An elderly loved one was admitted to the hospital recently.
As the doctor in the family, I was requested to come to the E.R. at once.
Sometimes, the 'Just for Today, I will do my work honestly' applies even on your day off.
I had to be a noodge. Do you know what a noodge is? A noodge is the person who stands up for the Truth, and annoys the heck out of people to get proper care for their loved one.
This family member had an eight-week history of malaise: not feeling well, not eating, needing help to walk. This was a change in the baseline activity level of a basically active senior.
The catch is that this loved one had a complex medical history, including diabetes brought on by steroid use in anti-rejection therapy for a solid-organ transplant.
Furthermore, this loved one, like my three other elderly loved ones who had passed on before, bought the motto of this 'big box healthcare organization' hook, line, and sinker. Somehow the five-dollar copay translates through as 'good care' to people who have lived through the Great Depression.
Blood sugar was over five hundred. The admitting internist wanted to send this loved one to the floor.
While I was in the E.R. for over six hours, and the hospital itself for eight, this is what I saw for treatment:
Glucose = off the charts. No diabetic ketoacidosis--yet.
Insulin ten units i.v.
Recheck in one hour. Glucose = four hundred and something.
No action. No insulin. Nada.
I ask about the plan of treatment with the E.R. nurse.
Delay while she calls the internist.
Ten units insulin i.v. PLUS eight units insulin subcutaneous.
No recheck as expected in an hour.
I ask again after two hours.
Recheck blood sugar. It is three hundred ninety.
The internist calls, and asks for me. This doctor says, 'I did test A and test B and test C and test D and test E and test F and...the results are A and B and C and D and E and F....'
I listen, acutely aware that this is a new doc, who is not yet able to synthesize a working diagnosis. This physician is 'ruling out' everything on the differential (list of possible) diagnoses, but does not 'get it' that something seriously metabolic is going on.
Here is the work up that should have been happening;
ABG (arterial blood gas)
Urine and serum osmolarity, and sodium (this was critically low)
Insulin drip
echocardiogram
in addition to the EKG, UA, lytes, CBC, renal ultrasound, chest x-ray and CT scan ordered.
(isn't it ironic how at the airport they x-ray your total body on the way in the gates but not at the E.R.?)
Guess what?
I said to the nurse, 'I know in my heart that is it was this intern's parent in this E.R. instead of mine, this intern would have been ten times more mean than I am being now!'
And the nurse looked at me, and let down her guard immediately, for I had spoken a Truth.
The internist agreed to ICU admission 'to make me feel better'.
Then I got told by same internist, 'The ICU physician refuses the admit because your loved one does not meet ICU criteria'
Guess what? The telemetry nurse refused the admission. The sugar was not controlled and too high.
Guess what? My parent experienced chest pain (I can't breathe I have pressure, and anginal equivalent) twice in front of me. You don't give one and a half liters of normal saline wide open to anyone over seventy. At the first time, we stopped the fluids, and the symptoms resolved. When the fluids were restarted later, on a pump, we mentioned in the hall that the patient was having chest pain. (I had programmed the monitor to track continuous EKG tracing, one lead, in the E.R. as it was only showing pulse ox and blood pressure before. I watched the ST segments steep depression, and knew the diastolic blood pressure was only thirty. I saw the ischemia happen before my eyes, just like in the O.R. Only there was no paper in the printer on on monitor to print out automatically with the alarms what had been going on).
Then everyone ran in the room.
The nurse in white scrubs came in. The one that knew what was what. Probably the house supervisor.
He asked why the sugar was so high and uncontrolled. And why there were all these different places to go--telemetry, ICU, DOU (step down).
I said it was because I 'squeaked'.
He looked at me, eye to eye, back to the rest of the E.R., and said, under his breath in the gayest 'you go girl' voice ever--You Did Right, looking around the room to make sure none of the Big Box Employees would rat on him. Over his shoulder, was the E.R. nurse, nodding their head, in support..
Again, in his sotto voce, 'Your parent needs DOU level of care. Needs an insulin drip. You did the right thing by speaking up.'
The internist came in the room, as I was holding my parent's hand while the nurse drew blood for troponins, a marker of cardiac injury. Transplant patients, like breast cancer patients, only have one arm for blood pressure cuffs, i.v.'s and blood draws. The veins are terrible.
I felt the internist bump into my aura. It was about six feet radius around me. The internist stopped.
The internist saw and understood everything, without words. I saw an extremely thin doc, with very well-developed veins, a runner, possible ultra-athlete, a top-of-the-class book-smart doc, still wearing a retainer, who chose Big Box so They Could Have A Life. In essence, they chose a 9-5 career in medicine.
I asked, 'what do you want to do about fluids? The i.v. maintenance is on hold.'
The internist touched the tubing and the beeping pump, and said, 'it is going'.
I said, 'no, the tubing is not connected to the patient, and the pump is on pause.' holding the end of the tubing and pointing to the pump, 'we need a decision to either restart it or hold the fluids'.
The internist stammered, walked out of the room. The pump kept beeping every two minutes. My sister and I took turns hitting the silence button, until after about ten minutes, I just turned the pump off.
What is the moral of the story:
The dark side of medicine today is that there is a difference in the standard of care between your doctor's mom and your own.
Let me repeat: there is a work ethic for 'care of the patient' that suddenly 'changes' when it is not just 'the patient' and it is 'the family member of the health care worker'.
Big Box Healthcare is a Business. End of story. Efficiency at patient care leads to more profit for shareholders.
When, every patient is considered someone's 'Auntie' or 'Uncle', a real breakthrough in Healthcare is going to happen. This is MUCH needed in medicine today. Even the ugliest, stinkiest street person, is still 'Auntie' or 'Uncle', just as much as the blood related 'Auntie' and 'Uncle' to the nurse, physician, physician assistance, nurse anesthetist, critical care nurse, E.R. nurse, orderly, nursing assistant, x-ray tech, echo tech, phlebotomist, janitor, dietary worker...and Reiki is going to be a huge part of this process.
Do you agree?
Namaste,
Reiki Doc
