December 26, 2007

Losing Patients

Posted in Journal tagged , , , , , , at 10:39 pm by Jenn

One thing I’ve never blogged about are my patients.   Today is the day I change that. 

Last week I logged in to my email and there was a notice that I had a message in my MySpace account.  Since I started blogging I haven’t really been keeping “my space” updated”.  I logged on and there it was titled “RIP”.  The message was from one of my dialysis patients back in NC.  Here it was two days before Christmas Eve and I’m staring at a message titled “RIP”.  I hesitated, then I clicked.

Inside were the simple words “Wilbur Chadburn 1970-2007* .  I cried.   

Wilbur like so many patients had been given the title “Non Compliant”.  Sure he should have come for treatment 3 times per week, but chose to come 1 time if a tech he liked was working to put him on the machine, sometimes he’d go 10-13 days without treatment.  Sure he ate what he wanted regardless of what it was doing to his body.  Sure he would fill his prescriptions once every 18 months even though the prescription should be filled monthly, but does he deserve the brand “Non Compliant”?  I don’t think so. 

Why not “Non Compliant”?  How many of you follow your doctor’s orders word for word?  Do YOU exercise 30 minutes a day, everyday?  Do YOU eat 5-9 serving of fruits and vegetables everyday?  Do YOU brush AND floss your teeth daily?  Do YOU take your antibiotics until they are gone?  Are you “Non Compliant” or are you simply human?

Working with the dialysis patient population is challenging.  These patients follow the most restrictive of any diet.  Limited fluids, limited sodium, limited phosphorus, limited potassium.  Naturally with so many limitations they think they can’t eat anything, and who can blame them.  Truth is that they can eat many things, and they can be tasty.  That’s the role of the Registered Dietitian and that is what I loved about my job…giving someone who had given up hope, the desire to eat and enjoy food again. 

Prior to working with dialysis patients I worked in Oncology.  I found personal satisfaction helping patients manage their symptoms, by altering their dietary intake, I loved helping people to rediscover food during their illness and I loved teaching patients how to feed themselves via a feeding tube so that they could remain nutritionally sound during their chemo/radiation treatment and greatly improve their clinical outcome.  These few minutes a day made all the difference to the patients and their families and that is what is was all about.  Life, and the QUALITY of that life. 

Dialysis patients are often referred to as “the walking dead”.  How horrible!  We are all since the day we are born dying, so why the need for labels.  Why can’t we just accept that some people have more challenges in their lives day to day and be done with it.  Let’s do away with the labels and start caring more for one another.   Now that’s a reason for living.

Someone asked me recently how I could stand working with patients who were so ill … my reply to that person, “wouldn’t you want someone who wanted to work, to care for you in your time of need?” 

SO for all the Wilbur Chadburn’s out there, my wish for you in 2008 is a year of education, health and happiness.  I urge you to partner in your healthcare, ask questions of your provider and most importantly be comfortable with your provider.

To all the doctors, nurses, techs, assistants, out there, STOP, before you label another patient, take a close look at yourself.  Have you given each patient the treatment that you would want given to you?  If you need to resort to labels, perhaps it’s time to refer the patient to a provider who may be able to help them.

I’m going to get off my soapbox now.  I just needed to get that off my chest.  Seeing that death notice really struck a nerve with me and made me realize just how much I miss patient care. 

 *name changed  



  1. Carola said,

    Geeze, you’re a dietitian. I need you.

    I recognize a lot of what’s said in your post about non compliants. Gosh, it’s hard to do what you’re supposed to do when you’re on a diet. Not being able to eat what I want makes me rebellious. Who suffers? Me…

    I’m type 2 diabetic, and overweight and well, I need to be more careful with what I eat, exercise more etc.

    Move to Sweden, and kick my a**?

  2. Mom said,

    It is always sad to lose a patient-we have lost three during the holiday season. One young and 2 older but it is not easy anyway. It is nice to know that there are people who truly care about their patients as real friends. Sometimes they respond to that with amazing results. It is hard for most of us to look deep inside!

  3. iowakitkat said,

    I’m on dialysis now and I can certainly relate to your post. Try as I might to be compliant, can’t seem to do it all all the time.

    And as terrible as the label “walking dead” might seem, it does make me realize that but for modern medicine and its miracles, I wouldn’t have celebrated Christmas with my son this year.

    I get moody and broody quite a bit, but I keep trying to remember to find something good about each day since each day is a gift to me.

  4. sjsmart said,

    Thank you so much for taking time to comment on this post.

    I realize that we ask a lot of patients to follow a renal diet, but you know, if you adhere to the diet most of the time then those times when you stray a LITTLE bit don’t matter quite as much.

    I wish you health and happiness in the new year and many more holidays with your son.

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