My father did not survive his most recent interaction with the health care system. I am not young, so you might imagine that by dad was not either. If you look back in this blog, you will see that my father suffered a cardiac arrest after he had a hospital acquired urinary track infection that advanced and was not recognized. You might imagine that the sequela from this was catastrophic. Remarkably, his mental status was intact, but the physical implications for him were severe. He lost a hug amount of weight and had difficulty walking. He had coronary artery disease prior to the cardiac arrest, but after it he had an ejection fraction of 30-35%. His kidney function went from normal to a creatine of 1.8-2.0. He had a terrible time with chronic nausea which didn’t do much to help him gain weight back. He worked to get the ability to walk back, but it was slow.
My father had some ups and downs during his recovery. With his new congestive heart failure he had a few exacerbations requiring time in the hospital. He had some episodes of low blood pressure because it was difficult for him to manage his fluid intake and with the ongoing nausea he had difficulty gaining weight. But little by little by little he was making some progress. Sometimes he was his own worst enemy and he made mistakes. Some of those mistakes set him back. But he was trying. He had things to try for. He wanted to write some stories and look into family history. He wanted to spend time with his granddaughter. He wanted to do more bird watching – he loved birds. I thought they were little black specks in the sky, but he could identify them all. And you know what….now I love birds too.
My father, with all of his medical conditions, went to the emergency department at the beginning of September with abdominal pain and vomiting/diarrhea. He was found to have a large kidney stone. The first one of his life. It was large…very large. Thus, unlikely to pass on its own. After a CT Scan with contrast they sent him home. With known kidney insufficiency, problems taking fluids, and no pain medication they sent him home. He did not do well and when he got back to the ER he had acute kidney injury, dehydration, and was confused. That was the first domino. This, plus a passive approach to his confusion, worsening kidney function, an aspiration, ongoing lack of food, severe hypernatremia, and it was too much. He could not survive it all.
Despite my attention, demands and expectations for better care from his hospital…..it was not enough. My father died on the the 18th of October after we put him in comfort care because we felt there was little left to do. I wonder why the hospital he was in could not seem to give him the dignity that he deserved.
If a family with a physician cannot manage to demand care and dignity for their loved one, what are others to do?