All the best medicine in the world is of no avail if a patient is not understood, or overlooked, or gets lost between shift changes. World class health care is useless without consistent input and feedback between Dr. and patient; and I mean more than the Dr. reading off test results and the patient grunting "Uh-huh" in the 3 minutes they spend in dialog every morning at O'dark 30.
My mom developed a very serious complication during a rather routine surgery last week and almost bled to death. The surgery, a gastric bypass, would help her shed many extra pounds- which would reduce the strain on her kidneys, lessen her need for insulin, and hopefully extend her life. Instead the Dr. uncovered a failing liver, mom bled out when a key incision was made, and the bypass had to be abandoned. Next, my mom went into renal failure and was on the verge of dialysis. She required a blood transfusion. Once the kidneys began to slowly function again a strange thing happened...my mom's mental status went completely down hill.
Now I know that people become easily disoriented in a hospital. I know some patients wake up in a panic because they don't know where they are, or are so exhausted from the sheer unrest which exists in a hospital environment they can barely remember their own name. All of these things I could have understood if my mom had slipped into the gray area of being merely disoriented, but alas- she seemed to have fallen into a deep black hole and for a while I was truly afraid I had lost her in a way I had never imagined. She was out of her mind.
Her mother, my grandmother, has been dead for almost 30 years. In the middle of the night I heard my mom "talking" to her mother. Several times my mom tried to get up (thankfully she was to weak to do so) because she told me she was in my sisters bed. She thought my other sister was a white hissing cat who jumped out of the wall. Mom said there were 2 men in the room over in the corner behind her and they were watching my sister. The worst part was when the sun finally arose and I saw my mom's face- her eyes specifically, glazed over, unable to focus, she knew who I was, but had lost all hand eye coordination. And worse than that, was trying to explain the Dr. who was an intern and had never met my mom before that something was very very wrong. All he saw was a groggy patient who'd had an unsuccessful surgery and her wounds were healing nicely. He completely dismissed my fears about her hallucinations and talking out of her head.
I wanted to beat the man within an inch of his arrogant life.
It really wasn't until the respiratory therapist came in to see mom that we got the attention we were looking for. Thankfully it was the same therapist who had seen her the day before while my mom was in her normal state. On this day she was alarmed to find my mom was "not the same patient" that she had been a day earlier. Dr's were paged, more blood work was done, and they soon discovered her CO2 levels were very high. Add to this the morphine she'd had earlier was still trapped in her body because of the decline of her kidney function. To much carbon dioxide in the blood causes a patient to act drunk and out of their head.
Within 48 hours mom returned from her abyss and was clear-headed once more. All the care she received in the hospital was top notch, her nurses and medical staff (aside from the one intern) were caring, patient, attentive, and helpful. I felt she was given the best care possible, except for the fact they didn't really know her (and how could they?)- and the key signs of her mental decline could not have been perceived by anyone other than a close family member. This is the 2nd time I've witnessed a patient's dire need for a caregiver in order to receive proper support. Had my sister and the respiratory therapist not insisted something was wrong I don't know how long it would have taken for her blood chemistry levels to be checked, if they would have been checked at all. A fragile diabetic patient with liver failure and on the verge of dialysis could be easily considered unstable in any number of ways.
It was a tough week being with mom in the hospital. Thankfully we have a big family who were willing to help in any way they could. My sisters and I took shifts, with the 3rd sister Robin taking the lions share of managing her care. My heart aches when I think of patients going to the hospital alone with no one to look over them. Hospitals, as good as they can be, are not places to linger alone. Good helpers make a big difference.
Mom is recovering at home and being well tended to with lots of visits, phone calls, and home cooked meals. Those of you who knew she was ill- I appreciate your thoughts, calls, and prayers. I imagine the road ahead will not be an easy one, but with every step I learn something new.
