Request today all medical once again
Mom calling for her adult son, with history of pancreatic and kidney failure and a history of transplants, on dialysis for the rest of his life, and just suffered a stroke 2 weeks ago. After the ER went to post acute care (SNF) and apparently checked himself out ama after a few days
Paralyzed on right side of body from the stroke. Can’t get himself to the port o potty next to the couch he’s laying prone on. Can’t get food for himself, can’t even chew solid foods. Lives alone, mom and sis are visiting until tomorrow
Refusing to go to dialysis. Sister got him McDonald’s because it’s the only thing he’ll eat cutting it into the smallest bites she can because every bite is a choking hazard. His legs are swollen and his mom mentioned his testicles are huge. I told her yea he seems to have peripheral adema. Mom called fire department to check vitals before I got there. His blood sugar was over 400 and blood pressure over 180 about an hour before I got there. Fire department said they recommend he go to the ER to not die. He declined
The little he’s willing to talk he’s mentioning getting some in home health service coming. So I’m getting the idea that he’s not suicidal, just dumb to the point of not understanding how he’s not only on death’s door, but he’s been slamming the metal knocker knocking too
So I figure I know the answer to this and point blank ask him “do you want to live?” and he says yes. He’s not that engaged, didn’t even want my service, so I figure there’s no point in going round and round about why then he’s refusing dialysis and going to the ER. His mom and sister and fire department already covered that exhaustively with him and he wasn’t budging. He didn’t even want me talking to his family but wasn’t in any position to stop me
So his mom asks about forcing him to go to dialysis. That can’t be done. A person can refuse invasive medical procedures like chemo or dialysis without being considered suicidal, that’s their right. You can’t drag them to a medical treatment kicking and screaming
I told her your son reminds me of a client I had a long long time ago, probably 15 years ago. It was a guy around his age who had given himself some horrible infection in both legs from shooting heroin. His legs were covered with open sores seeping fluid, and swollen to twice their size. His family was desperately trying to get him to go to the ER but he also had declined fire department and going. It wasn’t because he wanted to die. He just had a very naive idea of what he needed, in his case it was to put his legs in sunlight from the window and take a multivitamin every day. And he thought that would heal him
So I said to her the same thing I told the other guy’s parents: all you can do at this point is watch him until he either goes into a stupor or unconscious, and call fire department back. An unconscious person cannot decline treatment anymore
And of course I called Adult protective services, and the supervisor called me back within a few hours, when normally their investigation takes 5 days. He was like “wow, this sounds really bad”. And I was like “yup, it is”. He said he can’t get out there till tomorrow, should he request a welfare check before then? I said sure, if he’s conscious he’ll decline any help but may as well try
Even if she can get him to the ER, he doesn’t want to continue taking the meds he needs to keep his body from rejecting his organ transplant. Or to go to dialysis. So she’s buying him a few days
This one is not long for the world. I give him at most a week or two. I was in a bit of a hurry to get out of there, expecting him to code at any moment. And I haven’t had to do CPR yet on a client….
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