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We Are Staying

We Are Staying

The days pass quickly this December. The numbers of ill people in our community are on the rise as Christmas approaches. Some of them visit the emergency departments of local hospitals, only to be admitted because of their acute onset of their severe symptoms. Everyone who is a patient of the Stone Institute is welcome to come to our office when they are acutely ill. However, sometimes illness befalls them when outside of our office hours. If that situation arises, the emergency department seems to be their only option.

Monday of this past week, a woman arrived at our doorstep who had been hospitalized for three weeks at a local hospital. The moment she was discharged, she told her husband to bring her to The Stone Institute. He did. She was dressed in her pajamas, house slippers and robe. She was unable to walk from their automobile to the back of the office without taking a breather or two.

When our lead nurse came to get me, she had a deep concern on her face. One that every physician recognizes and does not want to see during the patient care day. When I entered the patient care room, the patient was slouched in the recliner and having difficulty breathing. She was cold and clammy. She was alert, but fading out periodically. From what she reported, it appeared she had been admitted three weeks ago to a local hospital through their emergency department after she had passed out several times at her home through the day. It was on a Sunday when her episodes of syncope unfolded. Her husband was out-of-town on business, so she was alone and afraid of waiting until Monday to come to our office.

She was admitted to the hospital and her care was assigned to two separate physicians. I do not know if these physicians were hospitalists (physicians who work for the hospital itself and practice medicine only in the hospital) or specialists on staff. She complained of having difficulty breathing. Initially, both physicians seemed attentive to her complaints. She was placed on oxygen, had an intravenous line inserted and several clinical tests such as a chest x-ray and blood work. According to her hospital physicians, her blood work was not diagnostic of any health disturbance. She laid in a hospital bed for eight days without any testing or treatments of any kind. There was a feud between the physicians regarding the necessity of oxygen. One would come in the room and remove it, the other would place it on her face. She felt better on the oxygen. The nurses were also trying to keep oxygen under her nose.

During the eighth day, she realized that she was not being treated for her breathing difficulty. It has worsened a bit. She related she wanted to be discharged so she could see her private physician. The nurses contacted the patient advocate who confronted the physicians in front of her. Both physicians ordered more tests. She had a CT scan of her lungs, followed by a bronchoscopy (an endoscopic technique of visualizing the inside of the lung airways for diagnostic and therapeutic purposes). During the procedure, they suctioned out some kind of thick tenacious goo from her bronchi and sent it to the pathology lab for definitive diagnostic testing.

Unfortunately, all diagnostic testing was negative. So she laid in bed for another two weeks, unable to take a full breath and receiving no therapy of any kind. Neither the two physicians saw her for eight days. That is when she demanded to leave the hospital. The first time she demanded to be discharged, the hospital staff told her that her leaving would be against medical advice, a phrase that would negate any reimbursement from her medical insurance. This time, one of the two physicians came into her room and discharged her from the hospital the next morning. He believed he had no reason for abandoning his patient in the hospital. She did not want one.

When I evaluated her, she had wheezing in her lungs and I could hear the bubbling of air through the goo in her bronchi. I started intravenous antibiotics daily and well as some intravenous corticosteroids to stop her wheezing. She came to the office twice, received the same treatments and a medical miracle happened. She could breathe deeply, her cough was productive, clearing the garbage out of her lungs and she was able to walk from the parking lot to her recliner in our office without the use of a walker or assistance of any kind. She had turned the corner and was doing great. She thanked us for getting her back on her feet again. This is probably the fifth or sixth time over the years that we rescued her from the jaws of decrepitude. It was satisfying to see her smile again.

When we received her medical records from the hospital, her story about her care was corroborated in the notes. She received nothing but frustration for three weeks. That is going to be a hefty bill for frustration. And all she needed was out patient antibiotics for three days to get the goo out of her lungs. I do not know what would have happened to her if she would have continued to stay in the hospital, but the most likely forecast would have been bleak. At least she did not catch a super-bug while she was there. I think she lost weight.

I will see her in the office each day next week to give her intravenous antibiotics. She must get well before the holiday season begins. It will make for a good Christmas.

If you think this is just an accident, or an unusual case, it's not. We have had several patients discharged from the hospital and come to our office for care. She was one of two last week. The other patient had no transportation to get to our office, so we arranged for a medical transport service to bring him, not an ambulance. And the transport service took him home. Is there is a message in these stories? Yes.

Everyone reading this blog should be upset enough to create a grass roots non-profit citizen run organization that will police the care of patients in our hospitals. The hospitals have become too big to fail, too big to manage and too wealthy to be compassionate. Their administrators control everyone from the housekeeper to the neurosurgeon. This committee must stay clear of the politics of medicine, even though we live in an area that is greatly enmeshed in the political fabric of the city and county mayors' office, city council and county commissioners. It should have an interactive website where patients can access real time information on physicians, nurses, hospital care and any problems associated with their inpatient experience. I am sure there are grant monies available for such an endeavor and if run properly, it will change the climate of healthcare in our city, perhaps being a model for changing healthcare in other cities. Healthcare in our country is a runaway train: It's big, it's expensive, it lacks compassion, and if you collide with it, you lose big.

This is a populace movement. We the people deserve better! But if you get discharged from the hospital and you're still sick, you know where to go. We're not going anywhere soon.

Doc 

Posted by Amanda Sanders at 11:44 AM
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