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:
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.