When they moved my grandmother from the hospital to the rehabilitation center, the doctors and staff thought that taking her by ambulance was better than in my fathers car. If she has the isses of non-gag and corneal responses, wouldn't it be better to take her by transport.
I understand the families fear that she might die "in transport" but isn't it better to have medical staff on board then the family to deal with this on their own. I don't think they would be prepared to have her die on Their watch in their car.
I mean really would they really want that memory seared into their brains in that particular minivan - no I'm sure after that IF that happened, that the car would be redered a shrine and therefore useless, if she died on their transport. (or their watch) I would want to try to talk them out of this however carefully. If not then negotiate a middle ground settlement.
We know that family might be prepared to take over when it is time, but in realistic terms - is that really responsible and necessary.
I think they are trying to bite off more than they can chew - so to speak.
If they fear that the move might kill her, then maybe some of them can ride in the transport with them and they others can follow in the family car. I mean how much closer can you get than inside the truck and an outside vehicle. how much family does it take to transport a patient from point A to point B.
I can understand the fear of the family loosing the patient, but I think it isn't very wise to have these kinds of demands, although i understand completely, because we did this twice for my father's parents. Both times I had to travel with them to make sure they got there and that my father did not collapse. (which he eventually did).
I think it would be wise for a medical - counselor to try and talk to them and take care of the fears and try to negotiate some middle ground as in the ride along/follow transport. If the wishes are set on paper, and the family is willing to work with the hospital staff to make sure she gets home in one piece - alive.
I would say go with the ambulance . It seems likely that she would do better in the ambulance.
I liked what Jeremy said very much. The thing is, what we think we want and can handle, and what actually happens, is often not what we can manage. I'm thinking of the whole trauma thing for both the patient and the loved ones.
Ambulance. Definitely.
Is it a long drive? That does have a little impact in my mind. I'd say home in the van if they are so adament about it that her journey home is being delayed. Is the hospital willing / able to help the family plan how this is going to happen so the family is more prepared than just tumbling her around and hoping the doesn't hit the ground? In doing that the hospital might be able to help the family understand how tough this will be.
I'd find out if it would be possible to get family to ride along in the ambulance and describe in great detail the chances of her passing in the car compared to those of her passing in an ambulance.
I also might suggest that the family rent a full-sized wheelchair-capable van for the day, then a whole bunch of family could ride along and there wouldn't be the problem of loading. I bet you can rent those things somewhere.
I think the minivan would be the worst possible solution - the patient would be uncomfortable and likely in a lot of pain, not only from the ride but loading and unloading.
In similar situations that I know of, family members were invited to ride along in the ambulance
There may be some unknowable reason behind it if the patient dies while in transport... she may somehow want to spare her family the logistical problems posed if she were to expire at home.
Perhaps she will die before even leaving the hopsital, secretly solving the family's conundrum.
Stranger things have happened.
My sisters and i handled a similar situation. my mother was suffering from pancreatic cancer. it spread very quickly to the organs, so not much they could do. she was tired of hospitals, tests and probing. she wanted to go home. period.
i was living with her, so i had a huge responsibility. we had hospice help, which i thank god for, but it was quite a trial to care for someone at home. if my sisters weren't there to help take shifts, i couldn't have done it.
i, normally, suffer from depression, although medicated. there were 3 times during that time that i had nervous breakdowns. i had to stay home and be strong, so no time for my grief.
i watched her degrade, stop eating entirely and we moved to diapers since she couldn't stand well enough to get to the bedside pot. (i found this out when i tried to help her one time and her legs gave out and i dropped her gently, injuring my back in the process. had my friend not been there, i couldn't have gotten off the floor. so, on with the back brace, and continue on.
my mother died about six weeks after coming home. i was with her. the death rattle was chilling. my mind hasn't been as sharp, ever since.
i think we go through the same thing, in these situations. i was terrified that i was doing the wrong things, nervous about administering many meds, changing her diaper (this caused much pain to her.) but i would emphatically do it all again.
it was a gift that i could spend this short time with her. she felt comfort, i could tell, even when she couldn't talk anymore.
when she passed away, i called my sisters and my dad. we were able to spend our time with her in our childhood house, on our terms. i waited a little before calling hospice. we cried and sat and talked with my mom still there, while we waited for the hospice nurse to come.
i loved my mother dearly, and whatever it took to make her comfortable and free of the hospital setting was appropriate.
above all, i think that if the patient wants to be home, please oblige if you can. it's hard as hell, confusing, tiring and sometimes frightening. but this isn't about you.
my mother died at home, where she wanted to be, where she belonged. i remembering her thanking me even after giving her the meds she hated. she was strong and beautiful, and i hope i can have the same dignity when my time comes.
i realized i didn't comment on the ambulance ride. i'd say yes. my mother was transported a number of times this way, and that was the best. it would be to hard, imo, to do it yourself, plus, take into account the comfort of the patient.
If the patient is not conscious or aware in any way, the issue is with the family members and the potential they may have to face a medical crisis or terminal event without being prepared. As is mentioned, it might be a horror for them. This might be mitigated to some extent by frank lectures on what can happen, what symptoms might present, and what they mean. Caring for the family and their wishes in this case, after the patient is beyond hope and beyond awareness, seems more important than the strict medical ethics questions.
of course, with ambulance. it's fast and comfortable, better than minivan
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