Appalled by lack of respect and tact from hospital staff...Very long post

[pnkrocdevil]

I'm having a difficult time right now understanding why some healthcare workers remain in a hospital setting when they are no longer (or never were to begin with) compassionate. On Sunday evening my grandmother fell down 5 stairs and fractured 3 cervical vertebrae, one of them causing extensive spinal cord damage. I was out of town when this happened and was at the hospital for the first time yesterday. Now this is a pretty well-known hospital located 10 miles west of downtown Chicago, it's the hospital I was born in.

A little background on my grandmother: she is an extremely healthy 96 year old, on no medications, and has been suffering from dementia for the last few years. She still knows who everyone is, and is still able to tell stories from her youth in Russia. She just gets confused at times, and forgets some things. Before this incident her only other ailment was blindness in one eye. She didn't wear diapers, and was able to get up and move around on her own and prepare some of her own meals. She fell while going to lock the main door of her 3 flat that she has lived in and owned for 60+ years. Thankfully my father and stepmother live in the second floor apt. and were home when this happened.

I was alarmed upon arrival at the hospital yesterday. The first thing I witnessed was an old man (clearly suffering from severe dementia) in the room next to her was being escorted out by his "caretaker" for a walk. He immediately fell over on his side , making a very lound noise, once in the hallway. There were several residents at their computers about 10 feet away that just sat there while his barely 5 ft. tall "caretaker" struggled to get him back up. After about 1 min she called for help and a resident came over and gave assistance getting him back into bed. There was no examination given to make sure he didn't injure anything, even though he landed right on his hip.

I had to wait about 20 min. in the hall because they were trying to insert an NG tube in my grandmother because she has been either refusing, or not responding when they are asking her to open her mouth or swallow (she has always been extremely stubborn). This was the only way of getting the contrast in her to do a CT scan of her abdomen because it had started to swell. One of the nurses came out, not her nurse by the way, and asked what happened to her. Her response was "my mother is 88 and I tell her no stairs, they just don't listen." Thanks for your input nurse on how my grandmother just "doesn't listen." This is where the frustration begins, and I am realizing that the staff probably thinks she's just some old lady who was trying to do something she wasn't supposed to do. A few minutes later some surgical residents come by to check her abdomen. She was being somewhat responsive for them and performing some of the tasks they were asking her to do. They said they were still waiting to hear from the neurosurgeon and would go from there. My father informed them we had already talked to him and he informed us surgery was not an option and how she is now is the way she will be for good, and that we need to start thinking about long term care. The response from the surg resident was "well, she is ONLY 96," meaning she's old why bother trying to prolong her happiness/life. I was amazed by this response, considering she's breathing on her own, able to move her arms, hands, legs, and feet and all bloodwork/vitals look good. About an hour later her nurse comes in to give the first dose of contrast solution through the NG tube. She's already in severe discomfort from the tube, and the nurse comes in chomping on her chewing gum making it pop and crackle in my grandmother's face. She starts crying from the discomfort of the solution in the tube, and the nurse is just chomping away on her gum. My grandmother has been blind since arrival because her good eye is swollen shut and has no idea what's going on because of the morphine/dementia, and this woman is just rudely making startling/annoying sounds with her gum. I had to leave the room before I said something.

Is this common for elderly patients to be treated in this way? I would expect this reaction from a veterinarian if my old dog was hit by a car, but not for a woman whose injuries don't seem to be life threatening at this point. My grandmother's good eye finally opened a few hours later and she was talking away once she could see who was there and was moving her arms and legs freely. It seems that the staff is treating her like she's an old dog that's not worth their time or energy. Also the lack of compassion from the nurses I encountered was upsetting, considering they are the ones that are supposed to be promoting her well being when we have to go home. It sickens me to think what might be going on when visiting hours are over. I am starting my journey into nursing this fall and I vow to always have this in mind: Every patient means the world to someone, and you should care for them and interact with them in the same manner their loved ones would.

[Lennonninja, MSN, APRN, NP]

A good veterinarian wouldn't act like that, no matter how old the dog was. I'm sorry you and your family had to go through this

[canoehead, BSN, RN]

There were several residents at their computers about 10 feet away that just sat there while his barely 5 ft. tall "caretaker" struggled to get him back up. After about 1 min she called for help and a resident came over and gave assistance getting him back into bed. There was no examination given to make sure he didn't injure anything, even though he landed right on his hip. Assisting with patient care isn't what the docs normally do so I can see why they wouldn't jump right up, but sure it would be nice. Like expecting your waitress to assist you with your coat- probably they'll do it if you ask, but not until then.

One of the nurses came out, not her nurse by the way, and asked what happened to her. Her response was "my mother is 88 and I tell her no stairs, they just don't listen." She was talking about HER grandmother, and HER frustrations, no reflection on yours.Thanks for your input nurse on how my grandmother just "doesn't listen."

The response from the surg resident was "well, she is ONLY 96," meaning she's old why bother trying to prolong her happiness/life. I was amazed by this response, considering she's breathing on her own, able to move her arms, hands, legs, and feet and all bloodwork/vitals look good. He was tacky and inappropriate. Plus he has not seen your gmother at her best, he's seen a woman who appears to not be able to communicate or follow simple instructions.

About an hour later her nurse comes in to give the first dose of contrast solution through the NG tube. She's already in severe discomfort from the tube, and the nurse comes in chomping on her chewing gum making it pop and crackle in my grandmother's face. She starts crying from the discomfort of the solution in the tube, and the nurse is just chomping away on her gum. If you have a considerate nurse she will tell your grandmother what she is about to do, and why. NG tubes are horrible, but not much will relieve the discomfort short of sedating her, and making her confusion worse. Putting fluid down the tube is not painful, but it could be frightening if she couldn't see, or wasn't told what was happening. She may have thought they were going to insert something else...I'd fight too if I was her. I agree with you that gum chewing is distracting and annoying, for sure.

Is this common for elderly patients to be treated in this way? I would expect this reaction from a veterinarian if my old dog was hit by a car, but not for a woman whose injuries don't seem to be life threatening at this point. My grandmother's good eye finally opened a few hours later and she was talking away once she could see who was there and was moving her arms and legs freely. Every patient should be treated with consideration, but I think once they know her and can talk to her you will notice a marked improvement. Not saying it's right, but hopefully better days are coming.

Good luck to your grandmother- bet she blows the socks off the staff with a rapid recovery.

[pnkrocdevil]

You were right canoehead!

My grandmother's prognosis has changed drastically. Yesterday morning they said they would be preparing to discharge her to a care facility because they felt she would not respond to any type of therapy. She is now awake, moving when asked to, talking, drinking and eating. The physical therapist thinks she is going to make a full recovery, with no pain from the injuries. What an amazing turnaround! Also, her gum chomping nurse's disposition has changed. She was thrilled when I called early this morning to tell me the news, and seems excited to see her progressing.

[wishNhopeNdreamN]

devil, I'm so happy for you that your grandmother is improving.

and that the "gum chomping nurse" is showing some compassion. I can imagine how stressful it was for you to see your loved one treated this way.

Best wishes on her recovery. She sounds like an awesome lady.

[XB9S, BSN, MSN, EdD, RN, APN]

Thats good news about your grandmother, please let us know how she is doing

[canoehead, BSN, RN]

Your grandmother is not the average patient they were expecting. Congratulations, and say hi to her from all us.

[pnkrocdevil]

The ups and downs when it comes to the care of elderly patients is enough to make anyone crazy. Things aren't looking as great as I initially expected, and am very frustrated with the hospital admin. Upon arrival yesterday I was very happy to see my grandmother alert and willingly doing exercises with the phys. therapist.

My hopes for a recovery were quickly crushed when the GI Dr. came in. The concern was whether grandma was going to be able to consume enough calories on her own to meet her daily requirements. They were supposed to do a calorie count, which they did not. The GI Dr. consulted with my father about g-tube placement, informing him of the many complications that could arise. Of course he declined that option considering she is able to swallow. She then informed us that she would have a chronic foley, and would probably be bed-ridden despite being able to move all of her limbs.

While trying to understand her prognosis I asked the nurse if she had been told anything about discharge. She said she felt that my grandmother was no where near ready, and that maybe monday she would be a good estimate. After all, she hadn't shown them yet that she could eat, and I thought that would play a role in her discharge date. About an hour later the case manager, (possibly the most abrasive woman I have ever encountered), comes in and announces she is being discharged tonight and a decision on a facility must be made asap. My father still had 1 place to check out so he quickly left. When the nurse came back in I told her about the discharge plan and she quickly said "I don't think so, we still need to do a calorie count, and she is not ready to leave. I am going to speak with the (GI) Dr." A few minutes later I hear the case manager bickering with another physician about the discharge. I clearly heard them say my grandmother's room and bed number, and the physician saying "no way am I discharging her today, that's not even an option." A few minutes later I heard the GI Dr. aguing with the other Dr. about her discharge, and I started to worry. Clearly some of the staff felt she wasn't ready while this case manager was pushing for it. The evil lady (case manager) was even standing at the nurses station trying to dictate the order in which our nurse took phone calls (the nursing home my grandmother was being discharged to was on one phone, and a family member of another pt. that she needed consent from was on another) insisting she took the nursing home call first. Additionally she came into my grandmother's room several times to see if my father had returned, not once stopping to introduce herself to me, or inquire who I was. I was starting to see what was happening, the case manager was in charge and the Dr's were being pushed to go along with premature discharge. Some time passed and I heard them discussing my grandmother again, the physician that was initially against sending her away was now saying she talked to Dr. so and so on the phone, and that she would sign the papers (with a regretful tone and look on her face). I immediately felt disgust because I now knew that being cost-effective was more important than my grandmother's welfare, just because of her age. Then to add to my concern she now had a fever of 99.5 which was the first fever she had since arrival. We now had only 1.5 hours until she was being sent away to what I discovered (doing research last night) to be on the Federal Govt.'s list as the worst care facility in Illinois. The evil woman came in the room and asked if everyone was aware of the plans, and my stepmother told her she felt like grandma was being "pushed out" of the hospital too early. I reiterated her statement and addressed my concern of her new fever, and lack of a way of receiving nutrition (still had not eaten more than a few tbl. spoons, still no cal. count). The case manager responded to me, very rudely "does your family know how you feel?" "The family made a decision against g-tube and discharge comes when there's nothing more medically we can do here." I was under the impression discharge came when the pt. was stable enough to leave a dr's care, considering dr's are only at the care facility 1-2x per week.

Case manager to my father: "aren't you the ONLY adult child? So it's YOUR decision to make and nobody elses." She then asked to speak to him privately in the hall for a few min. all the while giving me the stink eye. My grandmother has medicare and my father has arranged to pay additional costs in cash, with no limit. I know it's not my decision, and was simply addressing concerns that I felt were a big deal. So the decision was made by my father to go ahead and she was discharged at 7pm, so there would be an open bed in time for the friday night ER rush. Unbelievable.

Her nurse came in and said good bye to all of us, and was still hinting that she wasn't ready to go. She kept saying how sweet my grandmother is and this is very sad. She had a good laugh earlier that she said she would never forget while changing my grandmother, who is in a lot of pain each time this is done. The nurse kept saying "I'm sorry, I'm so sorry this hurts", and my grandmother responed with "no, you're not sorry.":lol2:

Upon leaving I informed the case manager of her abrasiveness regarding this hard time/decision, and assured her that should my grandmother need to be readmitted I would see to it that it would be at the university hospital down the street.

I have to say that this experience is making me less excited to work in healthcare, and I hope I find employment somewhere that pt.'s are looked at as individuals and not assumed to be typical for their age group. My grandmother has fractures and spinal cord damage at C5 and C6, so her being able to move is a miracle in itself. I just wish the hospital staff was as confident in even a partial recovery as we are.

Thank you to everyone for your kind wishes thusfar! Oh, and the nursing home has changed ownership and improved greatly since that list was published last November. Everything is new as is most of the staff. As of today my grandmother seems to be happy, saying how nice everyone is there. The nurses seem to be very compassionate in dealing with her dementia, encouraging her to ramble on when she get's off track.

[Transplant Nurse, BSN, RN]

devil,

sadly these sort of people are sprinkled pretty evenly at every facility. they do their job well [controlling costs]. they are there to balance out the compassionate care. hope gramma got better.

[wishNhopeNdreamN]

devil,

How is your grandmother doing?

[canoehead, BSN, RN]

Yes, please update.

[pnkrocdevil]

Sorry I haven't updated...Trying to get everything set before school starts (just had orientation last week so we only have 3 weeks for physical/labs/cpr/uniforms etc) and I'm leaving for Mexico next Friday for a week, so very busy.

Anyway, what a rollercoaster ride this has been so far. Grandma seemed to be doing well her first few days out of the hospital, but her new dr. (who was questioning the decisions made by the hospital staff) informed us that a feeing tube wasn't possible because her abdomen was still distended/hard. When I went to the home to visit last Monday things weren't at all what I was expecting. My grandma had been there a little over a week at this point, and her condition had deteriorated rapidly since I last saw her. When I arrived, she couldn't even open her eyes because they were crusted shut. Who knows how long they were like that. I immediately called her nurse to swab them for her. She looked about half the size she was when she left the hospital. She wasn't being responsive. She was just laying there moving her arms in a circular motion on her chest like she was in discomfort. When anyone touched her she would say "just leave me alone please, I'm sick, just leave me." While her nurse was in there she said she had just got the doctor to approve a morphine patch because grandma wouldn't take any meds. Her nurse was just kind of standing there looking helpless, telling me she didn't know what else she could do that she won't eat or take meds, and she just didn't want her to be in pain. She was very concerned about her condition and just kept saying "I don't know what else to do." She asked me if we were considering hospice and I said I didn't know, I wasn't aware of her poor condition. I was sick to my stomach. Apparently, she had been like this for a few days now, (my father failed to contact me to let me know she was getting worse) and I just couldn't believe this was the same woman I saw just 5 days ago that was doing ok. I know some of the signs of approaching death are refusing to eat, take meds, etc. I actually held her hand and said my goodbyes (silently) during that visit. When I told her I was leaving she finally looked at me and said "God bless you, you're a good person, please leave me." Everything I had seen was very surreal, I don't even remember driving home (1.5-2 hr drive mind you). I called my father that evening to talk with him about hospice and he said he had already made an appointment with hospice staff at the home for the following day. My relationship with my father is also becoming very stressed. He's having this pity party for himself instead of making the proper choices for her, and failing to provide support/updates for the rest of the family. Anyway, the doctor prognosed her with less than 6 months, and the decision to start hospice care was made. I haven't been back to the home since that day. I can't handle seeing this once vibrant woman, (whom I think about everytime I cook, garden, and clean because she taught me how) in that state, and am at peace with my decision.

Fast forward to this week for another spin. I called the home after giving a few days for hospice care to take effect, and got some good news (again no update from my father). Apparently now she's eating more and more everyday, and becoming responsive again. The nurse told me that she might be removed from hospice because of her improvement! I'm trying to not get my hopes up, but have decided to visit her this weekend.

All I can do at this point is keep praying that she is not suffering, and that she will get well enough for to have at least one more conversation with her. I want to tell her how thankful I am to have had her there to show me how to be a good (future) wife/mother/caregiver. She had nursed my grandfather, who had a brain tumor, at home all by herself until just a few days before his death. I was brought to tears when my mother told me that story a few years ago. She has always put everyone elses needs above her own, and it's very humbling to be around someone like her.

Nothing seems real right now. I live in one of the communities hit by the tornadoes that ripped through NW Indiana on Monday. It's like a war zone here, 60 ft trees completely uprooted, power still out everywhere. Just 4 blocks away there are about 30 homes/businesses without walls/roofs that are completley destroyed. Only 4 BLOCKS AWAY! I was terrified, home alone, hiding in the basement for hours with just my kitties and dog. It sounded as if a freight train came through full speed and you could hear people screaming. We were fortunate not to have any major damage, just some very large trees down that were struck by lightning. I still have a ton of stuff to do for school before I leave for vacation a week from tomorrow. I don't even know if I will go, I did buy trip insurance once this happened but what if she dies while I'm down there. It's not like you can just hop on any flight from Cancun, as most of them are charters. To add to all this I have been taking poor care of myself, drinking more, eating less (lost 8lbs since all this started) and now have to go for more labs because my comp. metabolic panel showed that my liver enzymes were elevated enough for my dr. to order more tests tomorrow. So hopefully its just from too much stress/alcohol. I did run out and buy milk thistle as soon as he called today.

Again, thank you all for your support/concern. Hopefully I will be able to pull myself together before the first day of Fundamentals (8/25). And hopefully the rest of grandma's days will be peaceful and positive.