We need to help coach families to be assertive — not aggressive — when your residents and their loved ones are hospitalized.
By Steve Moran
A few weeks ago I was in Aspen, Colorado, to talk to a bunch of senior living interior design professionals about where senior living is today and where it is going. Early Thursday morning my phone rang and the caller ID showed it was my brother calling. We have a good relationship, however, we are not particularly close, so I knew it had to be one of those dreaded calls.
Mom had a stroke and was in the hospital. The doctors were able to surgically go in and retrieve the clot and she was doing okay. I did my presentation, then called Delta. I told them what happened and asked what it would take to move my departure date up and put me on a flight to San Jose rather than home. Huge kudos to Delta — they made it happen and actually refunded part of the fare.
Great Docs, Terrible Decisions
I got to the hospital early Saturday morning to find that mom was, in many respects, doing better than expected — no paralysis, no speech impediments and no cognitive decline. However all was not well. She had no energy, and no interest in eating. While she would respond appropriately if asked a question, she displayed no interest in conversation.
It turned out that she was anemic, with a hemoglobin of 7 (normal is 15), and because of the anemia the Docs reasonably assumed there was internal bleeding. Here is the problem . . . in order to do a colonoscopy, she needed to drink a gallon of liquid solution to get her cleaned out (trying to be as delicate as I can). She was too weak to drink it and they kept pushing her to do what she could not do.
I started talking to some medical folks I know and they kept asking why are they not giving her a transfusion to help with the anemia? It seemed like a good question. We finally got a new hospitalist in the room and asked her that question. Once we started asking questions, we discovered there were other things — in addition to a transfusion — that should have been done, but were not being done. Such as, she needed B12 and it hadn’t been given; as well as, she needed her thyroid level tested and that had not been done (it was low).
The Most Important Thing
The problem was that these Stanford trained (I think) doctors were so focused on “there must be bleeding we need to figure out” they completely ignored her general health, which was going downhill like an out of control freight train. If we — as the family — had not stepped in, it is very possible that by the time they figured out there was no bleeding, her general health would have been so poor she would not have survived her hospital experience.
I was able to step in and help with the decision making process — not so much because I had medical knowledge (which I don’t really have) — but because it was clear things were not as they should be. So I started asking rational questions in a non-hostile, non-accusatory fashion. I just wanted to figure things out.
Unfortunately, this is a common problem. In fact, a similar thing happened with my 30-something son who was in another world class hospital.
We need to help coach families to be assertive — not aggressive — when your residents and their loved ones are hospitalized. It is easy to assume the Docs have it all figured out and are doing all the right things. That may or may not be true. Good Docs when asked reasonable questions in a reasonable way will not be defensive or blow family members off.
I believe the Docs missed these important pieces of her care for two reasons:
There is so much specialization that it becomes easy to overlook the not-so-special stuff.
. . . AND EVEN WORSE . . .
At some level they saw a frail little old lady in a hospital bed with lots of medical issues and a severely deformed face from multiple cancer surgeries. I believe . . . though I can’t prove it . . . that if this had been an anemic 13-year-old or 27-year-old, they would not have missed what they missed. At some level they did not care because of her age and condition. THIS IS NOT RIGHT.
She is now home and seems to be recovering slowly.