Discharged and left to die ????

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I will try and give as many detail as I can. I AM NOT ASKING FOR MEDICAL ADVICE. Only on how to handle this situation. Here goes...

One year ago, my grandmother was diagnosed with Pancreatic Cancer (Yikes!!) :crying2: She went through chemo and radiation (surgery was not an option due to her badly diseased liver) This February her CT showed that her tumor shrunk. Since then she hasn't done chemo or radiation. Earlier this month, we rushed her to the ER with severe abdominal pain and extreme fatigue. Turn out her hgb was at a 7 :eek: and needed a blood transfusion. An endoscopy was done. Esophogeal varices was discovered but there was "no evidence of an active or prior bleeding" She was discharged with meds for portal hypertension. Well she's back in the hospital (admitted 6/28) with a hgb of 5 :uhoh3:. They gave her more blood. They were going to perform an endoscopy and a colonoscopy but cancelled it. AND I DON'T KNOW WHY! Instead we got, "we suspect she's bleeding from her tumor" (btw the tumor is in the pancreatic duct not necessarily in the pancreas) and there is nothing they can do. They SUSPECT. :mad: I'm sorry but their hunch/theory is just not good enough!! I don't need them to tell me she's terminal, I'm fully aware of that. But do they just discharge patients from just suspecting that the tumor is where the bleeding is coming from?? I'm angry because they do nothing to definitively find the source of her bleeding. Do we just stop searching because she's eventually going to die? By discharging her they are telling me, "hey, she's gonna die anyway, why look for an answer" It's breaking my heart. I just want to know how I can get these doctors to not give up on my grandmother. The cancer has not metastasized and I assure you she's not ready do go. But sending her home with internal bleeding is going to kill her. Please anyone that could advise me on how to handle this situation. I'm beyond desperate :crying2:

P/S...my grandmother only has medicare which means she's responsible for 20% of her bills. Her chemo,radiation, CT's, blood work etc.. is very expensive and we try paying as much as we can. As you can imagine we owe lots of money. Could that be the reason they cancelled the endoscopy and colonoscopy?? :mad: Can they stop treatment when someone isn't able to pay even though she's clearly has internal bleeding? This isn't an broken finger where she can just go follow up with an orthopedist after discharge. SHE'S BLEEDING INTERNALLY FROM SOMEWHERE AND THEY'RE NOT FINDING THE SOURCE!!! :eek:

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Is anyone sure that she is actively bleeding? I know her H&H is low, but how is her apetite? If she is getting chemo and radiation, my guess might be "not good." Her bone marrow is suppressed from her cancer treatments too, I would imagine.

Also, when did she last have a colonoscopy? You said an endoscopy was already done that same month and they found no bleeding.

Maybe call the doctor and asked why he cancelled. I'm sorry for your distress. It must be agonizing. :(

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

(((((hugs))))) :hug: I'm so sorry for what your grandmother is experiencing.

Perhaps obtain a second opinion from a different physician at a different practice?

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Playing the devil's advocate here, so don't tear me apart....perhaps they don't want to subject her to tests that will compromise her condition further? The colon prep and sedation can be so hard on a body, especially one that's already weakened. Or maybe they want her to follow up as an outpatient? Or if her disease is so advanced, maybe they feel it's futile and don't want to subject her to procedures that are unrealistic? Did they suggest hospice care? I don't know the situation, this is just some thoughts...we see so many older, terminal patients who the family wants everything done for, when we know the end result will be the same regardless and we're basically torturing the pt for the familys peace of mind. Call her doctor and get answers, so that you can 1. find another physician you trust or 2. have some closure that everythings been done. Either way, good luck....and like I said, I'm just playing devil's advocate, so don't flame me!

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It's beyond agonizing. Her colonoscopy was within 4 years (WNL) but nothing recently. She hasn't had radiation or chemo in the last 4 months. She gets hungry but doesn't eat much. Her abdomen is severely distended from her ascites. She must feel too bloated to eat despite her hunger. And no, no one knows if she's actively bleeding. This is what the doctor's "suspect" She's at Memorial Sloan Kettering Cancer Center. Her oncologist is WONDERFUL!!! Unfortunately, she was admitted in the MSKCC in NY when her oncologist is based at an outpatient clinic in NJ. Her oncologist suggested we go the NY hospital since they have access to her medical records.

Can I make them keep her?? Is that possible?

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Specializes in Med/Surg., Geriatrics, Pediatrics..

Gabby, first I just like to say I'm sorry for all the hurt you are going through. You grandmother is very special to you and you want her to have the very best care. I believe since your grandmother only has medicare, they are only doing the minimum. My husband's mothers has health insurance up the wazoo and when she is admitted to the hospital for her regular trip of CHF, they want to do every test under the sun that is not even related to what she came in with. Their excuse is, "well we just want to rule this out and rule that out, etc." I literally have to remind them that she's 84 and leave her alone. My advise to you is why don't you have the endoscopy and colonoscopy done outside of the hospital by an Gastroenterologist? You don't need to the hospital to do those test. Speak with her PCF and tell him/her the situation. Good Luck, Gabby and be strong for your grandmother.

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Playing the devil's advocate here, so don't tear me apart....perhaps they don't want to subject her to tests that will compromise her condition further? The colon prep and sedation can be so hard on a body, especially one that's already weakened. Or maybe they want her to follow up as an outpatient? Or if her disease is so advanced, maybe they feel it's futile and don't want to subject her to procedures that are unrealistic? Did they suggest hospice care? I don't know the situation, this is just some thoughts...we see so many older, terminal patients who the family wants everything done for, when we know the end result will be the same regardless and we're basically torturing the pt for the familys peace of mind. Call her doctor and get answers, so that you can 1. find another physician you trust or 2. have some closure that everythings been done. Either way, good luck....and like I said, I'm just playing devil's advocate, so don't flame me!

I understand what you mean. I've thought about how selfish my family could be by keeping her alive while she's suffering. I tears me apart because I want to keep her with me as long as I can but at the same time I can't bear to keep her alive while she suffering. 4 years ago I lost my grandfather to Mesothelioma. I watched him suffer til the end. He didn't go peacefully but he did die at home surrounded by his family as he wished. At first, I was asking God for a miracle so my grandfather could stay with us longer but towards the end I was begging God to take him. It's far more terrible to watch your loved one suffer. But my grandmother is not suffering. She's not well when her hgb is low but once she gets the blood transfusion she's happy and laughing with us. She even jokes with the doctors and nurses. She really isn't suffering; I'd be the first to admit if she were. I'm angry because the doc's aren't looking for an answer they are just assuming it's the cancer. They don't even know if it has metastasized. Besides blood work there has been no other attempt to perform other diagnostic tests. For example, a CT would help to determine if the tumor has grown or if a new one formed. Maybe she isn't even bleeding from the tumor. This morning she had bloody stools (new symptom) and they still want to discharge her. If they suggest an outpatient colonoscopy I would agree to it if she wasn't bleeding from an undetermined source. I'm afraid she's going to bleed out and it will be too late to get her to a hospital :crying2:

P/s I appreciate your feedback.

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Gabby, first I just like to say I'm sorry for all the hurt you are going through. You grandmother is very special to you and you want her to have the very best care. I believe since your grandmother only has medicare, they are only doing the minimum. My husband's mothers has health insurance up the wazoo and when she is admitted to the hospital for her regular trip of CHF, they want to do every test under the sun that is not even related to what she came in with. Their excuse is, "well we just want to rule this out and rule that out, etc." I literally have to remind them that she's 84 and leave her alone. My advise to you is why don't you have the endoscopy and colonoscopy done outside of the hospital by an Gastroenterologist? You don't need to the hospital to do those test. Speak with her PCF and tell him/her the situation. Good Luck, Gabby and be strong for your grandmother.

I was afraid that may be the reason. Wish someone would have given her insurance before she was diagnosed with her present cancer but since she had breast cancer in the past, every possible secondary insurance refused to cover her. Thank you for you advise. I will look into it. :D

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Specializes in Emergency & Trauma/Adult ICU.
Playing the devil's advocate here, so don't tear me apart....perhaps they don't want to subject her to tests that will compromise her condition further? The colon prep and sedation can be so hard on a body, especially one that's already weakened. Or maybe they want her to follow up as an outpatient? Or if her disease is so advanced, maybe they feel it's futile and don't want to subject her to procedures that are unrealistic? Did they suggest hospice care? I don't know the situation, this is just some thoughts...we see so many older, terminal patients who the family wants everything done for, when we know the end result will be the same regardless and we're basically torturing the pt for the familys peace of mind. Call her doctor and get answers, so that you can 1. find another physician you trust or 2. have some closure that everythings been done. Either way, good luck....and like I said, I'm just playing devil's advocate, so don't flame me!

This excellent post does not "play devil's advocate" ... it plays PATIENT ADVOCATE.

The GI docs at my large, academic, tertiary-care hospital would probably not perform endoscopy on a patient with known esophageal varices, either.

OP, please consider what you said about your grandfather's peaceful death ... and then consider what you are asking for for your grandmother -- a procedure which could result in her traumatic, messy, definitely NOT peaceful death from ruptured esophageal varices. Since you mentioned that your grandmother also has some hepatic pathology, you might also do some reading re: liver disease and chronic anemia, and consider whether there is more than one explanation for a dropping Hgb.

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Specializes in Med/Surg., Geriatrics, Pediatrics..

No, you can't make the hospital keep you when you are discharged. If you want your grandmother to stay in the hospital, but they discharged her, wait a day or so and bring her back. My best advise is save the hospital for emergencies and take your grandmother to her PCF and have him/her recommend with a referral to a gastroenterologist. You can also ask your grandmother if she has been vomiting and if it looks like coffee grounds. Coffee ground emesis is a sign of bleeding in the stomach. Also, if her stools look black, that too may be a sign that bleeding is occurring.

Good luck again, Gabby. The most important thing you must remember is keeping your grandmother comfortable and free from pain and discomforts.

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i am so sorry that your grandmother is terminal.

i want you to know something. sometimes trying to keep terminally ill people alive with tests and treatments hurts so much more than allowing them a peaceful death without needles, surgery, etc. these tests are not comfy, warm and fuzzy, or easy for the elderly. add cancer to that mix, and you are basically torturing this poor woman.

"finding the reason" is a painful procedure she does not deserve right now.

it's not about just living, but quality of life. why should her last days/months/year be in pain from procedures to learn there really is nothing they can do? why can it not be beach trips, nice dinners at restaurants, etc?

she is terminally ill, spend time with her, laugh with her, communicate with her, and make sure she is comfy.

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Specializes in Tele, Dialysis, Med-Surg, ICU,GI.

You can appeal the discharge. In NY when someone is being discharged and disagrees with it, you can call 1800 number and appeal it, this part of the admission paperwork.

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