check-up appointment, so she went to visit the morning of his appointment. She walked in to find him laying on the floor, dead, where he had been for more than 48 hours.
The point is, it doesn't matter how many signs you do or don't see-- it's still not your fault, and chances are, if you feel guilty about it, no one else would have seen it coming, either. The important thing is to get back on the horse.
AS a health professionaltheses things happen. It is not when you figure it out but what you do about it. It seems that you and your supervisor did the right thing.You wouldn't believe how many people would have ignoed it or decided it wasn't there place. I myself am a nurse with some home patients and you never know what you are walking in to.
I love because i want to loved not to be judged!