Carilion, we have a problem

From the time my mother’s housekeeper found her unconscious on the floor of her home, a team of medical professionals moved quickly to save her life.

The Floyd County Rescue Squad responded swiftly and stabilized her. They were concerned about an erratic heartbeat and sky-high blood pressure and got her to the Carilion New River Valley Medical Center in record time.

At the hospital’s emergency room, the staff moved quickly to x-ray her for injuries and bring her vital signs under control.

The doctor who first examine her wanted to know if she lived alone. Yes, I replied, she does.

“Not good,” he said.

I couldn’t agree more. At 87 and suffering from advanced osteoporosis, emphysema and other ailments my mother needs constant attention but she has resisted all efforts by my brother and I to provide in-home medical assistance or other alternatives.

The hospitalist, who makes decisions on admissions, wasted no time in hospitalizing her.

“We need to stabilize her and then think about rehabilitation and her long-time needs,” he said.

Over the next two days, they pumped her full of fluids, antibiotics and other medications, got her sitting up and a she spent an afternoon with the hospital’s physical therapist.  He found she take only five small steps with a walker before exhaustion set in.

“She needs rehabilitation and extensive therapy,” he said.

It took two nurses to get her out of bed and into a chair to eat and then two to get her back into bed. They had to move slowly and carefully because of extensive pain from the osteoporosis.

“It’s obvious she cannot continue to live alone,” one nurse told me. “She needs rehab.”

My brother, a radiologist at another Carilion Hospital, agreed. Everything seemed to be on-track to transfer her to a rehab facility as soon as she regained her strength.

Then I walked into the hospital Friday morning and found that a doctor had told her she would be discharged that day and sent home.

Asked a nurse what was going on.

“We’re not sure,” one said. “Some of us are surprised.”

While I was on my way to the hospital Friday, one of the facility’s social workers called our home and — in a cheery voice — announced that my mother would be discharged later in the day and sent home.

The doctor in this case was an “attending physician,” hospital-speak for a staff doctor who makes rounds, reads the chart and makes medical judgments on the fly without much — if any — interaction with the patient.

The doctor had seen my mother twice for a total of about five minutes. He talked with her on Friday morning and asked her if she wanted to go home. Of course, she said “yes.”  Like most of us, she hates hospitals. Then he left her in the hands of two nurses who had to struggle to get her out of bed to eat lunch and then work for more than 30 minutes to get back in bed where she immediately fell asleep from the exhaustion of getting up to eat a meal.

For three days, medical professionals who had far more interaction with my mother reached just one conclusion: She would need extensive therapy and rehab to see if they could get her strength up enough to return to some semblance of a normal life. Then all their work and evaluation went down the tubes because of a “drive-by” analysis by a hospital-employed physician on rounds who sees dozens a patients a day and makes snap decisions on the fly.

The social worker, who spent a few minutes with my mother on Friday morning, bought into this farce by announcing that mom “appeared lucid” when she discussed going home and added that she suggested “home health care” that my mother “should consider.”

My mother is a proud, independent woman who would say anything to avoid going to the hospital, staying there or accepting anyone in her home. Over the past two years, she has gone through a series of home health care pros. None measured up to her standards. Her lucidity is directly related to the pain. When the pain increases, she loses track of reality.

I struggled to control my temper as I dealt with this churn and burn approach to health care. No way was I going to let them ship my mother back to the very environment that put her in the hospital this week. I lost my cool a couple of times but regained it while remaining firm. When I pushed, those who wanted to send her home to die backed down and agreed for a transfer to rehab.  We’re moving her to a rehab facility and — with care and luck — she may be able to find a solution that will provide some dignity and quality of life as she lives out her final days.

A doctor friend tells me that the average McDonald’s fast-food restaurant is more organized and efficient than most hospitals. Another says the only difference between the Boy Scouts and a hospital is that a Scout troop has adult leadership.

A number of good, dedicated medical professionals worked hard this week to save my mother’s life: the Floyd County Rescue Squad, the emergency room staff, the nurses on her wing and a concerned physical therapist. Then a drive-by analysis by a doctor who barely took time to read her chart or the notes from others who spent more time with her almost destroyed all their good work.

There’s something fundamentally wrong with a system that works in such a way.

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7 thoughts on “Carilion, we have a problem”

  1. We’re going through parallel experiences right now, Doug. My mother, who also has osteoporosis and is currently suffering from a cracked vertebrae from it, can barely walk and doesn’t accept help easily. My sisters (They all live in Mass.) are at their wits ends with the health care shuffle. It’s all very challenging and I do understand your frustration.

  2. Doug – Your mother is so fortunate to have you and your brother to serve as her advocates. Far too many people lack the support systems to ensure care is coordinated and meets their true needs. in As you found, there are hardworking, caring professionals who do their best. Then there are the beancounters of the corporate medical side of things…. Somehow the humanity gets lost in their bottom lines. Take heart in knowing that you can still find those who will listen and help you get the best possible care for your mother — but it won’t be easy.

  3. Doug,
    My mother’s 93 and living alone at home as your mother insists. My brother and I have done all we can to talk to her and bring her to understand she needs assistance. No soap. She won’t hear of it.

    I wasn’t three lines into your post when it dawned on me that I’ve been there and done that. It’s very hard to deal with when you don’t have the legal power nor do you want to institutionalize her.

    Hang in there, brother. Believe you me, I understand your trials.

    Jim Connor

  4. Unfortunately until the profit driven insurance industry is eliminated from our health care system this type of thing will keep on happening. There is enormous systemic pressure upon attending physicians to follow insurance company hospital admission/discharge guidelines and standards. Their paycheck and continued employment depend upon their obedience to these standards. Unfortunately, the standards are profit driven and not based upon what is the treatment that is needed to return the patient to good health.

    Personally, I think that certain sectors of our economy (such as health care) should not be profit driven.

    I hope your mom gets the best of care and recovers soon.

  5. What you describe is appalling, and borders on criminal as far as I’m concerned. There should have been regular staff meetings about this patient, her prognosis, her care plan with the social worker playing a prominent role in the process. His or her role should have been one of patient advocate, the fact that he/she advocated for the hospital is what I find criminal. What happened to “first, do no harm?

  6. Doug,

    I could tell ya stories…. endless hours in a waiting room with my girlfriend, who obviously had a blood clot… hours waiting to see the nurse, then hours waiting to see the doctor. She was diagnosed with a blood clot. She goes to the HCA hospital now.

  7. Another incredulous story-my son-in-law’s grandmother was in a 5 star NH -highest rated. She was in a wheelchair and on Medicaid. This 5 star Jewish NH had her Baker acted as “suicidal” because she said she wanted to die. She literally couldn’t get out of wheelchair so there was no way she could kill herself. The EMTs were incredulous but transported her to Baker Act facility where they , of course, said she was inappropriate for being Baker Acted. The NH refused to accept her back as they had already given her bed. away (I’m guessing to a pvt. pay) A Hospice program accepted her & she died peacefully a short while later.
    She had been a patient at this NH for over a year yet they manufactured this reason to remove her. The sad part is this is the #1 rated nursing home in Jax. Fl.
    Be sure your mom is in a good rehab but I would look into a Hospice program for her-there are rehabs that are in name only and w/ her dx. there is little chance for true rehab but an excellent opportunity to ease her final days through a Hospice program.

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