u/RipOk3600

Finally got around to playing the last of us part 2 and though there are issues from a game play perspective (hate the points of no return, the second tutorial and the fact you can’t run in the “non combat scenes”) from a story perspective I don’t get the hate everyone lumped on Abby. Honestly the whole game shows the “before you set out on revenge dig 2 graves”. The thread through the whole thing was “they killed us so we kill them, because we killed them so they kill us” without end.

If there was any character at all I disliked the most it was Tommy, he straight up said “we need to let it go” and then he’s the one pushing for it.

The only characters I actually felt sorry for in the whole thing were Dina, Yara and Lev. They were the only truly sympathetic characters in the whole thing.

Also don’t agree with those who say Abby’s dad was a good person. Even if it truly was the only way (and unlike the trolly problem there was no guarantee it would even work if he had done it), him not giving Ellie the choice is straight up against medical ethics.

I do really like how Abby deal with Lev, no judgment just acceptance.

In a discussion about VAD I was thinking of some of my experiences with palliation and the theme to me which runs through them all is poor preparation.

1. failure to have the conversation early with the patient/resident and their family so that advanced care directives are clear as to the direction of care wanted. Seen so many which say “not for uptransfer unless will improve condition” which is absolutely useless to me when trying to determine at 3 in the morning when you are now presenting as semi conscious am I following full measures or are we transitioning your care to palliation

2. failure to expect deteriorating, this one comes from my experience with my mum. We had brought her home because she had been moved to palliation and she didn’t want to die in hospital. I’m a nurse, sister is a physio and dad is young and willing to help us so we can look after her and we know what we need to do so. Community pal care ring on the Friday but she’s awake and talking and comfortable so they don’t admit her and say they will call back Monday. That night she wakes up screaming and then falls unconscious (another brain bleed), we have no contact with community pal care. I know 13SICK is national so I call them straight away to get some help and he gives her a shot of morp and leaves me 1 extra for morning. In morning I’m trying to get help so I call the hospital pal care service and her doctor and then community pal care call me and yell at me “where did you get this number” (hospital pal care had paged them on my behalf I believe). Initially they refused to admit her because “we can’t admit over the weekend” so I was trying to get supplies of her GP who was willing to give me needles and syringes to help her. They finally called back and said she had called the CEO and gotten permission to admit her but that was a huge amount of strain on me and I know the system. Dad straight up said if it wasn’t for me he would have had to send her back to hospital because he wouldn’t have known where else to get help and neither of them wanted that.

3. failure to write the drugs early. Had a resident I came on shift for night shift and she was being palliated, was told everything was in place only to find the only order I had was morphine every 6 hours. No midaz, really no morph because it should be hourly when palliating, no buscapan (there is a debate about the usefulness of this but it’s neither here nor there) and no maxalon. Oh and they hadn’t even ceased her oral mediation in spite of her being unconscious.

4. failure to utilise pumps early, a night shift I remember which I failed a dying patient and I kick myself constantly over this. It was a really busy shift so I couldn’t check on this patient as often as I should have and they were unresponsive. When the family came in they let me know that he looked uncomfortable and it had been way too long since I had given him the last dose of morphine (that’s me saying that not what the family said). After that I always try to advocate for the early use of pumps if a patient/resident can’t advocate for themselves because that way even if there is a code blue and you are doing CPR, they at least have base line analgesia to ensure they are comfortable. It seems like we use pumps more to lighten the load on nursing staff (they have needed .5 every hour for last 24hrs so let’s start a pump) than proactively to keep that person comfortable.