Tuesday, July 22, 2008

Advocating for elder care

My father is a Stage 4 colon cancer patient (met to liver) at a terrific medical facility in North Carolina. He is 75 years old. Advocating for my father as he undergoes cancer treatment has been quite a challenge. I am reluctant to name the medical facility because, unlike Carle Clinic Association and orthopedic surgeon Dr. Chris Dangles, I am not convinced that the problems associated with my dad are related to this facility specifically or a particular physician. I guess that judgment necessarily means that I consider the problems to be systemic to both the delivery of medical care and medical care to the elderly. Ouch.
  1. In April 2007, the hospital administered general anesthesia to my dad as he went through bowel resection. Dad experienced an adverse event as he came out of the anesthesia. The hospital nursing staff was either not equipped and educated to care for an elderly person post general anesthesia or the hospital nursing staff was mean. I prefer to believe the reason was the former.
    • By the time I finally calmed dad down enough that he was moved into a hospital room, it was after 10:00 PM. My elderly mom and I were spent. The nurse asked which of is would be staying with dad during the night. Ummm, neither.
    • Dad was not communicative. But I could tell he was in pain. Dad did not understand the pain pump. But the nurse made a point of telling me that it was "illegal" for any family member to press the pain pump for the patient.
    • When I arrived at the hospital room the next day, the anesthesiologist noticed that the nurses had placed the button for the pain pump outside of dad's reach. Nice.
    • I learned much later that there were ways for the hospital to actively remove the anesthesia from my dad in order to minimize the continued damage and adverse reactions.

  2. My dad was hospitalized in the same facility in September 2007. His oncologist wanted him to be inpatient because he was status post recent prostrate reduction surgery and he was experiencing symptoms of a UTI. dad had also fallen down a few weeks prior to this admit. A CT revealed a subdural hematoma. The hospital staff would not contact the urologist (associated with the same medical facility but at the clinic level). I (as a family member) actually had to contact the urologist to get the referral.
    • On day two, I arrived at my dad's room and I was met by one of the doctors, She asked me what I knew about my dad falling down the prior night and being found on the floor. I told the female doctor that I had no idea what she was talking about. I added that I expected she would order a repeat CT since dad presented to the hospital with a subdural hematoma. She said "of course."
    • A few hours passed and no CT. After lunch, I asked the nursing staff when the neurologist consult would arrive. The nurse told me that the (major, teaching) hospital had only one neurologist and my dad's case was not serious enough to warrant the referral. The nurse told me that my dad could obtain the consult as an outpatient.
    • Around the same time, the primary doctor in charge told me that there was nothing else that cold be done for my dad in the hospital setting. She recommended a nursing home and added "you have a life too."
    • My dad was discharged before he was ever evaluated by a neurologist.

  3. In November 2007, my dad had horrible skin sores from the chemotherapy. His oncologist requested that he be admitted into the hospital and I agreed. The oncologist wanted dad to have 3 days of IV antibiotics.
    • Okay. Long story short - dad was admitted to the hospital and the admitting doctor did not think anything was wrong with dad. She refused to order IV antibiotics. Dad's wounds were never cleaned. Dad's first dose of antibiotic was by mouth and was given at the time of discharge. Dad was only in the hospital 2 days. He was admitted on a Tuesday and discharged on a Thursday.
    • I literally begged the doctor to tell me how to care for the wounds at home. She was vague on the instructions. I expressed concern that my dad still seemed ill to me. The doctor said that there was nothing else that the hospital could do for him. She suggested a nursing home.
    • I took dad home. His condition deteriorated rapidly. By Monday, I had dad back at his oncologist's clinic office. Dad's oxygen level was remarkably low. The skin sores had worsened and were more painful than ever. The oncologist told me to get dad to the hospital.

  4. On Monday (after a Thursday hospital discharge), my dad was admitted back to the hospital with an admitting diagnosis of pneumonia.

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