Opining Online

See update here. 

A few weeks ago I wrote about an excruciating and medically scary 24 hour adventure my father experienced in an unnamed hospital. Read here and here, for that background. It’s time to name the hospital now:

Christus St. Michael in Texarkana TX.

I mentioned in that story that my step-mom was in the same hospital that my Dad was transported to. She’d had a hip replacement and was in rehab. She got out of rehab a few days after the ER fiasco and was doing pretty good getting around the house with a walker.

One morning a little over a week ago, she woke up with chest pains and too dizzy to stand. At the ER, it’s discovered she’s got a blood clot in her leg. It takes hours and hours (just like with my Dad) after the decision to admit her to actually get her admitted and out of the ER.

When she’s in her room and settled, my father goes home. Talking to him a few times that day, I chuckled at the thought that he was having some very mild PTSD symptoms from memories of his recent visit.

My step-mom is, of course, labeled a fall risk and she’s instructed by the doctor (not the same one my Dad had) to not try to get out of bed herself. Later that evening she has to go pee and presses her buzzer for assistance. And presses it and presses it and nobody answers.

She’s soon faced with a decision: Do I wet the bed or do I try to get up by myself? I don’t think anyone will be surprised that she decided to get up. And she fell. Fortunately, she wasn’t injured worse than a nasty bruise on her shoulder, but the hospital did x-ray her shoulder to make sure.

And then they addressed the issue of why no one answered when she buzzed. It was simple to fix — all they had to do was plug the buzzer in. The initial neglect in not making sure it worked when my step-mom was moved to the room is bad enough, but it was fixed now so there should be no problem, right?

When I wrote about my Dad’s experience, I made sure to compliment all the staff except the arrogant doctor and the maintenance people who didn’t show up in a timely manner. Now I don’t know whether my Dad was really lucky or whether my step-mom was just really unlucky. She didn’t get the same quality of care from the staff. Nowhere near it.

You’d think that after her falling the first night there, that the staff on that floor might have been a little extra-vigilant about answering her buzzer and responding to her requests to go to the bathroom. But that wasn’t the case. The buzzer was answered and she was told somebody would be there, but often no one showed up in what could be called a timely manner and sometimes no one showed up at all.

This hospital uses a blackboard to note patient information. In addition to noting she’s a fall risk, there’s a notation about warm packs to be placed on her legs three times a day and this was not ever done during her week long stay. Perhaps the doctor changed his mind, but the blackboard was never updated.

Shortly after coumadin was started, my step-mom started having stomach pains. She described her stomach as being on fire. Four days later, this pain was finally addressed and eased. I can’t imagine what took so long.

For two days, she and Dad pointed out to nurses that her IV was no longer working. While they all looked at it, no one did anything to fix it.

I’m not quite sure what all the problems with her bed were, but it was not comfortable. She used multiple folded blankets to try to make it better, but finally got to the point where she demanded a new bed. She got it and was then given medication to help her sleep. Or, as my Dad suspects, to “knock her out and make her shut up.”

Anyway, they tried to use the IV she’d been telling them wasn’t working for this medication, but of course it wasn’t working. They crushed a pill and gave her the medication orally. I don’t know what it was and am wondering why it needed to be crushed. She’d been taking other medications by mouth.

Ah… wait. Let’s back up a little bit. Before demanding a new bed last night, my Dad called the customer service representative that we (my sister and I) have emailed and talked with concerning the problems my Dad had while he was there. He got voice mail, of course, and left a message requesting she call him or come up to the room and talk with them.

She called him back a short time ago, approximate 20 hours after his request and five hours after my step-mom was released.

This morning when the doctor told my step-mom that her coumadin levels were good enough to be released, my Dad packed up her stuff and took them to their car. He got a wheel chair on his way back to her room and told the nurse she could mail the release paper work to them. She asked him to wait and talk to her supervisor about their problems. A half hour later, the supervisor got there and listened to their complaints and said the problems would be addressed. By that time the paper work was done and they left.

So, maybe we should just drop this right now, but we’re not. One reason is that my parents (and many many other folks) rely on this hospital. They’ve been going there for years and the problems seem to be getting worse.

My father had a stent inserted there (I’m guessing) 8 years ago. While I was sitting with him, his monitor started flashing bright colors and beeping. I looked at it and noticed his blood pressure was low. It went back up a little and the beeping stopped. But it started again soon and didn’t stop. The door to his room was open and his bed was less than 10 feet from the nurses station where his nurse was chatting with her co-workers.  I had to walk up to her to get her attention, and could clearly hear the beeping while standing beside her.

Frankly there are many other little incidents I could post about, enough to make me wonder if there’s a “systemic” problem with patient care there. Enough to make me want it further investigated before any more of my relatives are hospitalized there.

I need a color job and some 1950s undergarments to make this real… but here I am:

The first thing I’d like to note is that one does not appreciate or miss one’s favorite mode of transportation until one is deprived of it.

Horse theives were universally vilified were they not?

Having been raised in the West and living almost all of my life more than 5 miles from civilized “services” I can tell you that my car is of not only a utilitarian necessity but also one of psychological necessity.

Were my husband and I careful, it would be much more than a month before we’d be hungry based on what is in our refrigerator and cupboard now. Of course, if electricity were to be cut off, we’d be hungry much sooner. So why is transportation so necessary?

We have 5 vehicles that are currently running and capable of getting us miles and miles away from our current location. However, we both have our favorites.

Neither of us wants to drive the ancient motor home far. (Actually it might not get us far… it’s utility is iffy except it is home to a very reliable generator.)

Nor do we want to make any long trips in the near ancient Mazda pickup. It’s handy for many things, but is used most often as a lock for the garage — if parked close enough, the garage door cannot be opened.

The 19 year old F150… well, we have a sentimental attachment to it, but not to its gas mileage or odometer reading. Really, after 450,000 miles doesn’t a vehicle deserve to be put out to pasture… so to speak?

Enter the two vehicles we drive every day. There’s my husband’s 1996 Chevrolet pickup and my 1998 Cadillac. The pickup is holding up very well, though I think it could do with some new shocks/struts… whatever. It bounces a lot, okay?

My dear 1998 Caddy, purchased used in 2003 with 90,000 miles has another 70,000 on it (that’s six years worth, so I’m not REALLY complaining.)

And now… finally, I get to the point of this post. My dear Caddy has been overheating (little by little… a degree here, 10 degrees there) and I have not felt truly confident in driving her for some time. Today, we had her radiator replaced.

And I am so happy! I no longer feel that I cannot set off for Arizona, South Carolina, Colorado, or Dallas at the drop of a hat.

What is amazing is the relief I feel knowing I can do that easily, comfortably in my car, at my whim, without imposition on anyone else do that.

I’ve never been without the capability of going anywhere I wanted to go. But… to go on my terms is worth a lot, if not quite priceless.

The Liberal

A month or so ago, I got involved in several discussions over on ScienceBlogs in which conservatives were maligned rather harshly by other commenters. So I asked one of them to define what he meant by “conservative” and he directed me to his blog’s Ideology archives.

Obviously some of the entries are simply political snark and Coturnix of A Blog Around The Clock is a prolific blogger. He refers to George Lakoff’s books, particularly Moral Politics, very often. I haven’t read that book. After having read so much of Coturnix’s writing about it, I’m tempted, but then wonder if I’d just be bored.

I’ve chosen what I hope are representative posts of this one liberal’s idea of conservatism. Note that neither the author nor I have made any attempt to organize these in a manner of one thought flowing to another. They are basically chronological, which is fitting. Some of the following links go to a previous blog written by Coturnix. 

Regressives: What Should We Call Them? – March 28, 2005
Moral Order - June 23, 2006
Nurturant is not Coddly! – July 21, 2006
Why Creationists Need To Be Creationists - July 26, 2006 (see last comment for links to updates)

The Conservative

Assistant Village Idiot has thoughtfully arranged links to his series of posts on the roots of liberalism here. I cannot thank him enough because that makes finishing this post so easy on me.

The title of this post is a saying I’ve heard from my father over the years. And it’s truth becomes more evident as time passes. The saying does not address getting the money, only the severity of the problem. If your problem is that your shoes have holes in them, money can get you a new pair of shoes. 

If your problem is poor health — say you have cancer — no amount of money can buy a cure. That’s a Real problem. Money may buy you years and because of that, a “cure” is defined, medically or statistically, in years. Five years, usually.

If your problem is a cluster of diseases possibly or probably caused by somewhere you were 45 or so years ago, no amount of money is going to buy a cure.

If you’ve got a problem that money can solve, then your goal should be to earn that money. It may seem impossible, but it probably is not. If money can’t solve your problem, ponder that infamous creek and missing paddle.

We have air conditioning!

Or rubbing salt in a wound?

1902: With human comfort the last thing on his mind, a young mechanical engineer completes the schematic drawings for what will be the first successful air-conditioning system.

It was the effects of humidity on paper that he was trying to stabilize and I can assure that paper has been curling in my home the last few days. So has my hair.

Our new unit is on the way and hopefully installation will be completed by Monday evening. We’re not just getting the old one (aged 24) repaired, but installing an entirely new unit, including heat.

The heater part hasn’t worked right in 5 years or so, but that’s seldom a huge problem here.

http://billysacheat.ruudreliable.net/

As noted in the post below, we have no AC. The unit is about 24 years old and well… it’s likely beyond repair.

Plus it’s the middle of summer in the south and getting someone out to look at it and repair/replace it means waiting a while. I think we’re lucky we found someone to come look at ours tomorrow.

But then there’s the weekend… please send cool thoughts our way!

Our AC is not working. It’s 83 in the house and 91 outside at 10:40 pm. And yes, I’m leaving home tomorrow. Perhaps tonight.

See update here. 

See the first part here.

I ended the last post with my father being admitted to the hospital for further evaluation of his dizziness, low blood pressure, and slow heart rate. Simply being in the ER had made his arthritis flare up so severely, he needed narcotic pain med to tolerate it.

Up to the floor to a nice room furnished with a bed that was, if anything, more uncomfortable than the ER cot. It was also suffering from bad wiring so that it constantly had the call light on, which effectively translate into the call light not working at all.

Except for the ER hospitalist who admitted my Dad, every person we came in contact with was friendly and trying to do their best. It’s hard to do that when you’re dealing with malfunctioning equipment and equipment that causes unnecessary pain to your patients.

After the nurse fiddled with the call light for a while and tried to figure out why it was so warm in this room, she called maintenance. What else could she do? Well, obviously maintenance was overwhelmed as they showed up 30 minutes before my Dad was discharged the next day.

In the meantime, Dad says he feels like he’s smothering, but at the same time he’s cold to the point of shivering. He insists my brother and I go home that he will be fine. This is a tough thing for us to do (for reasons I won’t post about), but we do because we don’t want to upset him by arguing with him. He said if either one of us stays, we’ll just keep him awake all night.

During the night, the inflatable mattress that’s supposed to make this hospital bed more comfortable deflates in the middle section. I believe I’ve covered my Dad’s severe arthritis and do I need to point out that this didn’t help that pain?

Also during the night the smothering feeling my Dad was complaining about has become a general shortness of breath. So let’s recap this 86 year old man’s recent onset symptoms:

Dizziness
Low blood pressure
Slow heart rate
Shortness of breath

If I have any health professionals or anyone with strong Google fu, you’ll be able to figure out what at least one probably diagnosis is.

Enter the same obnoxious hospitalist from the evening before who writes on the discharge orders to discontinue the diuretic and heart medication (which has a side effect of lowering blood pressure) that my Dad has been on for years. The written orders do not say to taper off the heart medication.

No cardiology consult was requested and no interest shown in the addition of shortness of breath to his symptoms.

My Dad is by this time ready to leave. He feels worse than when he came to the ER. And he wants to make his radiation treatment. (I don’t think I mentioned earlier that he has Stage I NSCLC.) By now all Dad wants to do is go home. So we do.

By early afternoon, the shortness of breath is bothering him much worse and he goes to his storage shed to get a 3 year old bottle of oxygen (with 3 year old tubing) that I didn’t even know he had. This makes me very unhappy and I tell him he shouldn’t even try to use it because his blood oxygen saturation had been good. He says he that can’t be true because he can’t breathe.

Fortunately, the oxygen tank and tubing aren’t working. While he’s fiddling with that I suddenly remember that he has a lung doctor! Why yes, I am really, really slow sometimes. I look at the clock and tell my Dad that we can make it there before 5 pm. We’re in the door at 4:45 pm.

After the routine vitals, the RN comes in, a nurse practioner. She questions him, checks his oxygen saturation (96) and listens carefully and thoroughly to his lungs. Thanks to electronic medical records, she can see the results of his chest xray and other information from the ER visit.

It’s then that I fell in love with this woman. She said that the hospitalist was no more qualified to order discontinuation of his heart medicine and diuretic than she was and told him he should not change it until he’s seen his cardiologist. She explained that the cough he’d seen her for two weeks before and the current shortness of breath combined with the radiation warranted a prophylactic round of antibiotics and that a round of prednisone would get him feeling decent again until he could see his cardiologist.

She explained that he had multiple risk factors for fluid build-up and that discontinuing the lasix could be dangerous.

It’s a shame we can’t all take prednisone all the time. It’s a feel good drug like no other. And since Dad’s cardiologist is out of town all this week, it will sustain his energy until his appointment next week.

I’ll be going back to my Dad’s soon, but the thing I’m undecided about is exactly how to word the nastygram I want to send about the obnoxious hospitalist and his lack of follow-up and follow-through. Fortunately my siblings are better at that kind of thing than I am.

UPDATE — July 22, 2009 (read the comments for earlier update)

This morning, I got a call from the head of the customer relations department of the hospital. The first thing she assured me of was that none of their junior volunteers would ever be asked to deal with patient or family complaints, ever.

She was very nice, apologetic, and assured me that several departments would be hearing from her about our complaints about the facilities and explained that problems with the doctor would still have to be addressed by the VP of medical staffing, but that she would also forward her notes on our conversation to him as well as the hospital CEO.

See update to the medical story here. 

I left last Friday to go to a niece’s wedding in Arkansas with my father. She was married on July 4th in a beautiful outdoor ceremony near Little Rock AR. The photos on the site’s page do not come close to the majesty of the setting. They do justice to the facilities, but not the nature surrounding them.

My father mentioned on the drive up there that he’d been having dizzy spells which, at first, sounded like orthostatic hypotension. He’s 86 and I really thought that this was probably natural for his age.

However, the day after the wedding, he was more than tired. He was suffering fatigue. He had no energy and no appetite. I decided to stay another day or two. In all honesty, it wasn’t just that, it was also my innate dislike of leaving wherever I am. I’m pretty much at home anywhere and hate moving. Staying another day or two sounded great to me and I have the most understanding husband in the world.

Tuesday morning, my Dad was feeling dizzy sitting down and lying down. We eliminated the possibility of it being an inner ear infection because he’s suffered those numerous times and it certainly wasn’t that bad.

We got an appointment to see his PCP Tuesday afternoon. He confirmed my father’s suspicion that his blood pressure was low and they decided to discontinue two medications that might be contributing to his problem.

We go home thinking the problem is solved. Wednesday morning, 11 am — blood pressure is 106/51. Pulse is 37. (This machine had been previously ”calibrated” with an RN’s manual BP reading.) Checking BP again, the reading is 81/45 with pulse still 37. My choices are… call an ambulance (and first responders) or attempt to transport my father 40+ miles to the nearest ER.

I take my hat off to Little River County’s first responders. Before I was through giving the ambulance service all the pertinent info, a trained first responder was in the house. His BP reading was a bit higher, but he noted the pulse was irregular. Within minutes of his arrival another first responder (who also worked as an EMT for the ambulance co.) arrived and confirmed the irregular heartbeat and slow pulse rate, although the BP was within normal ranges by that time.

Keep in mind while reading all of this that my father is 86 years old.

When asked where he wants to be transported, my father names the hospital where his wife is getting rehab after a hip replacement.

His transport takes 45 minutes. During this time he is sitting up in a gurney. This means that his legs are, at best, a 45 degree angle to his torso. He is then transferred to a standard ER “bed” which is not capable of raising the knees or ankles to a comfortable position for a young person not suffering from near-crippling arthritis.

Imagine that you are 86 years old and that doctors have told you that your back/hip/knee/wrist pain is inoperable and that the best they can do is narcotic pain relievers. Imagine that you’ve always thought that you didn’t need pain medication, that your mind could overcome it.

Now you are put in the most uncomfortable position a human can be in for 4+ hours. Imagine that all your blood relatives suffer from painful arthritis. Imagine a doctor questioning you as to whether you are REALLY in pain or not… the same doctor who thinks your BP of 110/60 is fine even though you are in writhing pain.

At least this doctor listened to (or gave into) the ER nurse with 29 years experience who insisted that my father was experiencing REAL pain. She administered 3 demerol shots during the 10 hours my father was in the ER.

My father was admitted for “observation” overnight. I will post later (if I feel like it) about how that turned out.