Nursing Rounds

For the Spring 2022 issue of the magazine, we featured three MSU College of Nursing faculty members. They highlight the toughest patient cases they've been a part of.

Mary Chenge, Assistant Professor: I had a frail elderly patient with an advanced life-threatening condition who couldn’t make their own medical decisions due to altered mental status and the family who had durable power of attorney (DPOA) rights were refusing palliative care consult.

It was sad to see this patient suffer because family was pursuing aggressive treatment without understanding the patient’s quality of life was compromised. Also, due to visitor restrictions during COVID, family was unable to see firsthand how hard their loved one was fighting. The patient kept asking to “go to heaven” but family kept insisting the patient didn’t know what they were saying.

This family signed off from palliative care after the first visit because they assumed it meant withholding treatment. The family would’ve benefited from palliative care which assists in addressing goals of care for patients with life-threatening conditions.

There’s need for providers to start talking about palliative care with patients and families right from when a lifethreatening diagnosis is made so patients and families make informed decisions toward end of life.

 

Jaime Croley, Assistant Instructor: When I was a case manager and cystic fibrosis coordinator about three or four years ago, I was caring for a 15-year-old cystic fibrosis patient and that patient’s lungs had an infection of influenza.

That patient lost half of their lung function, which put them into a transplant category. Their lung function was down in the high teens to low twenties, which is criteria to start talking about transplant.

With this particular patient, I had grown very fond of and cared for the last eight years. In parallel with the mom, we both said they should look at a transplant to buy you some extra time because we don’t want to selfishly lose you right now. It was a hard and difficult situation, but traumatic growth grew from that.

That patient had been fighting all their years up into that point. That patient was scared about the possibility of not making it through the transplant surgery and life expectancy was only an extra five years. The pain of the surgery, the possibility of dying during the surgery, and there wasn’t a guarantee on the other end.

That patient decided to go ahead and forgo transplant and end all treatments. They had spent the last few days choosing their breath. I learned a lot including quality over quantity. I also thought I was always patient centered, and that moment made me even more pivotally patient centered.

I definitely cultivated a strong philosophy that I am a medical advocate and a medical guide, but they’re in the lead. It is their path, their choice. If you have a moral or ethical dilemma then you must pull your own ethics out of it. That was really challenging.

 

Jay Gottschalk, Instructor: A patient was struggling with her mental health and, while we were treating her, she lost her job and health insurance. She had too much money to be eligible for Medicaid, was too young for Medicare, and struggled for months to find employment that had insurance.

We had worked with her previously to find the combination of medications and therapy that would best help her, but she could no longer afford either the medication or the therapy. We made referrals to our team of social workers and financial navigators and finally were able to get the patient on an insurance plan that she could afford. However, that insurance plan did not cover the mental health medications the patient had been taking and had expensive premiums and a high deductible that meant the patient had to transition to treatment that was less effective at treating her symptoms. It took over a year for the patient to finally find a position where she got somewhat better insurance and enough money that she could again afford her original, more effective medication.

This is not only a reminder of the many gaps that still exist in getting people the health care coverage they need, but also our need to collaborate with other members of the health care team to help people get access to the resources they need to achieve their wellness goals.