Healthcare in America, Las Vegas Style

Entries in medical, healthcare, doctors (7)

The Hardest Discussion to date

My Dad has always been an active guy. West Coast Judo champ, judo teacher, runner, he tried to keep himself in good physical shape. But the years took their toll and after his stroke in 1995, he ultimately ended up in a wheelchair. Even then, he made the best of the situation, zipping around the house and the yard doing his chores. As diabetes took its toll, he often wondered what would happen to his feet. A small cut or infected toe nail could spell disaster. Since he couldn't feel his feet he was often nicking them on shrubbery and stubbing them on doorways. He maintained he would hate to lose them.

I was reminded of this as I drove back to tell my mom what Dr. Holland had said. Dr. Holland had agreed to come back the next morning to tell my dad that he would be losing his right leg, hopefully below the knee. The orthopedic surgeon would have to come in and take a look before deciding how much of the leg my dad would get to keep.

My mother took the news stoically. She worried that Dad would take the news badly. The next morning we were at the hospital by 8:30 am to wait for Dr. Holland. Dr. Holland came through about 9:00 am. Dad was awake and listened as Dr. Holland explained how the vaso-suppressors had kept him alive but at what cost. Remarkably, Dad took the news better than any of us expected. Dr. Holland said he would call the Orthopedic surgeon to come and take a look at Dad and set up surgery. Serena took Mom home and I spent the day with Dad waiting for the Ortho surgeon. He remained in good spirits which I took as a good sign. By the end of the afternoon the surgeon had not come through. I asked the nurse to leave a note in the chart for him to call.

The next morning I went to see Dad. The surgeon still had not come through. We were getting a little irritated at this point. Dad had a wet cough and was trying to cough up phlegm. I was finally able to convince the nurse to get him a suction tube. As he was on dialysis, the nurse didn't want to set him up any further in the bed because she was afraid it would kink the dialysis line. Once she left, I asked the dialysis tech if there was a work around. The Dialysis tech and I raised Dad up a bit in the bed and the tech made sure the line didn't kink. This seemed to help Dad with coughing up phlegm.

Again, I waited all day with Dad for the surgeon. Still no surgeon. By now, we were very irritated and Serena wanted a new surgeon. I said I would call Dr. Holland's office first thing in the morning and find out what had happened.

Dad was sleeping when we left. I went back to the house and gave my mother an update. She was tired.

At 12:15 am the phone rang. There is nothing as heart stopping as hearing the phone ring in the middle of the night when you are dealing with a medical crisis. Barring a wrong number, it is never good news. It was Annabel the nurse. Dad had coded.

We jumped out of bed, threw on some clothes and hurried to the hospital. The only upside was that the streets were nearly deserted so we were able to get there very quickly, ignoring the speed limit and red lights.

They had gotten the crash cart and brought Dad back. He was resting by the time we got there. On television was Keifer Sutherland as Jack Bauer. I said a quick prayer of thanks. Serena decided to stay awhile with Dad and I took Mom home.

The next morning I called Dr. Holland's office, gave them an update about Dad coding and asked about the Ortho surgeon. There had been a miscommunication mishap in getting word to the Ortho surgeon. The surgery was scheduled for Wednesday evening. I told them that was fine but we wanted to see and talk with the surgeon before Wednesday. I didn't want for Dad to go into surgery not having an idea of how much of his leg he was going to lose. That just sounded wrong on too many levels. They assured me that the surgeon would be through sometime today.

Again I waited. It's amazing the amount of time you spend waiting for doctors in hospitals. Everyone's time seems to be of value except ours, the ones waiting to talk to the doctors. And, too often, you are forced to sit there and wait because it is the only way you are assured of getting your questions answered and finding out what is going on. Leaving notes in the chart for the doctor to call does not insure that you will get a phone call. Leaving a message for the Doctor at his office or with his service is no guarantee that you will get your phone call returned. The only way to guarantee talking to the Doctor is to sit there and wait. You would think this being the 21st Century and with all the technology we have to communicate that there would be a better way. The reality is there isn't. Be prepared to sit and wait.

The surgeon finally came through about 6:30 pm. There was no denying Dad's foot looked awful. It was turning black and a couple of the toe nails had split. The surgeon and I had a talk about how much of the leg Dad would lose. The surgeon assured me he would only take as much as needed. He hoped that it would be below the knee but he wouldn't know for sure until he got in there. He looked at Dad's other foot and commented that Dad would likely lose that one as well. This was a surprise because everyone else was talking about how that foot seemed to be recovering.

On Wednesday evening, Aug. 22nd, they took Dad into surgery. Mom, Serena and I waited. Less than an hour later the surgeon returned to say that all had gone well. He was able to take just a portion of Dad's leg. He talked about Dad recovering and being fitted for a prosthetic.

We went back to ICU to wait for Dad to brought back upstairs. His leg was wrapped up with a note written on the bandage with the date scribbled for removal. We left him sleeping.

The next day he seemed very foggy. There were moments when he remembered what had happened and others when we had to remind him that he had just had surgery and the reason he was in pain was because of the loss of his leg. It broke my heart each time I had to remind. He began to run a fever and his white count increased indicating an infection. Here was this mountain of a man who couldn't seem to catch a break.

I spent Saturday with him. It was my Mom's birthday. The first one he had missed in over 40 years of marriage. He was able to sign the card that I had picked up for him. Towards the early evening I started talking to him about going to see Mom and that I would see him in the morning. He told me no I wouldn't it. I asked him where he was going that he wouldn't be there in the morning. He would just shrug. I began to think of what he was trying to tell me.

We have all heard stories of people who seem to know when Death is pending. This conversation with Dad spooked not only me but Serena as well. Was Dad trying to tell us that his time was at hand? We weren't sure but agreed we would not tell Mom about this. Before leaving, I found 24 on Channel 5 (it was Saturday after all) and left Dad in Jack Bauer's capable hands.

I called Jon and told him what had happened. He agreed that it seemed spooky and we were all concerned that Dad, having come so far, might not make it through the night.

We had a very low key birthday celebration for Mom. My brother called from Australia and we updated him on what was going on. He said he would come home as soon as possible.

Posted on Sunday, November 25, 2007 at 1:36PM by

LasVegasLynn in medical, healthcare, doctors |

Stop Babying Him

I am at Harmon Rehab the next morning about 11:30. I have plans to return to Los Angeles after checking in with Dad and making sure everything is okay.

When I get there, he is laying almost on his back. Knowing that is very uncomfortable for him, I raise his head up and ask him how he is doing. He says he has bad heartburn. I ask if they have given him anything for it. He says the food sucks and they gave him some Maalox earlier but it's not having any effect. He also is trying to cough up phlegm and says that he still does not have a suction tube.

I go out to the nurse's station to talk with his nurse. She says they gave him Maalox. I tell her he is still having bad heartburn and the Maalox isn't helping.

Is there something else we can give him? Maybe some Zantac?

Well, they have to have the doctor's okay to do that.

Well, how about calling the doctor and see what he says, I suggest.

She says she will try to find him.

Is he in the facility or not?

She's not sure.

While I wait for her to find out, I ask about the suction tube and am told that someone from Respiratory has to evaluate him.

I go back to his room. A few minutes later, a young woman comes in. She is the Respiratory Therapist.

I explain that he needs a suction tube.

She asks why.

I tell her that he is weak and has a hard time coughing up all the phlegm.

My hand to God, she tells me that we have to "stop babying him". She has worked in many hospitals and she knows that all they do there is baby their patients. Now that he is here, we have to stop babying him and get him strong enough to be able to go home.

I tell her that is all good and fine but that he had surgery barely a week ago and is still very weak. A suction tube would help him cough up phlegm.

Again, I am told to stop babying him.

She says she will do an eval, consult with her Supervisor and let me know what they decide.

Fine, do the eval, I say. The sooner, the better.

She listens to his chest, his lungs, takes his pulse, asks him to cough. He does so weakly, complaining of heartburn.

Serena comes in and I explain what has happened. The Respiratory Therapist leaves but not before telling us that she will be back to let us know what they decide.

I go in search of the nurse to find out if they can give Dad some Zantac. The nurse says they are still waiting for the Doctor to call back.

Serena offers to go to the near-by 7-11 and get Dad some Zantac. It seems the fastest solution.

While she is gone the Respiratory Therapist comes back to say she was right. No suction tube is needed.

I bite my tongue.

She leaves.

About 15 minutes later another Respiratory Therapist comes in. She performs the same eval as the first one. Her reaction, however, is very different. She says that Dad needs to be moved to another wing with oxygen portals on the wall. She rushes out to the nurse's station to find out if there is a bed available in the right wing.

Serena returns. We are both concerned by the very quick turn of events. The second Respiratory Therapist comes back in and says there is a bed and he has to be moved NOW! Two other nurses come in and they try to move the bed. The bed won't move. The wheels are stuck in the immobile position. Another nurse comes in. For a few minutes they are more concerned about the bed than Dad. He is now complaining his chest hurts. ALOT.

While the comedy of errors about getting the bed to move continues, the Doctor shows up. He listens to Dad's chest and lungs and pronounces Dad in congestive heart failure. The Paramedics are called. Serena tells Dad not to worry, the Paramedics are coming and we will be going back to the hospital. The Charge Nurse scolds my niece, telling her that only the Doctor can make that pronouncement. Serena tries to explain that she is trying to keep Dad calm. The Charge Nurse continues to scold her.

The Paramedics show up and get him hooked up to oxygen. I explain that he had come from Valley Hospital just yesterday and we would like for him to go back there. They tell us that it is doubtful that he would survive the trip across town. Desert Springs Hospital is just around the corner. We are going there.

They get Dad on the gurney and we all fly out the door. From the car, I call Mom and tell her we are on our way to Desert Springs Hospital and why. I call Jon and tell him.

All I can hear in my mind is that Respiratory Therapist telling us to "Stop Babying Him". In less than seventeen hours in this facility, they have managed to undo the last month's progress and Dad, again, is fighting for his life.

Posted on Sunday, November 25, 2007 at 4:46PM by

LasVegasLynn in medical, healthcare, doctors |