It has been just over two years since my father went to a nursing home after months in a hospital. He had fallen and broken his kneecap. He did well after his surgery but while in acute rehabilitation he developed a urinary track infection, likely because of a bladder catheter that was placed during his surgery. This is recognized as a hospital acquired infection. He got sicker and sicker and the team did not seem to recognize what was happening. As a physician I tried to tell the team that if my father had altered mental status, this was highly unusual and concerning. I believe they saw an old man and assumed he was demented, despite what I said. Ultimately my Father suffered a cardiac arrest. Somehow, he survived this and after a very long hospital stay, he went into a long-term rehabilitation center. We can have a different discussion about these places, the care they provide (not great, but some lovely people trying very hard), as well as the challenges they face (they can’t pay people enough so they can’t hire enough staff).
My father got through this period, but it has been a rough two years. At his age, you can imagine the hole that he was trying to dig out of. Some of the subsequent ups and downs he has to own. He has had some falls with injuries that set him back and those are on him. But some of the difficulties continue to be related to a health system that does not seem able to provide care for complex elderly patients.
Most recently my father developed the first kidney stone of his life. It was a big stone and was diagnosed using IV contrast. The problem is that he already has kidney injury and does not drink enough fluids. Despite his significant history he was sent home from the ER. They never called me to ask what I thought. I would have told them they were insane to even consider sending him home.
He received no pain medications, likely because they thought that he would be a greater fall risk. But that night he had severe pain, could not eat or drink and got sicker and sicker. By the time my mother got him back to the ER his kidneys were failing because of his dehydration, well recognized preexisting kidney injury, and the IV contrast he had received. Shortly after his readmission, he was uroseptic. He survived yet another failure of the health system but it has been up and down. Once again, I find myself needing to be my father’s doctor despite the fact that this is not good medicine. I wonder what families who do not have a medical person available to them are suppose to do?
It is hard sometimes to know whether you should keep fighting for someone. I think my Dad wants to do some things. I think he wants to see some birds at Montezuma. I think he wants to play with his Granddaughter. I think he still has books to read and stories to write. But I imagine he is tired. Really tired.
So he was not eating well at all and getting weaker and weaker. Is he doing this because he is tired and done and wants to stop trying, or is he delirious from a few weeks in the hospital and doesn’t understand what is happening? My mother and I are not sure, but we decided to put in a tube into his stomach to help feed him. We asked and we pushed and it finally was set, but the doctor failed to see that my father was on a type of blood thinner. So…his procedure was delayed by days. This is basic medical care folks, but this guy couldn’t manage the care. Also fair to say that the hospital seems more interested in not caring for him than caring for him. He is old after all, so why bother.
People need to know that when the those they care about are in a health system, they need someone to advocate and watch out for them. Ask questions, double check. And if you have a friend who is in healthcare ask them for help or advice. Don’t let the doctors and nurses ignore your concerns. Ask for a patient advocate or to see the Chief Medical Officer or other people in charge. Be respectful but forceful until you feel that your concerns have been heard and your questions answered.