Saturday, January 31, 2009
How to Kill an Old Lady
I haven't blogged in a few days, because the world fell apart.
Tuesday, Day 1:
My 93-year-old grandma woke us all up frantically searching for "the kids" - three kids she used to babysit forty years ago. I assured her they were sleeping, just to talk her into sitting down so I could take her blood pressure. While she'd never shown signs of dementia before, so she was making up for lost time now. 197 over 99. Off to the ER. Immediate diagnosis: stroke. One EKG, EEG, and CT scan later, no stroke. In fact, her EKG and EEG are both good, and her CT scan is clean. They admit her overnight for observation. She's in good spirits, and laughing about her "episode", reminding me to "keep an eye on those imaginary kids."
Wednesday, Day 2:
They can't keep her blood pressure down, she has a UTI, and her labwork indicates something's off kilter. Abdominal MRI scheduled for tomorrow morning, and another on her brain right after, just to be safe about the stroke/not stroke thing. Abdominal MRI scheduled for 8 a.m.; no food or water after midnight (because it's her abdomen).
Thursday, Day 3:
8 a.m. comes and goes, and no call to go downstairs. (Remember, they're not feeding or watering her.) In fact, transport doesn't show up until 6 p.m. and they didn't call ahead as ordered so her nurse could administer Ativan for the hour-long procedure. They just stole her away. She's forced to lay flat on her back (something she's been unable to do for five minutes since a fall down a flight of stairs years ago) without being medicated. Results: Cranial MRI postponed to day three, a blurry but worrisome abdominal MRI, and one starving old lady in such unbearable pain she's unable to move or feed herself.
Friday, Day 4:
Cranial MRI conducted in the morning (with Ativan this time, but only because my mother was there to stop Transport from stealing her away again - again, they had neglected to call ahead), renal angiogram scheduled for afternoon. No pain meds because they'll have to sedate her for the angiogram. Transport arrives to take her to the Cath Lab for the angioplasty just as Transport arrives to take her for a CT scan someone has ordered STAT. Who ordered another CT scan, and why? Nobody knows where she should go first, or what's going on. 30 minutes later, orders for the CT scan are confirmed - this morning's cranial MRI shows signs of intracranial bleeding. ("We want to assure you: a neurosurgeon has been called in." Assure us?) She'll go to the CAT scan first and then straight to the Cath Lab for the angiogram. Think it worked out like that? Haven't you been paying attention?
First there's the agonizing transfer from bed to gurney, then from gurney to CT "machine". Then back to gurney. THEN transport insists her angiogram has been cancelled (in spite of our having been assured it has NOT) and they insist on taking her back up to her room. When they exited the elevator back on her ward, my mother hailed the nurse on her way past, and stepped between transport and the gurney. "You are NOT taking my mother back off this $%&*#@% stretcher! She has to be downstairs in less than 45 minutes." To the nurse just arriving in the room, "You get on the phone and get this $#!% straightened out NOW!" Twenty minutes later (and do we care how pissed Transport is?) they're headed down to the Cath Lab for an angiogram that had NOT been cancelled. Results: 70% blockages in both main renal arteries, and two stents to open them back up. Surgery is successful, and once sedation wears off, she is allowed Darvocet for pain.
When we get back to her room, her neurologist is there. He advises us that this CT scan isn't clean, but it isn't conclusive either - her brain could've been bleeding earlier and maybe now it isn't...or maybe it is. It could be something that just looks like blood. Some kind of protein, or possibly a tumor. We have to do a lumbar puncture, scheduled for tomorrow between 8 and 9 a.m. If her CSF (cerebrospinal fluid) contains blood, we'll have our answer right away. If it doesn't, it will be tested for other abnormalities. If the tests are inconclusive, we will have to perform another angiogram, this time on her brain. (He assures me, they will not actually enter the brain, just the arteries at the base of the brain. How reassuring.) Her age and condition mean that not just "any doctor" can perform her lumbar puncture. It will have to be done by the radiologist, and under flouroscopy (x-ray) to prevent mishap. Now THAT'S reassuring.
Saturday, Day 5:
Sometime after lunch (maybe 12:30, definitely not between 8 and 9) Transport arrives to take her for an MRA. OK, what the hell is an MRA, she's supposed to be going for a lumbar puncture. Transport doesn't know anything, and the nurses are just about as pissed as we are. They actually call (without prompting from her now paranoid family) to confirm that this is not another mistake. Nope, it's the real deal. An MRA is an MRI on the blood vessels of the head. Turns out the results of the MRI and CT scan together indicate further intracranial bleeding, in a different part of her brain. So she's off for the lumbar puncture, with Xanax administered first (right this instant, except the procedure is in less than ten minutes and it won't go into effect until they're done), and then straight to Imaging for the MRA, with Ativan administered enroute.
LP goes off without a hitch...except for the screaming we can hear through the walls. Then Ativan and an hour wait outside Imaging...only to find out her surgeon didn't note in her chart the details of the stents he implanted yesterday. "She should've been given a card with this information. Did she get a card?" Um, let me think about it...NO SHE DIDN'T GET A DAMNED CARD OR I WOULD GIVE IT TO YOU. Well, Imaging has to know what brand, what kind, medicated or unmedicated, steel or another material. They can't do the MRA without knowing. But today is Saturday; guess who isn't on call this weekend. Yeah, her surgeon. Imaging contacts the Cath Lab, her nurses upstairs, even the supplier (whose business hours are Monday through Friday). Nobody knows. Nobody can find out. Procedure postponed. Grandma is laying on a stretcher in the hallway, stoned out of her gourd, and still crying with the pain. They don't expect to have the required information until Monday. And she may or may not have a brain bleed that could kill her before then.
I have avoided mentioning the name of the hospital or any of her doctors. Don't get me wrong, her neurologist has a wonderful bedside manner; he took the time to listen to and answer completely every one of our many questions. Even the surgeon who performed the angiogram-turned-angioplasty was great - until nobody could obtain any details of the stents.
I've never encountered anything like it. I don't know who to blame for this Three Stooges approach to medicine. I hope that tomorrow brings a change in procedure. I don't want to feel like we should be considering litigation.
(Original photo by otisarchives2, some rights reserved.)