Saturday, December 1, 2007

Prayer request...

I have not been posting much since just before Thanksgiving because my mother has been quite sick and is in the hospital again. This time, it appears she has an infected knee joint and cellulitis.

I humbly ask for your prayers for her as these last 6 weeks have been most difficult on her.

I want to share something so that you understand the importance of not just leaving your loved one in the hospital without diligent followup, a little simple research, and knowledge of your loved one's medical conditions and medications.

In the many times she has been hospitalized, we have experienced the best of professionals (nurses and doctors). There have been times when I could merely visit her and feel confident she was being properly assessed and cared for. We have unfortunately experienced negligence and complacency, resulting in much loss of time from work and other things, and I - an ordinary family member was left in a position to assess her condition and put a fire under people to get them moving.

We almost lost her in the spring at another hospital when she was in with a GI tract bleed, and nurses just stopped taking her blood when they could not get it (when someone has blood loss it can be difficult to get samples). Rather than call in a surgeon to implant what is called a medi-port, she went nearly two days without bloodwork and I watched her slip away before me without any transfusions. How could they know she needed them if they had no lab work? It took serious intervention on my part and by the time they got the sample she was down into the 6's, and ripe for heart attack or stroke with her age and infirmities. Add to that, a nurse attempted to giver her Plavix - a drug that is given to people with cardiac stents and acts very similar to a blood thinner (you must be off of it two weeks before any surgery and mom was aware of this because she had taken it temporarily). It could have killed her had she not known what it was and refused it.

She recovered without permanent damage, and we elected to work with the quality care people at the hospital, who were very responsive and very disappointed in what they uncovered. The head nurse was involved, as was the chief medical officer. They told us we had the right to consult an attorney, admitting to many things and taking disciplinary action on some people who violated protocol (and common sense). With no permanent damage and a full recovery, we elected not to get involved with lawyers and drive everyone else's insurance up.

Now, in another hospital, her knee should have been drained when I first took her in to the ER which is why the family doctor wanted her to go there immediately because he could not do it, and he said she would need to be on IV antibiotics ASAP. If the knee is infected, it can not only rapidly destroy the joint, it can work it's way into a serious bloodstream infection. Timing is important. She already has poorly performing kidneys and a heart murmur - two things that can be worstened with such an infection.

The knee still received no attention as of 8:30 last night (26 hours after I took her in) when she called me, but another doctor - a gastroenterologist resident and another with him, responded to my plea at 4:30 when he stopped by. While leg care is not the job of a GI doctor, it didn't take him long to see what she needed when he looked at her leg. The concern on his face and on the woman physician with him, was visible. He ordered Vancomycin which was started somewhere around 8:00 last night. There was nothing more he could do.

My mother told me that the doctor of internal medicine assigned to her case told her he had no idea why she was in there, that her red blood count was not that bad (he treated her two weeks prior for anemia and couldn't see the forest for the trees - she was not in for anemia). She explained that there is something wrong with her knee. He looked at it and said he would send in an orthopedic doctor, which we later found out wasn't going to see her until sometime today - Saturday. The orthopedic doctor is the one that needs to drain the knee and he should have been called right into emergency when she came in. Still, here is a doctor who doesn't have a clue.

Unless they did something overnight, it is now over 36 hours since I took her to emergency to have her leg drained and the fluid cultured for bacteria and white blood count. I am headed back up there to sit and wait to talk to doctors and will more than likely be getting with hospital administration, especially if she is in worse condition.

When I first took her in, she had to be taken by wheelchair, and could not put much weight on the leg, nor straighten it. The knee itself was swollen and very hot to the touch in contrast to the other knee - a strong reason for our family physician to suspect a septic joint. There was some redness in the knee area. As of 4:30 yesterday when I visited her, and before that GI doctor came in, I noticed the whole shin was turning red and hot and her foot was looking more swollen. What little mobility she had was completely gone and she is now unable to get out of bed at all.

Furthermore, my doctor had given the ER department, on the same slip he mentioned possible septic left knee joint, her medications. He has been doing a delicate balancing act with her medications to keep her kidney functions, her potassium, and her blood pressure reasonably in good shape. We have had to fight ever step of the way to have them dispense her medications as they should be given. My brother was told that my mother was a CHF patient and could not be moved by wheel chair and when he asked what that meant, they told him Congestive Heart Failure. This was news to me because no one told me my mother was in heart failure. Furthermore, her lungs where completely clear at the family doctor's office (heart failure usually results in fluid pooling in the lungs).

I was unable to talk to any doctor about this upon requests to the nurses.

I won't name the hospital here, or the doctors, so please don't ask. If you work in the medical profession and have advice for me, feel free to comment or send me an email at I can't guarantee I'll return emails at this point because I am hardly home.

Te Deum Laudamus! Home


Esther said...

I'm praying Diane. I hope you don't mind me taking the liberty of posting your prayer request on our prayer blog:
God bless,

Diane K said...

Thanks Esther. I appreciate it.

Mom developed a higher fever today, but they are doing all the right things at this point. I'll post more later - I'm quite tired.

Easter A. said...

How is she doing? Praying...

Peter Simpson said...

We remembered your Mother (and yourself!) in our Bidding Prayers at the Chapel of the Resurrection this afternoon. The youngsters really take these prayers seriously.

eulogos said...

My advice in these situations is that unfortunately you have to be pushy. If the nurse or doctor you speak to doesn't give you satisfaction, first ask for the charge nurse for the ER, or on the hospital floor. If she doesn't give you satisfaction, insist on speaking to the nursing supervisor. Ourside of normal working hours, the nursing supervisor is the person incharge of the entire hospital. In a small non teaching hospital like the one I worked in, the one ER doctor may be the only doctor in the entire hospital during the night hours. Nurses are hesitant to call doctors at night with anything but truly urgent concerns. If the ER doctor has not determined that the knee needs to be drained, no ER nurse can do anything about it over his head. But the nursing supervisor can call the Chief of Medicine for the hospital, who can prescribe for any patient in the hospital, change doses ordered, and also insist that a doctor come in to the hospital to treat a patient. People will roll their eyes at you and show you their displeasure when you insist, but they will call higher-ups if you persist.

Another resource during daytime hours can be the "discharge planner" for the hospital floor. It is their job, basically, to get each patient out of the hospital as soon as possible. Patients who develop complications stay longer, at the hospital's expense. (Insurance companies only pay for so many days stay for a particular diagnosis; if the hospital causes complications, they don't get paid for subsequent days stay.) So the discharge planner, usually an experienced nurse, is inclined to address such a concern.

Hope these suggestions help.
Susan Peterson