Nurse Creates The Mother Lode of All Advance Directives.

Albany, NY -- Adrian Fleming knew all about the horrors that went on at her hospital everyday.  As a seasoned floor nurse at SunnyView Hospital for over 20 years, she had a front seat view of the face palms that threatened patient safety everyday. She also knew someday she would be a patient in her own hospital and with that fear in mind, set out to create the mother lode of all advance directives.

An advance directive is a written statement of a person's wishes regarding medical treatment created to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

Her advance directive began as a collection of wishes and prayers and fears written on the back of sticky notes and used napkins, the communication method of choice between doctors and nurses.  After her first year on the job, Adrian had a large collection of random demands, each meticulously notarized by the hospital chaplain for authenticity.

Over the years, her collection of requests grew into a 17 page hardback nonfiction book titled Nobody Is Ever In a Fu*king Vegetative State:  What You Should Really Include In Your Advance Directive, an Amazon Times best seller.

An advance directive nobody will ever miss.
Then tragedy struck.  After twenty years of caring for patients, Adrian found herself hospitalized in the ICU,  seriously injured after hitting a light pole trying to avoid a barely gowned patient that just left AMA to buy cigarettes at a gas station across the street from her hospital.

Luckily, Adrian had her advance directive with her at all times; a barcode tattoo on her wrist, where she knew all the nurses would place her numerous armbands.

Unresponsive and intubated, but not in a vegetative state, Adrian's new grad nurse working in the ICU for the first time because seven nurses quit the week before after being accepted into nurse anesthetist school, scanned her wrist before placing the first of her seven  Joint Commission mandated arm bands. And what she found was a treasure of information on how to care for Adrian in the hospital.

Up on her computer popped a message that started, "Think of this as my birth plan for my ICU stay. I can hear everything you're saying.  As your guiding force, if you're thinking 'I would never let that happen to me, then don't let it happen to me either.'"

Then page after page of medical directives started flowing from the computer, as if a damn had broken upstream and a river of knowledge was released on the newby.  All in all, 496 legally binding demands were laid out for all the medical staff to adhere to.  Here are the top 10.


1)  Don't let these surgeons operate on me Dr. XXXX, Dr. YYYY,  Dr. ZZZZ, Dr. XOXO, Dr XXY.   I don't care if they are the only ones on-call.  Transfer me AMA to another hospital if you have to (Names protected for publication).

2)  Don't even think about putting a Foley in me just because you don't wan't to clean me.  And that means no rectal tube either.  This is nonnegotiable.

3)  I don't want a CT scan to rule out shit that you and I both know I don't have if you just take the time to examine me.

4)  Don't put me on antibiotics because you can't tell if its CHF vs PE vs PNA vs COPD.  The xray is probably abnormal because of poor technique.

5)  If the radiologist says clinical correlation recommended, I don't want any other images read by that radiologist.    They are fired.

6)  Don't even think about consulting dermatology for any reason.   Instead, if it's wet make it dry and if it's dry make it wet.

7)  If you don't put me on VTE prevention dosing prophylaxis, I'm going to sue, when I get a DVT.

8)  If I get c diff, it's because you didn't wash your f**cking hands.  I'm not a carrier, I can assure you.  That means I'm going to sue  Don't give me c diff.

9)  If I'm in isolation, I expect you to follow all the precautions, every time.  Not just the first 30 minutes of your shift.

10)  I am not hospice material.  Don't let the hospitalist tell you otherwise.

"You get a Foley. And you get a Foley. Everyone gets a Foley!"

You get a Foley.  And you get a Foley.  Everyone gets a Foley!

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