Kirsten Is Sick – August 28, 2012

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I had the senior resident, Dr. Windy Wyatt, paged. When she finally made it up to the floor I asked her about the results. There are none. I asked her to put Kirsten on NPO (Nothing By Mouth) so that if they decided to do surgery we wouldn’t lose a day simply because Kirsten had eaten.

The care on R6 is pretty bad. The nurses are mostly kind, but they have lots of patients and little information about Kirsten’s specific needs. It’s frustrating, but that’s the current state of the US sickness industry.

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Kirsten gets another ambulance ride
Kirsten is enroute to Maine Molecular Imaging in Scarborough for another octreotide scan. I’m glad they are sending her to somewhere she can get a better scan, if that is the reason. It’s annoying that nobody seemed to know the scan was two parts, that they didn’t send her to Scarborough yesterday for the better scan, and that they didn’t know today that she was going and had to scramble to find a nurse to ride with her in the ambulance.

In addition to the problems we experienced this morning in her new room on R6, the nurse and CNA sat her up in bed and left her sitting on the edge. She’s not strong enough to arrest a fall and her right upper arm is paralyzed from the neck fracture. Add that to the documented fact that she’s prone to seizures. It was an unacceptable and unnecessary risk. Then, when they lowered her to a recumbent position, they did so without rotation (sideways) and with her neck completely unsupported. The physical therapist wasn’t there, but coincidentally entered the room after Kirsten was laying. Kirsten had a fat pillow behind her head, which was causing her neck to flex inside her collar. The physical therapist incorrectly stated that she would be fine because the collar is providing the stability her neck requires. This is a direct contradiction of the orders from the neurosurgeons.

EVERY single person who entered the room this morning to talk to Kirsten and me admitted to not reading the chart (medical records) because they are still in the SCU.

I don’t blame the nurses. The nurse to patient ratio on the floor is a function of money, not patient care. Insurance companies determine the quality of care, not doctors and patients as uninformed Republicans tell themselves and would like us to believe. Capitalism doesn’t work in health care, which is why we have the highest cost and the poorest results. I digress.

The CNA on the floor brought in a tub of soapy water, toothbrush, johnny that is way too large, a towel, and a washcloth. Then she walked out of the room. They seriously expected her to clean and dress herself. I was/am SO FUCKING PISSED OFF! As I lifted her johnny and began to wash her legs, Kirsten started crying. The biliousness of her condition combined with her sorrow for being a burden to me was more than she could take. I consoled her as best I could, then proceeded to wash her torso and left arm. After I had given Kirsten a not-so-awesome bath and she had brushed her teeth, the nurse came in to help put on a clean johnny Kirsten had in her belongings (the johnnys that fit Kirsten must be specially procured from pediatrics).

Kirsten was told to wash and dress herself

Flowers were delivered from her sister Amy, which was the only bright moment of the morning.

The room Kirsten was in by herself is for noisy crazy patients, so when Kirsten returns she will be in a different room and will have a roommate.

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Kirsten called me this morning, which was nice itself simply because she can. She’s in a double room with a single bed. When she got in last night they did not put up the bed rails and would not let her elevate her head. The orders are for head elevation above 30ยบ for aspiration prevention, and bed rails for seizure precautions. Those are pretty big fucking mistakes. I’m trying hard not to be angry.

A medical student came in and asked a bunch of questions during Kirsten’s breakfast. When she asked if she felt weak and wanted to look at her right arm, I asked her if she was in here for Kirsten or her own training, and to please leave until Kirsten had finished her breakfast.

Dr. Wyatt, the senior resident, whom we have worked with throughout this ordeal, came in and talked to us. She was very excited to see Kirsten in this improved condition. She hadn’t read the chart because Kirsten is officially a patient of the SCU, and they haven’t yet sent up the records.

Then Kirsten’s nurse, Paulette, came in to tell us they want to transfer Kirsten by ambulance to Scarborough for the second octreotide scan today. I’m frustrated that we’re just learning about this now. If they have a better machine, why didn’t we go there yesterday? They have to find a nurse to travel with Kirsten, and are scrambling to get one as they didn’t know of the transfer. Yes, I’m frustrated.

Shortly after Paulette left the room an endocrine resident came in to talk to us. She didn’t have anything new to tell us, and apologized for the deficiencies of care.

A per diem nurse has been called in to ride with Kirsten to Scarborough. They will go around 1100 and be gone for at least two hours.

19 Comment

  1. Kris Lethin says: Reply

    Ever consider going into medical advocacy as a career path? Sad to hear that the transfer didn’t go as smooth as hoped but good to know agent Daniels is on the case. Love you guys.

    1. I have really enjoyed the learning curve the past week or so, and would love to be a doctor, I think. In my next life, perhaps.

      1. Kris Lethin says: Reply

        Socialized medicine is not better my friend. I think in the final analysis the best care always comes from a loving partner like you. We will all need to become more self/partner reliant as the government wastes more of our cash on burdensome beurocratic infrastructure. More cash will be spent to provide less true care. It is a frustratingly scarey slippery slope into acceptence of a larger amount of lower standards. Excellence is always internally motivated. You are doing an excellent job because you care deeply for Kirsten. There is nobody more suited to provide care than you. Love you guys.

        1. The problem with your argument is simply that it’s wrong. All one has to do is to look at ANY OTHER industrialized nation for a better alternative. Medical care can never, by its very nature, be a free market. When the payer is a profit-motivated third party, that can’t even be called capitalism.

          It is the profit motive, not bureaucracy, that makes health care in the US so expensive. When patients don’t pay or they are very ill, they don’t care about the cost.

          Kirsten’s problems are solvable without invasive, life-altering surgeries. The problem is drug availability. Those drugs aren’t available because they aren’t profitable to produce.

          The free market drives down the nurse to patient ratio and makes expensive testing equipment less available.

          1. Kris Lethin says:

            My argument wasn’t the third party payer system is better. My argument is that the best care will always come from someone who… well… CARES.

            The payment metrics in our country have been completely poluted. To say that our current system is private care is not honest. We have not had true private medicine in our country since the Government started buying up services and redistributing them through all of the various social wellfare channels.

            Been to a DMV lately? How about applying for a Passport or go to the post office to mail a package. I’m not saying that people are intentionally negligent but in most government employment environments the beaurocratic system is so top heavy and oppressive that the people doing the actual work loose whever internal motivation for excellence that they may have come to the work with. After a period of time most become clock punchers and stop caring. Not all but most and most is very bad for all of us waiting in line.

            I am just not comfortable with handing this kind of power over to what has historically provided less than great results. Just compare the efficiency and exellence of Fedex/UPS and the USPS. Now imagine setting up the economics through legal construct that would intentionally bankrupt Fedex/UPS so you no longer had a choice. That is the nature of the direction of current healthcare policy in our country. The Austrailian system sounds better.

        2. Brent, I think we have touched on health care previously in our chats. Our system in Australia is subsidized, i.e. essential care is discounted or free (paid for by taxes), but private insurance is encouraged (by tax rebates) and provides ‘upgraded’ care and additional services. Of course, it’s not perfect, but compared to most of the world (most notably USA), it seems to work great.
          http://en.wikipedia.org/wiki/Medicare_(Australia)

  2. Jim Troutman says: Reply

    I think anger is the correct response. It is distressing how often basic care instructions are unread or ignored and how many mistakes are actually made every day in hospitals.

    One of many examples I have seen personally: once was visiting a friend’s mom in an ICU, she was diabetic and was there for a nasty necrotizing fasciitis case. I noticed the nurse had improperly setup the automatic insulin dosing machine, and it was delivering 10x the proper amount. Her blood sugar level was about 60 when this was caught.

    You are doing the very best thing possible, being there and involved and double checking everything and making the attending folks stop and think a little bit.

    If there is anything at all I can do for you, let me know (I know everyone says this…) You are an amazing person.

    1. Thank you, man. Some of the mistakes are so avoidable, they’re inexcusable.

  3. What a relief that Kirsten has such a capable, committed companion. It must be a relief to her, and – if I may presume to speak for others – a comfort for the rest of us. Hang in there, my friends.

  4. DISLIKE.

    Insert the appropriate amount of F-Bombs and other assorted four letter words <>

  5. You are such an amazing advocate Brent! I will refrain from expressing my feelings on here right now but suffice it to say that my eyes are NOT dry at the moment! I’m working tonight from 11p-7a and would be more than happy to visit Kirsten for a spa session before going to work! Also willing to come in on my day off on Thurs and I’m working all weekend so would be happy to give up my dinner breaks to spend girl time with her for spa sessions…or I could come up before or after my shift! I know just what she likes and can wash and rebraid her hair if she would like me too! It’s always a pleasure to spend time with her and I enjoy listening to her chat about the girls :) Let me know! Btw…I sent 3 extra “johny’s” with her so she would have proper fitting ones not to mention fashionable :) Just want you both to know that I’m there for you <3 {{{HUGS}}}

    1. I love you, Maggie. I thought about you a lot today, and longed for your tender care for Kirsten. I told her about your comment, which made her smile. A lot. She’s wearing one of your johnnys.

  6. I was pretty horrified to read this, Brent, and especially dismayed to read that Kirsten was just *left* there to fend for herself – as if her sickness weren’t enough for her to deal with! I would have been LIVID as well. I was livid just reading about it, I can’t imagine how you must have felt. I am glad that Kirsten has such a wonderful advocate in you, but it really shouldn’t have to be your job to ensure that the hospital staff are taking good and proper care of her >:-((
    Let’s hope for a better day tomorrow. Holding you both in my thoughts and sending big, big hugs.

    1. No, it shouldn’t be my job. I don’t even want to think what her care might be like without me here. There have been some egregious and inexcusable mistakes and oversights. Yet there are so many patients who have nobody with them. This is when Kirsten’s sweetness is too sweet. She lacks the assertiveness required, and, quite frankly, she’s not sufficiently coherent a lot of the time.

      What really stresses me out is that I haven’t started my new job and haven’t been working. In order to make sure our bills get paid, I’m going to have to return to work soon. Then what? I hope they move quickly, but because she’s now stable there isn’t a lot of urgency.

      We’ll get through this. Someday soon I’m going to want one of those hugs in person. :)

  7. Awww…happy to hear I created a smile! I love you too, you, Kirsten and the girls :) Mission accomplished! She was relaxed and comfortable when I left :) Will message you later! PS…she gave me a great big hug and told me she loved me a couple of times :)

    1. I cannot thank you enough, Maggie. Kirsten just beams when she talks about you. For that, you are tops in my book. Thank you, darling. :)

  8. Colette and Danielle Marceau says: Reply

    We just wanted to let you know that you are in our thoughts all through the day.
    If love, strength, loyalty , devotion and intelligence made everything better, Kirsten would be well.

    1. Hah! :) Wouldn’t it be great if the world worked that way?

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