The Discharge

Discharging patients can seem like a happy task for a nurse, you get to send patients home who have been hospitalized and more often or not have experienced the worse time of their life (excluding those who received elective surgeries). when we discharge a patient, it is typically because the doctor has deemed the patient medically stable to leave the hospital (other than those who left AMA-against medical advice). Sometimes, discharging can be a breeze and one less patient off your plate, however, most of the time I find discharging patients stress-inducing. 

The other day I discharged a patient who has been in the hospital for months and is finally heading home, yet I know the patient and her family have a long and tiresome road to recovery. I have discharge enough patients to know that there are some typical items to complete prior to the patient's discharge - follow-up appointments, medication list, post-surgical/medical care, emergency precautions, caregiver teaching, referrals...the list goes on. we thought we were thorough, but really it was just a checklist to check off. 

I brought in the discharge instruction to go through the paperwork, at the corner of my eyes there was another thick stack of paperwork. The daughter was clearly frazzled and overwhelmed by the information; afraid to miss any detail. When a patient is hospitalized, the caregivers hand over their loved one to us, the professionals, but when a patient is discharged, we hand over the baton back to the caregiver. The burden is unimaginable, for us to expect that they have the knowledge to care for a fragile human being.  Not to mention that sometimes patients are discharged with lesser health conditions than they were before getting hospitalized, even if we have medically treated them.

When I was going through the paperwork with the daughter, she kept asking me "so they will contact me, or should I contact them? who should I contact if this or that happens?". Other than the nursing knowledge I can provide, for the logistical questions, I found myself repeating the same answer, "you should ask your doctor, call this number". The truth is, I've only taken care of the patient for 2 days, I haven't followed through the whole hospital course to answer these questions and I had hope that the number would be the answer to all of her questions. Most likely someone at some point has discussed the questions she has to the patient or family, but with all the information given to them, it is impossible to remember everything. After all, it takes the whole discipline to manage and care for this patient and all that responsibility is put in the caregiver's hands. 

While some might think, "well, what about the primary care provider?". The reality is that it is often time still the caregiver's responsibility to initiate contact and advocate for the patient when care is not met. While I remain hopeful that there are roles such as care coordinator, social worker, home health services that help relieve burdens and covers the care gap that caregivers may have, nevertheless, everything else inevitably falls to caregivers. 

I ran to the patient board and looked up the daughter's number. "Wendy, I forgot to mention that you should pick up your medication at the pharmacy before you drive home". 

Relieved that she won't have to drive back an hour just to pick up the medications, I head to my 2 other patients with more lists to check off for the remainder of the shift. 

note to reader: this post does not represent all the experiences people have, and this is a reflection of a particular event through my experience and perspective.