Capitulation

-or- not so sweet surrender

Published on February 1, 2007 By BlueDev In Misc

Rolling over and playing dead.

It is a survival mechanism that has been around for centuries. Convince the predator you are dead, no longer a threat, and there is a chance they will leave you alone. It ain't survival of the fittest. It's survival of the limpest.

It's no different in medicine. With some patients, all you can do is play dead. Case in point: a patient I had this week.

She had a pretty minor surgery. It was a procedure that, normally, would have been outpatient. Do the job, send her home a couple of hours later with some Percocet and have her come back in a month. But not this patient. She has had numerous procedures in the past, and her abdomen is most definitely not normal. Anatomically, she is one of those who isn't going to be completely normal in the post-operative period. So she spends the night.

Or at least that was the plan.

Her procedure was last Friday. Saturday I round on her in the morning, with the thought in my head that she is going home. So I advance her diet, get rid of her IV narcotics, start her on oral pain meds, order her foley catheter removed, etc. All the things you do to get someone out of here. But she knows the game. She has been around enough she knows what to say to not have to go home.

So she does. She says all the right things. She stays. Sunday, it's the same story. Monday, more of the same. The nurses are going crazy (she isn't the easiest to take care of), they want us to force her out the door. So I pull her nurse aside and share a little secret.

This patient, if you start to force her out the door, will make your life miserable. She has the power. She will bug the nurse all day and all night, who will then bug me (because they can be vindictive like that - but that is another blog). It will become a never-ending cycle. So just roll over and play dead, I tell her. She will go home when she is ready to go home. She may still need a nudge, but when she is ready, she will make it out of here.

In the end, we just capitulate. It is the only way to come through it with our sanity intact.

Comments

DrDonald

on Feb 01, 2007

I agree. The patient needs to know the financial risk of accepting additional in-hospital care vs. visiting her family doctor or going to the hospital outpatient clinic a couple of times per week. Once aware of the risks, a person will usually make the sensible decision. You can even quote the daily basic rates ...usually quite a bit of a shocker.

I respect your general attitude, though, of avoiding the frustration of trying to control the uncontrollable.

SanChonino

on Feb 01, 2007

Heh. That sounds like less-than-fun. But . . . at least you know how to deal with people like that.

And hopefully the nurse will be wise enough to take your advice.

dynamaso

on Feb 01, 2007

See, in Australia, the patient would have been told, prior to their admittance, just how long they would be staying in the bed, barring complications. Of course, the hospital still does get patients who want the extra attention or the bed rest while being cared for. Capitulation is not a great line to take, but I understand why you do it. Most of use have to, at some point or another.

BlueDev

on Feb 01, 2007

You've done the right thing, Doctor. Unfortunately, in these days of HMO's, it's not likely to win you any friends upstairs in the accounting department. And if she truly is malingering without reason, she's in for a rude awakening herself when she gets the bills her insurance has refused to pay.

In this case, I think it was the best thing to do. I didn't enjoy doing it honestly, but I think it was the right solution.

I respect your general attitude, though, of avoiding the frustration of trying to control the uncontrollable.

Some days you just have to roll with the punches.

And hopefully the nurse will be wise enough to take your advice.

They did, and it all turned out fine in the end. But boy, it was nice when the patient left.

We usually try to do that as well. Of course, you just never can predict with 100% accuracy how someone will react to the procedure, or what exactly will happen. So you run into snags. But you get through them the best way you can.

Zoologist03

on Feb 01, 2007

Rolling over and playing dead.It is a survival mechanism that has been around for centuries. Convince the predator you are dead, no longer a threat, and there is a chance they will leave you alone. It ain't survival of the fittest. It's survival of the limpest.

Unless of course you happen upon a predator that's pretty hungry and doesn't care if you're fresh or rotten, just that you're made of food.

~Zoo

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