A 93 Year Old Woman, The Paid Care Giver, and The Hospital Emergency Room

“No more than can be expected in our money driven system”

Vera lives in an assisted living facility. She has almost no short term memory, but her blood pressure, respiration, blood tests, and general health are normal. In the past she has had fainting spells about once or twice a year since she was a young woman. The doctors think it is caused by a sudden drop in blood pressure. They are probably right. After a fainting episode she recovers in about five minutes and feels normal again. When she is with family members they know what is happening and that she will be back to normal in a few minute. When she is with “professional” care givers and because of her age and that she is in an assisted living facility the response to her fainting is to call 911.

In the last year this 911 response has happened twice by two difference nurse’s aides. The result has been both expensive for Medicare and Vera. The care has also been uncomfortable and risky. The desire to “first do no harm” seems to be canceled by the “please protect me from a mistake.” So, the EMT comes and says, “my, my, this could be a heart attack,” and they take Vera to the Emergency Room at Kingwood Hospital in Houston, Texas. While she was in transit, the nurse’s aide called the family and told them about the fainting episode and the 911 call. The son went to the hospital to meet his mother and arrived shortly after they had put her into an ER room. A nurse had put a needle into her arm in case they wanted to give her an IV or to take blood samples. He had also done an EKG and had put leads on her chest connected to a heart and blood pressure monitor and an oxygen sensor on her finger. It was 65 degrees in the room so he gave her a thin but heated blanket to help her adjust to the cold.

The ER doctor came in, asked Vera how she felt to which she responded that she guessed she had a heart attack, but that she felt fine. He asked why she thought she had had a heart attached and she said that is what she had been told by the EMT. He told her that was not the case, but that she could have had a drop in blood pressure that caused her to faint. He then said that she probably should not have been sent to the ER, however he would run some blood tests and do some Xrays to confirm that she was as she said she felt. The son asked about the X ray and the doctor responded that if he was concerned about the radiation it was no worse than being in the sunshine for a few minutes. The son then asked what kind of X ray and the doctors responded that it was a CT Scan and the son said, “No, you’re not going to do that. A CT Scan was not an X ray, but many X rays and was like being about a mile from the explosion of an atomic boom.” The doctor then said, “You have the right to reject care” and he left the room.

The nurse then drew about eight tubes of blood and told Vera that if she needed anything to just push the nurse call button. Two hours later the nurse came back into room and took a urine sample to test for a possible infection in the bladder. The urine was taken, not donated, and Vera was not even asked if she could provide the sample. She was coherent and cooperative, but with Vera at age 93 maybe the young nurse was making some assumptions about old people and whether they could urinate at will.

Five hours passed in the very cold room. No one checked on Vera and she did not push the call button.

She had no water, there was no IV, there was no food. She had a bowel movement and had urinated in the diaper they put on her after the urine extraction. The doctor returned to room with the lab and chest X ray results and said she was OK, but he was going to keep her overnight for observation, because he was a very conservative ER doctor. The son said, “No. I’m taking her to my home,” to which the doctor replied, “Okay, that’s fine.”

The nurse then brought in about ten pages of documents to sign saying they were not responsible for anything and then brought a wheelchair, loaded Vera into it and took her to the son’s car which was brought to the ER doorway. The Nurse had not cleaned her up nor had he removed all of the sticky tabs from the EKG and the Monitor leads. The son drove her home, cleaned her, bathed her, put her into a warm bath to soak, dressed her in her night clothes, fed her and let her rest in a warm bed until morning. She was up and around walking on her own the next morning. No harm was done, but the idea that it was to be avoided seemed never to cross the minds of the care takers, nurses and doctor.

The ER had at least thirty rooms and about about ten people were in rooms. There were at least twenty-five people working in the ER and at any given moment twenty of them were sitting in front of a computer screen doing something. As far as I could tell no nurse, technician, or doctor touched a patient or talked with them for more that a minute. It was the closest thing to a game room that I have seen.

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