Report on the Hospital Stay
Of my Mother
Starting on Sunday May 20, 2007
Died June 3, 2007 at 11:00PM
Sunday May 20, 2007
She was taken to XXXXXXXX Hospital from xxxxxxxx Assisted Living in late morning of Sunday May 20th suffering with a nosebleed due to Coumadin. The level of Coumadin in her blood should have been 2. It was 6+.
(We had expressed to her Doctor many times in the past 6 weeks since starting Coumadin that my Mother could not tolerate that med. She had been treated with that med Previously after a knee surgery and had nose hemorrhages from it that had resulted in a hospital stay. Her surgeon at that time had told her that she should not take Coumadin again as it thinned her blood too much. )
She was evaluated in the Emergency Room and later that same day admitted to the Hospital.
The bleeding could not be controlled. That night she was taken to Surgery, and the bleeding was cauterized under local anesthesia. Surgery lasted from Appr.10:30 PM Sunday night until early Monday morning. (1AM or so)
Her family was waiting for her after surgery. They wheeled her past us as we sat in the waiting room. I glanced at the large clock on the wall as they wheeled her under it. It was 1:32 AM. Her attending Anesthesiologist, Dr.XXXX, came to the Critical Care waiting room to talk to us. ( Her Surgeon wanted to get home, as it was late, and could not be bothered to see us) The Anesthesiologist was very concerned and expressed to us that his decision to allow this surgery without a generalized anesthesia was based on the condition of my Mother's Chronic Pulmonary Fibrosis ( C.O.P.D.).
His opinion was that if he had sedated her to that degree (General Anesthesia) he would have most certainly "Lost her" and she would not have survived the surgery.
He also expressed what a cooperative patient she had been through what must have been a frightening and uncomfortable few hours for her. He told us that she had followed all of their instructions and had even said a prayer for herself and them. He was touched by how "Sweet" she was. He also expressed to us that in two or three days she may develop an infection in her airways due to aspirating some blood during the 18 hours of her nosebleed. He instructed us to be an Advocate for her care while she was hospitalized, as his experience was that most staff members and doctors were so overwhelmed and stretch so thin that the consideration needed for great care would probably not be provided and to be there with her as much as possible.
She was in Critical Care and was now resting comfortably. We all saw her briefly, reassured by staff that she would be properly attended to, and we all went to our homes to go to sleep. (It was appr. 3AM when we left)
The night of my Mothers surgery was the beginning of a strange but true experience that I can only believe because I lived it and had other family members there to verify that I was not sleeping and having a bad nightmare.
The first strange encounter was with the Anesthesiologist when he came to talk to us. He talked of his decision to use a local anesthesia instead of a general. He spoke of this being his last night on duty at this hospital. He had been called upon to give them some of his time because they were short staffed. He told us that he practiced in a hospital in the Philadelphia area and named it. I replied that I knew it well.
He stressed how we would need to be an advocate for our mother while she was a patient in this hospital and the many instances of medical uncertainties he had encountered through his career, including his own hospital stay. He expressed that when he was a patient himself, he only felt secure if he ordered his own meds. (Was this an omen?)
He spoke of the real possibility of lung infection developing because of the long duration of the nosebleed. He suspected that some blood would have had to been aspirated.
He talked openly and friendly and I got the sense that he really wanted us to read between the lines. It was very bazaar. Had my daughter, brother and sister in law not been present, I would have thought that I had just been in "The Twilight Zone".
Monday May 21, 2007
Mom is responding to treatment and improving. The packing inside of her nose from the cauterization makes it difficult to breathe, but her vitals look good. We did not see Mom that day. I did phone and speak to her nurse on each shift. I was reassured that she was doing well.
I also spoke to XXXX XXXX, (the Social Worker on Staff) to start arranging for Mom's release to XXXX XXXX Skilled Nursing facility upon her release from the Hospital.
I also spoke to NXXX , the Director of Admissions at The Nursing Home, to secure a room for Mom. We all expected that Mom would be released to Skilled Nursing care in a day or two.
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This was my youngest daughters' birthday. We were all reassured that everything was well and that there was no need to make the two-hour trip to the hospital that day. I spoke to mom on the phone a few times. She seemed optimistic and was really starting to feel better. I was already forgetting about the warnings of the previous night. This is the hospital where my children were born. This was the hospital that had cared for all of us at one time or another. I felt a sense of relief that my mother was in a safe place and was being cared for. As one of Moms' primary caregivers for so many years, I actually decided to relax and enjoy the few days that she would be in the hospital, as that meant that I didn't need to worry about her.
Tuesday May 22, 2007
I did see Mom on Tuesday May 22. She was having difficulty breathing with the packing in her nose and was becoming quite tired from all the effort needed to breathe. The oxygen mask at that time sat on her chin so that she could bring oxygen in with mouth breathing. We were assured by staff that her vitals were good and that as the packing came out of her nose she would get some relief. Mom has had Physical Therapy and is walking in the halls with her walker. She is proud to tell us that she had walked 127 ft. one way and then walked 127 ft. back to her room. Matt is in charge of her Physical Therapy.
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She is in a room usually reserved for morbidly obese people, although she is a normal size person. I guess that wherever there is a vacancy, the hospital will use the room, even if it is not suitable for the patient. There are lifts and pulleys above her bed. There are pull bars on the wall to assist lifting a large person. Mom does not seem to mind these things today as she is mobile and seems to be feeling better in spite of the packing, but she does comment on how strange this room is compared to the kind of hospital room that she is use to being in. If anything, she is a bit annoyed at the packing and expresses her hope that it will be removed soon.
She has a roommate, but she does not want to be friendly, so Mom does not try to make much conversation with her.
Wednesday May 23, 2007
I did not see Mom that day. I did speak to her by phone both in the morning and in the evening. Mom tells me that she feels as if she is more congested. She feels ill. Her roommate in bed #1 has a lot of visitors. Mom cannot rest. I can hear the congestion as she breathes that evening on our phone call. This is not a usual pattern for Mom's C.O.P.D. Her usual pattern is congestion in the morning hours due to sleeping all night. On a usual day, mom can expel the congestion by about 11AM and breathe more comfortably for the rest of the day.
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All of a sudden, the forgotten words of the Anesthesiologist from the first night came rushing into my mind.
I talk to the nurse on duty. I explained what he had said that night, after mom's surgery, about the real possibility of her having aspirated blood and it causing an infection. She replied,"That this was not noted on Moms' chart from him". Therefore, she did not believe this to be the case in her condition today.
When I called back in the evening for a report on her condition, it was "the same". I once again stressed to the nurse on duty that Mom needed to be watched closely for signs of infection, and once again, I was treated with indifference.
That night, I called my mother before she fell asleep and found her, for the first time in her life, not wanting to talk much. She said that the patient in the bed next to her had visitors that evening who were still there and that the visitors had been very loud and used a lot of "cursing" in their conversation all evening. This really bothered Mom, because she was a devout Christian who did not "Take the Name of her Lord in Vain". (Her Words)
I offered to get the nurse on duty involved. mom said "No, the visitors would have to be leaving soon,as visiting hours were over 15 minutes ago".
We ended our call and I promised to call first thing in the morning. She said the same phrase at the end of our call as she had said many times before whenever she heard worry in my voice.
"Don't worry about me. I will be all right. My God protects me and this too shall pass. Go to work tomorrow. The nurses will call you on your cell phone if I need you.
Mom was always thinking more of the other person than herself. That was her way of Life.
Thursday May 24, 2007
I receive a phone call from a nurse at XXXX Hospital at home at 7:47 AM.
She states that Mom has had nightmares and had awakened confused, not knowing where she was, and became very stressed and upset. She informed me that they had injected her with a sedative and that she was having hard time breathing. I told her that I would come as quickly as I could. I live a distance away and it takes about two hours to get to where the hospital is located during that time of the morning with traffic. I immediately started to get dressed and prepared to make the trip.
I received a cell phone call from Dr. xxxxxxxx (Mom's primary care physician) at 10:04 AM.
I was in route and had about 30 more minutes to reach the hospital. Dr. xxxxxxxx told me that my Mom was extremely ill. She said that she had arrived to do rounds and went to examine Mom and found her in severe respiratory distress. She had transferred her on to a Bi Pap breathing machine to allow us time to reach the hospital. She indicated that she believed that death was close. She instructs me to "come as fast as you can"!
I called my daughter to instruct her to meet me at the hospital. I called my brother and instructed him to come. I called my oldest brother and informed him of the situation.
My Daughter & I arrived at the hospital at appr.10:30AM to find my Mom unresponsive and struggling very hard to breathe even with the Bi-Pap machine. My brother & sister in law arrived shortly after. The nursing staff provided us with extra chairs and a serving table complete with two cases of soda, a pot of coffee, a pot of tea, and a package of cookies. It seemed to us that every one expected her to die.
No one came to check on her.
If someone from the staff did come in, they only asked if there was anything that they could do for us.
Mom did not die. Although we rallied around her, talked to her, prayed for her, and spoke our last words of gratitude and love for her, to her. She did not die. Her breathing was very irregular and had long pauses and gasps. Mom is struggling to breath and she tries to cough. When she does finally manage to cough, she expels mucus. It is yellow with dried blood in it.
She seemed to be fighting to come back. My sister in law kissed her head at about 2 PM and exclaimed, "Your Mom has a fever!" We ring for a nurse. They take her temperature. It is 100.7. Within minutes, the staff returns with an I.V. antibiotic drip. With in an hour Mom starts to respond weakly to our questions.
By the evening hours, she is becoming more responsive. She communicates to us that she had very bad nightmares. The visitors at bed 1 had been loud and used some vulgar language the day before. Mom is a devout Christian and gets upset when she hears what she refers to as "cursing and swearing " She had not slept well on Wednesday night and early Thursday morning had been having a nightmare when the staff woke her up.
Mom did not have her glasses with her. She was in a hospital room that is set up to care for morbidly obese people. It has systems on the ceiling to attach lifts and pulleys to aid the staff in lifting obese patients. Some of the lift equipment was on the wall next to her bed. With out her glasses that equipment looked liked knifes to her. She was frightened and indicated to us that she would like a different room.
We requested a different room at the Nurse's desk. They quickly came and moved her to a private room, although we a not requested "Private ", only "different."
We felt that something was not right, although we are not sure what it is. My daughter and I decide to stay all night with Mom.
Mom stays on the Bi Pap machine all night. She sleeps extremely sound and does not wake up until 8:00 AM Friday morning. My older brother arrives to the hospital during the night (about 2:30 AM ). He sees that my daughter and I are with Mom and goes to his hotel, planning to arrive the next morning to relieve us.
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A decision is made by the nursing staff to use adult diapers at this time. Mom was humiliated to be in a diaper and dependent on someone to change her. She was looking forward to regaining her strength and being able to use the bathroom on her own.
We are still clueless at this time and assume that the hospital is still competently on top of things. We are relieved that Mom has rallied and never connect the report of her waking up "confused "with the events of the day.
But my daughter and decide that quite possibly she has developed an infection in her lungs ,as we had been warned was possible, and we should stay in the area and take shifts at the hospital, so as not to leave her alone. What was to unfold in the next few days was so bazaar that we could never have prepared ourselves for it.
Friday May 25, 2007
Mom wakes at 8AM and feels better. My brother arrives. Mom eats breakfast. She is very weak but feeling better and breathing better. Everyone seems surprised that she is alive, including her Doctors and the hospital staff. My daughter, my brother and I stay with Mom for part of the day. My daughter and I go home to rest and my brother takes over at her bedside.
Mom was required to use her Bi Pap machine for most of the day, except for the times when she was eating. She also was drowsy for most of the day and had difficulty breathing and clearing secretions, which she said, were in her upper airway. During mealtime, she was able to feed herself but tired quickly. Both lunch and dinner had to be reordered for her because a standard diet was provided and she required a soft diet due to her bottom dentures having been lost.
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Sometime during the day, as Mom got stronger and wanted to eat, we asked the nursing staff for her dentures. We were informed that they had been removed the bottom denture the morning prior, when they thought that Mom was dying. They were most likely "discarded with the dirty laundry". (Thrown away!)
We reported this to the nursing supervisor, who promised to do a complete search of the hospital, including the laundry area.
We never saw Mom's bottom dentures again.
About the same time, Mom started to ask for her 14k gold cross necklace. It had been a 50th wedding anniversary gift to her from my father and she cherished it. It was on her neck prior to "The Death Episode". We were informed that when Mom went into distress that it was also removed. No one knew what happened to it. No one could remember exactly who removed it. That item was not recovered as well.
Wow! They really were quite sure that she would not need her things again.
Mom is still in the private room that she had been transferred to yesterday. (She is a Medicare Medicaid patient with some supplemental insurance, but not insurance to cover a private room) We are amazed that as she feels better, the hospital is quite adamant that she stay in this private room. It is a large room and they have provided us with two reclining lounge chairs. We are using these chairs to sleep at night. The plan is that a family member will always be present and we are documenting all activity at this time.
No one bothers Mom during the night, except for the occasional LPN coming in to quietly check her vitals. Mom is sleeping sound and well. Of course, we are not.
We are feeling very suspicious at this time. Although, we cannot discern the exact reason why.
Could it be ..........................
The Death vigil where all the staff was so certain that mom was expiring at any time...So certain, that no one disturbed us, as we sat around her bed, for hours. In fact, no vital checks, no changing of moms bed pad.
The only time we were disturbed was when they offered to bring us more snacks.
That evening, when Mom rallied, and she was moved to the private room, she was soaked from head to toe from lying in her urine all day long.
We realized now that we had been selected to "hospice her".
The nursing supervisor coming to mom's private room, and bringing us lounging chairs pillows and blankets.
The comments made by one or two of the nursing staff? Comments of how sorry they were about what had happened to Mom???
They would not elaborate further.
It was as if there was something to "cover up" and we could sense it, but it was still not apparent what it was.
So......Apprehensive, but still with some degree of trust, we all decide to move forward and start planning for mom's release. We decide, with her agreement, that Skilled Nursing Care is the next step in her living arrangements.
Saturday May 26 2007
We are moving Mom's possessions out of the Assisted Living Facility where she has lived for the past 21 months today. My daughter, my brother and I visit with her in her hospital room before we start the move. She seems to be improving; she is getting out of bed for her meals.
After moving her possessions from the facility, we go back to visit with her at the hospital. She is out of bed and feeling better. My daughter and I go home. My brother will be staying with her.
My brother reports to us later that Mom is using the nasal canula and does not need the Bi Pap except when she is sleeping. She seems alert and regaining strength and brags about how good her memory is. She says the alphabet backwards. She is still in the chair when he leaves at 8:00. ( Everyone, including the hospital staff, so no need for a family member to stay all night)She has improved appetite with both meals today and her breathing is much improved over yesterday. She has been sleeping soundly through the night without being disturbed by staff, and has been wakening with much improvement each morning
Sunday May 27, 2007
I take the day off. My brother is staying with her. He reports to me that Mom is doing well. They are having nice conversation. Mom is eating her meals. They talk about family history, her old neighborhood, and conversations that she has had by phone the last day or two, with her friends. They talk of her next move to a Skilled Nursing Facility. Although she is concerned about the expense of living there, he reassures her that everything is being taken care of and she need not worry about finances. She is very lucid and has better recall of the previous hospital events than we do. She has been very alert to what has been happening. Mom tells my brother that she feels much better.
My brother reports to me that:-
She is able to be out of bed and in a chair for most of the day. She still has a lot of congestion in the AM but feels that the new breathing treatments are helping. In the early evening, they have a conversation about old neighbors and events that happened when he was younger. She remembers details that he had forgotten. Her voice is significantly stronger than it has been, and she is able to maintain extended conversation. She talks about the 1st event in which she was given an injection of some medication during the early hours of the morning and how she had trouble that night because the roommate's family had been in to visit and had been loud and used vulgar language and profanity. They had frightened her. During the night, without her glasses the hoists hanging from the ceiling had reminded her of dangling knives when she had been half-asleep and she had felt afraid and disoriented. She was worried that something like that would happen again. She felt that the injection that she was given was to blame for her coma like condition that day and that she was just starting to feel "herself" since that incident. My brother reassures her that her room is safe. She seems to be of calm spirit when he leaves at 8:00 to have dinner and go to his hotel room for some rest.
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Never in a million years would I have believed that this was the last peaceful day that my mother would experience in her life.
As a family, we were all well aware that mom was 84 years old and had health issues. She had chronic conditions had been under the care of her medical team for years. None of those conditions were "life threatening" of there own accord. But the management of her medications and carefully watching her lab reports was crucial to her overall well-being.
If mom had expired that night from her existing conditions, we would have accepted, mourned and moved on.
But the reality of the last week of her life and the events that unfolded have haunted us all very deeply.
This would be our last night of peaceful sleep for quite some time.
Monday May 28,2007
I receive a call from the 6th Floor Nurses desk at 6:07 AM. The nurse identifies herself as xxxxx. She states that the staff had woke Mom up for treatment at 4AM and is that she is confused and resisting treatment. Nurse xxxxx states that Mom became combative and that she injected her with Haldol. Mom was asking for her family. Would I talk with her and calm her down?
I said that I would try. When my Mother came on the phone, she was very alert and did not seem confused.
She said, " Honey, they are treating me nasty. Call your brother at the Hotel and tell him to come quick. Tell him to bring the police. They are abusing me. They put gloves on my hands. I am tied to the bed.
I called My Brother with my cell phone. My Mother is still on the other phone pleading with me to get help. My brother said he would go immediately. I got up to leave for the hospital as well.
Brother I arrive at about 6:45. The nurse on duty approaches me and tells me that Mom was combative during the night and they had to administer a sedative and apply restraints. Mom's arms are restrained to the bed by gloves and ties on each side. She appears sedated and initially acknowledges my presence by saying "they were terrible to me." She is not on the Bi Pap but a regular O2 mask. When I asked what had happened she said, "It was awful but it's a long story, I can't tell you now." Then she becomes unresponsive. Because of my personal experience with sleep apnea, I notice that she is having difficulty breathing. She takes ten breaths in which there is air intake then for five breaths, she struggles and I cannot hear intake - it appears that these are apneas. I tell the nurse who comes in and says this is not a problem because her O2 level is maintaining. Mom appears to be distressed when she is not having air intake and I request that they put her back on the BiPap to assist with the breathing. The nurse advises that this has not been ordered and she cannot do so. The respiratory therapist comes in for a breathing treatment and I advise her of the breathing difficulty and again request that she administer the breathing treatment through the BiPap and she indicates that this is not necessary. During this early period, the Nurse Practitioner from Mom's primary care Doctor's office arrives and I note to her that Mom had been sedated during the night and was very groggy. Mom became aware of the NP and responded to her questions, them went back to sleep when she left. Her disrupted breathing pattern lasted into mid morning then she seemed to be breathing regular with air intake on each breath. Through the rest of the morning, until I have to leave around 1:00 she remains unresponsive.
I arrived at about 8:30 AM. Mom was unconscious and was in great respiratory distress. Her Breathing was in gasps and pauses, exactly like Thursday when her family was called to her dying bedside. Her heart rate was again very irregular.
We asked the nursing staff to explain what had happened. The Staff informed us that Mom had become combative. (Very out of character for Mom) and had been given a sedative called Haldol.
As we sat there, we slowly began to realize that Mom had apparently been overdosed and that this seemed like the exact same situation that we found ourselves in the previous Thursday morning.
By now, My daughter had arrived to join my brother and me. My brother needed to get back to his home across the state. He had obligations for the next day. I promised to stay with her, day and night if necessary, until she regained consciousness. Mom is breathing irregular and labored.
She was in a coma like state.
Her Pulmonary specialist arrived first during rounds. He was shocked to see her in this condition. We explained what had happened to her to the best of our ability. He was very angry. He goes to the nurse's station, which is directly outside of mom's room. We hear him reprimanding the nursing staff in a very loud voice. Although we could not make out all of his words, we do hear him demand an explanation for what has happened.
He puts mom back on the Bi Pap machine.
Her primary care Doctor arrived. She walked into the room, her mouth dropped open and she exclaimed, "What happened?"
My daughter and I proceeded to tell her of the events as we knew them, starting with the phone call to me by Nurse xxxxx, that morning. At this point my daughter and I are so distressed that we are pleading with her to "Please help us before this incompetent hospital kills our mother and Nana".
Dr MiXxx XXXx looks shocked. She goes to the Nurses Desk and returns with Mom's chart. As she reads the chart, I can see the blood drain out if her face. She looks at us and states " Your Mother was given two injections of Haldol this morning. She reads the chart from front to back. She looks even more distressed. She states. "Your mother was also given an injection of Haldol on Thursday morning. When I came in to see your Mother on Thursday morning, I found her turning grey and in great respiratory distress and ordered the BiPaP machine. I really thought that she was dying. I had no idea that she had been given Haldol. I never would have allowed her to be treated with that sedative. In addition, it concerns me even more that it appears as if the second injection of Haldol was given after family was contacted. That would be very inappropriate. She makes a note on Mom's chart in large, bold letters....... No Haldol.
Dr. xxxxx xxxx goes to the nurse's desk to investigate the situation. She returns to inform us that the "On Call Doctor" gave the order for the Haldol Injection. She states that all we can do at this point is allow the drug to come out of her system. When Mom received 2mg. of Haldol on the previous Thursday, she was unresponsive for about 12 hours. Dr. xxxxx xxxxxx expresses to us that she expects that she will be unresponsive for at least 24 hrs. This time Mom had received 4mg. of Haldol.
Mom continues to struggle and battle the effects of the sedation.
Mom's level of unconsciousness seems much deeper this time. Much greater than the Haldol experience of last Thursday. It seems to take an incredible effort for her to breathe even with the assistance of the Bi Pap machine. Many times that day her breathing stops for 20 or 30 seconds at a time and then starts again with a gasp. It is heartbreaking to watch her struggle to come back from this latest assault.
How much can her poor body take? We are angry and horrified. We truly do not know if mom can fight this second deliberate drug overdose.
We express our anger and fears for mom's well being to the Nursing Director.We are advised to file another complaint with the patient's rights representative in the morning.
My younger brother and his wife arrive. We fill them in on what has been happening. They are also in shock and immediately go to the nurse's desk searching for answers.
But by this time it is too late for answers....
It seems as if everyone now, with the exception of two or three sympathetic nurses, has been instructed not to give out any information. This is when we start to request to view my mothers chart whenever it is brought into the room.
My daughter and I stay all day. We talk with zzzzz zzzzzzz the Nursing Director. She brings extra lounge chairs to Mom's hospital room to allow us all to recline and sleep that night. A few sympathetic nurses and aides come in to tell us how sorry they feel for us and to ask if we need anything. We are once again advised by some staff that in the morning we should go to ddddd ggggg, the patient rights representative and file a compliant.
Mom is unconscious all night.
We are in a state of fear, disbelieve and exhaustion.
What is happening here? Are they so short staffed and impatient that they would prefer putting their elderly patients into life threatening comas instead of coping with a confused elderly patient who is awakened from a deep sleep during the night? We are now beginning to see the whole picture. Some of the nursing staff are very sympathetic to the situation and see how we are in a state of confusion and disbelieve ourselves. They try to guide us in what action we should take ,but the hospital has already begun to silence it's employees.
Haldol is a major antipsychotic drug indicated for the treatment of schizophrenia.
Haldol is contraindicated in patients with Parkinson's disease, cardiovascular disease and respiratory ailment and can cause respiratory depression and possibly death, especially in elderly patients who are sensitive to the medication.
Tuesday May 29, 2007 AM
We all wake up at dawn Wednesday morning
Mom is still battling sedation. She is still breathing irregular. Her heart rate is still all over the place. It can be 90 one second and 150 the next. She is still on the Bi Pap machine to assist her breathing. She has brief seconds of responsiveness. When she is awake, she is very scared. You can see the terror in her eyes. I have never seen my Mother like this before.
She asks us repeatedly "Why did they do this? It was terrible ".
My daughter and I meet with the Patient Representative. She makes note of our complaint and tells us that she will start an investigation. She spends time at the sixth floor nurses desk that afternoon .The Representative comes into Mom's room to talk to her about the experience. Mom is trying to tell her story, but she is still fighting the Haldol overdose and is talking in fragments. She expresses to the representative that she had been violated during the night. She keeps repeating..."XXXX did it XXXX did it" She gets very upset, and talking about what happened to her makes her heart rate skyrocket. We decide to give it a day or two to allow her to regain full control.
PM
Mom is starting to respond. She c
