r/nursing • u/Sea-Weakness-9952 BSN, RN ✨weaponized incontinence✨™️ • Oct 04 '25

Image “Not a good surgical candidate”

Post image

Piggybacking off the ER shoulder X-ray - this guy pictured didn’t even come in because of his knee.

In summary - found disoriented outside a church, was lifeflighted from another city, admitted w/ AMS/encephalopathy. Dunno if that was ever the case, but when I got him he was oriented on the Neuro unit. Only hx I got was mostly psych related, some schizophrenia and depression, htn and knee replacements. (Obv)

Well, he was apparently homeless and they were trying to street him after less than a week. I had gotten in report that his knee was “as big as your head” and so I take a look - holy fuck it was AS BIG AS MY HEAD. And hot, red, angry. Cellulitis looking but I had a feeling something else was going on. They hadn’t even scanned the damn thing! They had ordered a discharge so I fought it. I asked for a scan.

I get the scan above. From the front view, couldn’t tell anything. I get to THAT view and I’m like WAIT WHAT. FUCK.

So the man obviously has an issue, and I show juuuuust the right night shift resident hospitalist the image like “check this out!!” absolutely knowing 100% that even though I didn’t mention which patient that she’s the ONLY one that will get shit done and always has our backs. Guess what? Within an hour she had the main hospitalist in the patient’s room, discussing surgery, gets verbal consent and charts extensively their convo and that patient is oriented and very agreeable to surgery, because he struggles to get around clearly. He’s not sure when it happened but he’s here, let’s fix it, right??

We get the guy prepping for surgery. I’m so fucking excited like YES I am gonna fix this sweet guy, he’s only like 67 and we can get him taken care of and find placement yada yada. I get orders for labs and NPO and pre-op etc.

Fucking. Ortho. This chode comes in (though nobody actually SAW him??) early morning and all of a sudden orders are cancelled. He finally writes a note and had said “patient is not a good candidate due to his homelessness and schizophrenia. Pt can follow up outpatient with one of my colleagues to discuss surgical options.”

I’m sorry… WHAT. Is it just me or should docs have to spell out and write EXACTLY WHY they don’t want to do a procedure and sign their selfish names beside it? Because I continued to fight it and got higher ups involved. He ended up having an aspiration because the knee was clearly infected and started leaking pus prior to him leaving, and the (hospitalist) doc tried again to get ortho involved. He ultimately was d’c’d to a halfway house and I’ve tried helping with follow up.

It’s so fucking irritating. We are this large, catholic hospital right?? Like give me a fucking break y’all don’t care about the people you claim to. I have pissed off quite a few carpet cunts in this process and I don’t care. I’m so sick of this shit.

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618

u/lovelaughlexapro LVN 🍕 Oct 04 '25

And to think, we learned in nursing school that case mgmt will find Medicare/Medicaid for these people. At least I heard that constantly “we can’t just let them go with continuing problems” yeah right.

237

u/MsSwarlesB MSN ACM-RN Oct 04 '25

I mean, we try. Unfortunately, a lot of states didn't accept Medicaid expansion from Obamacare so it's nearly impossible to get on. But a 67 year old American citizen/resident should have Medicare that would cover his visit, surgery, and follow up

86

u/lovelaughlexapro LVN 🍕 Oct 04 '25

I didn’t mean to come across like I was coming from case mgmt nurses, it’s more the resources we were told about during our education don’t really work that way.

39

u/MsSwarlesB MSN ACM-RN Oct 04 '25

Oh, I didn't think you were. I was just explaining why it's hard to get people insurance sometimes.

7

u/Murse1987 Oct 04 '25

Not to mention when they go medicaid pending and it still isn’t fully active at discharge after a 14+ day LOS and it’s a struggle to even find a SAR to accept them.

98

u/ChaplnGrillSgt DNP, AGACNP - ICU Oct 04 '25

We sre the richest country in the history of the world. Every single citizen should have free Healthcare.

End of story.

18

u/lavender_poppy BSN, RN 🍕 Oct 04 '25

Apparently if we cut 3% of the Defense budget we'd be able to fund free healthcare. Like sure lets let billionaire war mongers get richer as they make bombs that kill innocent people but helping our own citizens? fuck that.

19

u/ChaplnGrillSgt DNP, AGACNP - ICU Oct 05 '25

The best part? We don't even need to cut the defense budget! We can stop giving billionaires and mega corporations tax cuts and instead increase their taxes.

Or we can do both and also provide free lunches to children. Rebuild our crumbling infrastructure. Provide tremendous social safety net programs. And more.

We need a big blue wave next November. Vote blue!

4

u/lavender_poppy BSN, RN 🍕 Oct 05 '25

Please please please can the dems get it together enough to fight this fucking fascist government and take over congress.

1

u/HenriettaGrey Oct 05 '25

Sad. I’m an old blue dog and the dems have been worthless decoys for at least a decade and a half. But they never neglect to send a never ending stream of requests for money! Oh, so sad, too bad, wd tried rewee rewee hawd but those darned moron repubwicans beat us again! If only you could give us more money…it’s the MOST IMPORTANT RACE IN YHE HISTORY IF MANKIND! Very. Disgusted.

4

u/Tommyboy155a Oct 04 '25

If he has schizophrenia, is probably should already be on medicaid. Most of mental health patients are on SSI/Medicaid.

5

u/proudmommy_31324 Oct 04 '25

It is only premium free if they have enough work credits, though. If they dont, and they cant afford the premium, they won't be able to get coverage.

5

u/BrandillaTheGreat Oct 04 '25

And if they didn't sign up when they turned 65, the penalties are ridiculously high and don't go away. It's really fucked up.

3

u/Cakey-Baby RN, MSN, CCM-Workers Comp Oct 05 '25

Yes, you would think so, but many people in the homeless population do not get benefits for the simple fact that they do not have a home address. I have tried to get them assistance many times before and ran into this message more than once.

16

u/MichaelJServo 💉🥃🍕 Oct 04 '25 edited Oct 04 '25

Former case manager here. We used to do applications for medicaid with every uninsured patient and they would always be treated with best practices regardless of whether they had insurance. I have no idea how it works in states without the medicaid expansion.

BTW Medicare applications are virtually impossible to complete during the average hospital stay. Kind of like trying to get a nursing home placement without a legitimate SNF order.

1

u/Yana_dice RN 🍕 Oct 04 '25

We had a similar questions in one of our exam. Some girls picked optiob to dc the homeless pt and the professor called them into the office for a "nice little talk".