Omamacare III
Mama Bear's 3d modern-hospital encounter ...
by Brian Wright
Will it be the charm?
More or less keeping track of ol' Mama Bear as she struggles with her later-in-life medical issues. At the beginning of her dialysis treatment for polycystic kidney disease (PKD) I made some observations that as bad as the existing corporate system is, nationalizing it via Obamacare will make it ten times worse. Then about a year ago, Mom had a medical emergency that entailed a weeklong stay at Henry Ford Hospital, Detroit, which I documented as O-mama-care II (OMC2). Get it? Omamacare. Ha ha.
The latest installment of my mom's modern health care
ritual comes on her 85th birthday, October 6, 2011.
Of all days. We are going to go out to a local Italian bistro for dinner, but she demurs, saying she feels lightheaded and short of breath. No problem, we'll stay home. Tonight is the fifth and deciding game of the Tigers/Yankees divisional series; we catch the first inning where the hometeam (Tigers) hits back-to-back solo home runs... then, because neither of us has much vicarious athletic interest we pop Nobody's Fool into the DVD player.
It's a great little movie starring Paul Newman when he was on the verge of 70, but looks 60. It was also Jessica Tandy's final film (she lived to be 85). Part of the reason Mom and I so like the film is because the Paul Newman character, Donald Sullivan,
reminds us of her son/my brother Forrest who died at the young age of 56 (from cardiomyopathy). Perhaps I should have been more sensitive to any reminders of people passing on—Newman himself died way unexpectedly (for me) in 2008—on a night when Mom is looking so weak. She's just gotten over the bulk of an awful head cold; the coughing, but especially the bouts of breathing difficulty worry me.
... yet the breathing problems always seem to occur when she's done something. She'll sit still, watch the movie, go to bed, we'll be fine. Not. No sooner do the credits wind, I see she's breathing hard: "Hey, Mom, you okay? Do we need to head to Emergency?" She responds, "No, I'll be fine." Then the breathing gets a little better, but soon, another cycle. At some point she announces we'd better go after all. We have to walk to the car, and the breathing seems to be getting worse. I tell her I'd better call an ambulance. She says, "I can darned well get to the car on my own!" Next minute she's crumpled on the wet lawn by the sidewalk.
I dial 9-1-1 and try to think positive thoughts, as I kneel down beside her and offer encouragement. Just trying to keep her conscious and breathing. She's really gasping now. I'm also on the line with the EMS dispatcher for four or five minutes that seem like eternity. I don't mind answering the dispatcher's questions, but when the five or six Community EMS guys arrive, I don't have much patience left. I tell the guy with the clipboard, "Yes, she's Phyllis Wright, just turned 85, kidney disease, undergoes dialysis, brushes her teeth regularly... and she's at your feet dying for air; do something." I distinctly hear Mom panting,
"I need oxygen, give me the damned oxygen."
Eventually, they apply the O2, get her on the stretcher, move her to the ambulance, and off she goes to Henry Ford West Bloomfield emergency. I follow in my car after getting a few things together, prepping for several hours in and around the ER. Happy Birthday, Mama Bear!
Sad. So they stabilize her and admit her about midnight, Thursday, then keep her through Monday. She's dialyzed on Friday a.m. and on Monday a.m. The cardiologists/internists basically come to the heart-attack conclusion from atrial fibrillation and elevated pulse, along with other things I'm not conversant about; they change her meds to a different beta blocker to stabilize the heartbeat.
We're set to go home Monday afternoon, but as she comes down in the wheelchair so I can go around to get the car, we notice she is becoming woozy and says she feels 'not okay.' We detect a mini-convulsion and she seems about to pass out. So the nursing assistant and I, with an ad hoc contingent of other medical personnel, roll her her straight back to emergency. Her blood pressure is way down, they hook up a saline solution and eventually get her stable again. More tests, she's off to an ER room, after four or five hours her numbers are good. Mom is anxious to leave, and doesn't like it taking so long. I have to talk her out of pulling out the sensors and making a break for it. I tell the nurse I don't think I can stop her, so better get the doctor over here and let her go. He soon does.
Now she's back and she's good, no stroke, no angina, her basic health factors have always been positive. I'm redoubling my efforts to ensure her med regimen is as prescribed and intended.
Lessons Learned Omamacare III
The following are condensed from observations I made in OMC2 on what needed to improve to make health services more responsive at Henry Ford:
Continuity of care—Maintain core responsibility for a patient from one process to another.
Communication of care—Patients or patient advocates need to know a) what the care decisions are made, and b) who makes them.
Integration of care—The number of individuals involved in resolving my mom's issue: 23, exclusive of office staff. Someone needs to be the controlling caregiver of and communicator to the patient.
Personalization of care—If you have a problem away from a facility, after hours, you're told to call 9·1·1. Most times you need an explanation, not an ambulance.
More "laying on of hands"—As kind as Mom's nurses are, lying in a hospital bed with nothing to do, and no one looking in, is like being in a Romanian orphan farm in the Ceauşescu regime.
These observations hold for Omamacare III, as well. This time, I come up with a couple of other suggestions for improvement... aside from 'the whole system is awful and needs to be replaced from the ground up.' The top two:
Sterling Enunciation—Nurses and attendants who interact with the customer need to speak distinct and clear English at all times. Phone clarity is essential.
Medication Overview—Being in the era of 'wonder' drugs doesn't mean the patient should ever wonder what he's doing with such powerful, potentially dangerous substances.
On the latter, consider: An 85-year-old patient who lacks an advocate will seldom know how to assemble an 'at-a-glance' picture of what medications he's taking and when. He or she is given prescriptions, but how do you assure they put the pills in the right slot in the pillbox when they get home? I've talked to some of my peers, who are in their 60s and come from a technical orientation: they know to put together a spread sheet. But honestly, how many nontechnical or 80+ patients can do that? The medical people should work with a patient to create the 'at-a-glance' overview of what meds they're supposed to take and when. If you make a mistake on meds, it can be fatal. This link shows what I have in mind as a tool; I created these tables for Mom's meds.
Omamacare III:
Speak clearly and help the patient manage his meds.
I dial 9-1-1 and try to think positive thoughts, as I kneel down beside her and offer encouragement. Just trying to keep her conscious and breathing. She's really gasping now. I'm also on the line with the EMS dispatcher for four or five minutes that seem like eternity. I don't mind answering the dispatcher's questions, but when the five or six Community EMS guys arrive, I don't have much patience left. I tell the guy with the clipboard, "Yes, she's Phyllis Wright, just turned 85, kidney disease, undergoes dialysis, brushes her teeth regularly... and she's at your feet dying for air; do something." I distinctly hear Mom panting,
"I need oxygen, give me the damned oxygen."
