Old People and Hospitals

It would seem silly to suggest that hospitals are not good for the elderly, because where else would they go when they, for example, fall and break a vertebra in their neck, like my mother did last Monday?  Curiously, though, it seemed that her overall well-being took a rapid and steep decline after she was admitted to INOVA Fairfax Hospital.

Perhaps it's more reasonable to say that INOVA Fairfax Hospital is not good for the elderly.  When we brought my 91-year old mother to the emergency room there after a fall, her only complaint was sharp neck pain.  After an hour or so of sitting, she was poked around a bit by a nurse and got a CT scan, where she was lifted up on the table by two technicians and pulled and prodded on to the machine, reloaded back into a wheelchair, and returned to the hallway, where we sat for a while.

After about an hour, a nurse came rushing over to us with a cervical collar and told my mother that she didn't want to scare her, but she "needed to use a little tough love" because my mother had broken a bone in her neck and it was a serious injury that could paralyze her.  Well, now you tell us.  One might think that medical professionals should respond proactively to an elderly patient who had fallen and was complaining of severe neck pain by putting on the collar proactively instead of taking no consideration at all to the potential vulnerability of her spinal cord.  And is it too much to ask for a hospital to have the right sized collar to fit someone who is petite?

My mother made it to her shared room in the Intermediate Care Unit late Monday night.  We were told by the emergency room doctor that given the nature of her injury, she probably would be sent home the next morning with the collar.  The next morning, we were told that the attending trauma physician (the Trauma Department was in charge of her case) was ready to send her home, but the neurosurgeon assigned to her, Dr Jae Lim, wanted my her to have an MRI and that he had ordered her to be confined to laying flat on her back until she had one.  We were told getting the MRI would take a few hours, so we left with the full expectation of taking her home that evening after she got the MRI.

I called the IMU on Tuesday afternoon and was told that she had not had the MRI but should have it in the next hour or so, suggesting that we not arrive earlier than 6 pm to pick her up.  We arrived around 6pm, and still no MRI.  Worst of all, my mother was a basket case, extremely disoriented and fidgety with a thin hold on reality.  Three things contributed to this--being flat on her back for an extended period of time; not sleeping well; and being given Percoset for pain.

I was told that my mother's disoriented condition was typical for elderly hospital patients.  In other words, the staff accepted severe disorientation as the norm rather than considering the potential for disorientation as something to anticipate and try to prevent, for example by avoiding giving them narcotics.  I told the nurse not to give my mother any more narcotic pain killers without consulting me and to opt for Tylenol first.  This is another thing that seemed automatic at INOVA Fairfax--opt for the hard drug instead of other potentially effective options that don't have risky side effects (my mother was to get Ativan, which is strongly discouraged for elderly patients to keep her from moving during the MRI).

The medical staff noted that there was no immediate necessity for the MRI--it was something that could be done as an outpatient--an appointment that I could make for the next day.  They told me the dirty little secret about INOVA Fairfax and its MRI machines--they are reserved for outpatients who made an appointment, ER patients, and patients that were deemed as medically needing one.  My mother fell in the ER category the previous night, but it was not ordered for her; when it was ordered for her, she was constantly put at the bottom of the list because she was not considered to require it as an in-patient, and she couldn't get one as an outpatient, because Dr. Jae Kim wouldn't let her out.

I asked to talk to Dr. Lim, but was told that he does not answer pages after 5 pm.  A nurse was able to contact his physician's assistant (PA), but she said that the MRI decision was up to Dr. Lim, who was unreachable.  The nurse called the MRI department and came back to tell us that they had assured her that my mother would have her MRI at 1 a.m.  We left the hospital with great relief.

When we returned Wednesday morning, we were shocked by two things:  the continued decline of my mother's mental condition and the fact that she had still not received the MRI.  She had spent two useless nights in the hospital SOLELY WAITING TO GET AN MRI THAT SHE NEVER GOT.  I was unhappy.  I spoke to the attending trauma physician, who was unhappy about the situation too.  He had already put a page into Dr. Lim, who had not answered, so he paged him again.

Dr Lim decided to wave the MRI but required a back X-ray instead.  This was done relatively quickly, but unfortunately, we were back in the hands of Dr. Lim, who had to read the X-ray.  Three hours later he read them and ok'd her for release.  By that time the attending physician had changed, and the new one decided that my mother needed to eat and urinate before he would release her.  She had no trouble eating, but peeing was a problem.  The attending physician assumed that she had a condition that often develops with the elderly who have been confined to bed for a few days that makes their bladder become "lazy," so he told us that if we wanted to take her home, she'd have to wear a Foley catheter for about a week and then come back for a test to see if she could then pee.

The nurse, who clearly did not want to install the catheter, and I argued that my mother could not urinate because she had no fluids in her bladder.  The doctor decided to do a bladder scan, which proved that the nurse and I were correct.  But the doctor still wanted her to pee or wear a catheter before leaving.  So she spent another useless, expensive night in the hospital while she was pumped full of fluids.  And she peed.

I described these circumstances to my mother's new neurosurgeon, a gentleman who is rated as one of America's top neurosurgeons.  He noted that my mother's treatment was deplorable and now sadly typified patient care at INOVA Fairfax.  He also noted that he had other patients at the hospital who offered similar complaints about Dr. Lim.  He told me that he no longer associates with INOVA Fairfax and gave me the names of two of the hospital's senior administrators, encouraging me to tell them about my mother's treatment.

Aside from the apparently low patient-care standards at INOVA Fairfax, in general it seems that hospital care of the elderly is a woefully undeveloped field.  Baby-boomers be warned--your time is coming; take note of how your parents are being treated and be proactive in demanding that they are looked after in a way that fosters their overall well-being.  Change will only occur if we push for quality care.

My mother at last is allowed to sit in a chair.

Our Country 'Tis of We

Williamsburg was not our first thought when Tom, our son and his wife, and I tried to figure out a winter break destination.  For a while, the Florida Keys was the front-runner because it was warm and three of the four of us had never been there, but the cost and distance led us to brainstorm closer spots, and ultimately Williamsburg won out.

Come to find out, we were not the only ones to reach that decision.  The staff members we talked to said that the week after Christmas was one of Colonial Williamsburg's peak weeks for visitors, and I could see why, since it's not that long a drive from a number of major US cities, has tons of activities, and the odds are that the weather will be somewhat better than it is in the Northeast.  Not for us, though--much of a five-inch snowfall remained on the ground, revealing a new truth about the colonists:  they don't like to shovel snow and aren't going to waste valuable salt on it either.

As we trudged through the ice and snow along the miracle mile of Virginia's journey toward liberty, I distracted myself from my paranoia about falling and breaking an ankle by trying to define for myself the difference that social networking as we know it would have had on the Virginia branch of the Founding Fathers back during that pivotal time when they were deciding the future of their relationship with Great Britain.  I think my subconscious was recalling a parody of FaceBook that featured a Status + Comments of Ben Franklin, Thomas Jefferson, etc., but I was trying to be serious about it.

My conclusion was that Virginia's decision to take actions that in effect supported the Boston Tea Party and to author its own constitution, a precursor to the US Constitution, was a model of effective social networking and that Twitter and FaceBook probably would have contributed very little and might have undercut the effort:

• The communications methods of the day enabled the colonists to have a surprisingly thorough understanding up and down the eastern seaboard of the central issues relating to their colonies' interactions with England.  A range of opinions was continuously discussed and debated, even after Virginia's colonial governor disbanded the House of Burgesses.  Twitter was not required for word to spread quickly to Virginians about the Boston Tea Party or the taxes that led up to it.

• The young history major who guided our tour through the Capitol made the point that Virginia's colonial leaders weren't all that original in their revolutionary thoughts--that they drew heavily from the great political thinkers of Europe like Locke and Rousseau.  This suggested to me that even the primitive circumstances of the American colonies still allowed for the transmittal and discussion of important ideas.

• Even when the Members of Virginia's House of Burgesses decided to support independence, they had plenty of disagreements among themselves, and the dissolution of the House of Burgesses forced them into meeting secretly.  I can't help but think that Twitter and/or FB would have made these disagreements even more difficult to resolve by turning them into soundbites; by adding more opinions to weed through from well-meaning "friends;" by undercutting the perceived need to meet face-to-face (which I think was critical to coming to closure); and by increasing the colonial leaders' vulnerability to being caught in the act of sedition, since one false sharing of a FB chat or Twitter trend would have provided the British hard evidence of the full scope of the plotting against them.

My musings got me over the precarious footing I faced in Williamsburg, and it also increased my respect for the sophistication of thought and actions of a relatively large number of people in colonial times who sought and achieved change.  I can't really say that I'm as impressed with their current political heirs--all of whom are well-equipped with FB, Twitter, and every other social networking tool.  Of course, I love FB and am slowly acclimating myself to Twitter, but I don't think we should assume that the spectacular increase in the quantity of communication through these tools has led to a net increase in the quality of communication.