At 8 a.m., I was lounging in pajamas when the phone rang. For the past hours, I had been reviewing my place in the maze of a manuscript and revising it thusly.
The caller identified herself as the nurse at my mother’s memory care home. “Your mother fell, we’re sending her to the ER.” she told me, setting my day off in a direction different. “Where do you want her sent?”
Despite the emergency, I hemmed and hawed, contemplating my decision. During Mom’s last admission, we battled with staff at that hospital to transition Mom to her care home and not skilled nursing. Second, her in-house doctor had privileges at this next hospital of my choosing.
I arrived in the ER shortly after the phone call, to find Mom sleepy. She dozed most of the day while enduring rounds of tests in the ER. X-rays, CT scans, MRIs.
Late that evening, she and I settled into a room on the neurology-trauma-orthopedic floor. I kissed Mom goodnight with the hopes morning would find her chipper and simply sore.
I rose early to beat the traffic. In my experience, I knew there was the chance the doctors would round early.
Mom was still snoozing, looking peaceful. I had steeled myself for how I would find her. Always, after one of Mom’s incidents, I scrutinized her level of engagement and ask myself, Where is she on the continuum of forgetting? Always, I answer, Half-way there, wherever there might be.
I nudged her awake and she spoke in a drowsy fashion, not wanting to open her eyes, but still eating spoon-fed oatmeal and eggs. She moved around in bed, in obvious pain despite no broken bones.
Finally, the in-house orthopedic doctor stopped by.
“Hi, I’m Doctor O.”
“Hi, I’m Jean’s daughter.”
“So you want to tell me what happen?”
I retold the story, making certain to include her dementia.
“Well, I’ve looked at her tests and don’t see fractures. You know she’s old, and may have decided to check out.”
Was that his “diagnosis”?
“Sure, she fell, but I don’t think she’s checking it out,” I said flippantly.
“I guess we can get PT in here, see if that helps, but this may be where’s she’s at.”
“She may have to go to skilled care.”
I decided not to waste my breath on why skilled care didn’t work for someone with dementia.
I let him walk out. Actually, I wanted to push him out the window.
While doctors are being counseled to advise patients and families on end-of-life issues, it was inappropriate for a doctor who had no history with my mother to make such a pronouncement.
An hour later, the hospitalist rounded. After our introductions, he offered his own misinformed assessment.
“I don’t see signs of anything broken. She’s less alert than I would expect. I guess in the ER they gave her pain meds.”
“They did,” I asked, alarmed. “But I was with her the entire time.”
“Are you sure,” I questioned Dr. H. again.
“Yep, the ER doc told me she was given morphine, that’s why she’s out of it.”
“What? Can you look it up?”
He appeared reluctant to take advice from a five-foot tall, non-medical person wearing orange sneakers.
The doctor turned towards the computer. “Here it is, no, wait. No, it’s probably on this screen. I guess she didn’t get pain meds.”
“You guess? Or there’s nothing in here?”
“I thought ER told me they gave her pain meds. But oh well.”
By now I was huffing.
“What does it say about her blood work? Her loopiness makes me think she has a UTI.”
“It could just be because she is old and confused.”
Did he just say that?
“Let me check. Yes. A UTI. Antibiotics were ordered this morning.”
What if there hadn’t been a family member around to grill those doctors? What would they have prescribed or missed, based on their lack of knowledge?
Hospitals need to evaluate staff that is no longer concerned about aging patients. While those doctors promote prolonging life through unnecessary treatments, when faced with the prospect of administering to the elderly with compassion, they have lost interest in dispensing care.
I will not fight for my mother’s last breath. She has had too many incidents in which I find her to be vulnerable with her quality of life slowly slipping away.
However, I will not cast off those doctors’ comments. Mom has returned to her care home surrounded by those who love her. And I will be sending a letter to the hospital informing them of their doctor’s actions.
If those doctors would have taken two more minutes to listen to her background or her daughter, they might have seen Mom for the human she is.