Monday, September 14, 2015

A Doctor at His Wife's Hospital Bedside

I became moved to share my story with my readers by an article published in the NY Times.  The similarity is uncanny and while the details are different, the theme is the same.

My last blog, A Doctor at His Daughter’s Hospital Bed - The New York Times describes an episode where the physician is present in hospital when his daughter is critically ill and dying.

Because the hospital system is so dysfunctional he takes matters into his own hands to treat and save his daughter from dying due to septic shock.  Our medical communication system lags greatly with the necessity of real-time communication and to manage the increased number of transactions.

Old habits and patterns of behavior die hard, and not just in the health sphere. Health communication and health information technology are still not optimized.  In many cases the old way of doing things has just be digitized, not really transformed.

The transformative changes will come as a result of physicians, software developers, and professional businesss managers  working, thinking and creating the new model.

About 15 years ago  my spouse suffered a severe bowel obstruction from a cecal volvulus. Her abdomen became distended in one  hour as if she was 9 months pregnant.  She was rushed to a nearby small busy hospital emergency room. The hospital was in an area of less affluence than the surrounding resort community. It was a less than sought after hospital my most physicians in the area. At that time the development of managed care was in HMOs with restrictive physician membership.

I knew many of the  physicians who worked at this hospital. Shortly after arriving, it was determined that she was non-transferable, and in critical condition.  There were no physicians available on our particular managed care plan. Other than the physicians who were present in the emergency room, there were no surgeons availble.

Fortunately for our family one surgeon (a recently trained trauma surgeon was in the emergency department.  The staff pointed out that she could not be admitted due to not having an admitting physician.

Time was ticking by and her  condition was worsening rapidly.  The only physician available was the critical care surgeon, and though on duty as the     emergency room doctor realized the nature of the situation. She took the responsibilty of admitting her and scheduling a new doctor to immediately assume responsbility   for the emergency room.

She ordered the staff to  prepare for the surgery, and to transport my wife to the operating room. The staff again balked, however the surgeon overruled the nurses, and administrators.  By this time several hours had elapsed. She had arrived at the ER at about 7 PM and it was now 11 PM.

On the way to the operating room blood was drawn, several portable X-rays were done. Not all the lab results were ready by the time the incision was made.  The operation took about  two hours.

As a physician I already knew the gravity of her situation, even if the operation were successful.

As I waited, nervously thinking about our family of three sons, one of who had cystic fibrosis Dr Y appeared in scrub suit, to reassure me.

I went to the recovery room where I waited several hours. Dr. Y.  appeared, and asked, "Did you know your wife is pregnant ?  The pregnancy test did not come back until after the surgery began.

In a case such as this it really doesn't effect the immediacy of the problem at hand.

Her  post-operative course was stormy, with fever, shock, respiratory distress and

Despite her critical illness she was not admitted to an ICU but rather to a  regular surgical floor, where nursing was less intensive.

Over the course of several days she spiked fevers and became weaker. She had a tachycardia, and severe abdominal  pain.  I thought she belonged in the intensive care unit. and requested that she be transferred.  There was a discussion about her not meeting the 'criteria'  for transfer. I protested, and they 'compromised' by assigning an aide to stay with her through the nite. I was working nearby and had an office full of patients. It was close by and I   could be back in five minutes. She was so ill she was delirious, and not aware of her surroundings.  I needed to get some rest. Our children were in the care of friends.

I returned a bit later to find she was not much better, and began raising 'h', calling the chief of staff, the hospital administrator, and  anyone who would listen. She was transferred shortly later. Her delirium  conttinued in the  ICU, taking 24 hours to resolve. As the situation evolved it turned out she had a large pleural effusion, and a subphrenic abcess above the spleen under the left diaphragm.

After two weeks of IV antibiotics she had recovered well enough to be discharged. She was however on IV nutrition, forbidden to eat.  We went home.  About a week later she developed pain and a draining abcess in her lower abdomen. We rushed her again to the emergency department where her surgeon examined her. Her bowel had ruptured, and she was developing an entero-cutaneous fistula.

This time I was wide awake enough to insiste she be transported to a university hospital, about 65   miles away in a metropolitan area.

There she was well attended and in a surgical ICU where intensive antibiotics  were administered by IV and into her abdomen directly, The cultures grew methicillin. resistant staphylococcus aureus. At the time there were few alternative antibiotics, save for some very toxic ones.

Eventually she went home after four weeks. The good news was that the fistula was closing. She was discharge and remained NPO and on  TPN for six more months at home.

Is there a moral to this story ?

     Be involved with your loved one's care in hospital, ask questions, ask for second opinions,
     Don't hesitate to ask to be transferred to another hospital.   In some hospitals there is an                  unwritten theme of not saying anything disparaging about a fellow physician.

We were locked in to where we were since no one would order a transfer due to her unstable condition.

We were grateful that the trauma surgeon had accepted her, and she seemed totally dedicated and committed to  my wife's welfare. It was a bright spot in a very frightening situation.

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