What can happen to an old person in the hospital

My mother, age 93, recently suffered a serious stroke. She was transferred to a big-city hospital that specializes in stroke treatment, where a highly qualified and brilliant, to put it mildly, doctor removed a clot from her brain. I’m grateful that people like him exist.

So far, so good.

During the ensuing week, I spoke to two different doctors by phone. These doctors were handling her post-intervention care.

The first doctor asked me all about heroic or extreme measures, such as whether I wanted them to perform full CPR on my mother if her heart stopped. He also asked me to consider whether my mother should have a ventilator, should that be required for her breathing.

I considered all that and gave some tentative answers.

Until two weeks ago, my mother was active. She gives music lessons, and is paid for it. Until two years ago, she conducted a choir. She’s an avid reader, and the last book she read was a biography of Haydn. I’d given her a recording of Haydn’s twelve London symphonies for Christmas, so she was interested in telling me about the biography.

I spoke to the second doctor a couple days later. She, the doctor, had taken over my mother’s case.

The doctor said that she understood that my mother had had some memory problems. Right, I’m thinking, like she couldn’t remember some actor’s name in some movie she saw. About as severe memory problems as I myself have, which is to say hardly any.

Your mother is 93, she said, old. Maybe she shouldn’t be resuscitated if her heart stops. Also, think about what you want to do if she doesn’t improve.

It took a day or so for all of this to sink in.

It was starting to seem like they wanted to throw my mother onto the discard pile, because of her age.

The next day, I called the doctor, left a message, and told her I wished to speak to her. She didn’t return my call.

That night, it hit me. I needed to do something, what I didn’t know, but with my suspicions about what they were thinking at the hospital, I had to do something. I called the nursing station and began asking some tough questions, like did they have my mother’s medical records, who was the doctor in charge at the moment, what doctor would be responding to a medical emergency, and so on. I told them that I was unhappy with my mother’s treatment.

No sooner had I put the phone down than the second doctor called. I guess the word was out that I was an unhappy customer.

I told the doctor that the only message I was getting was that we should let my mother die. She said that she was sorry that I got that impression, as if it were all my fault. Just a matter of getting wrong impressions.

I responded that I expected full enthusiasm in my mother’s treatment and that I didn’t think that she was getting that. That she was not ready for the discard pile, and that I very much resented their implications that she was. The doctor and the hospital are of course being paid piles of cash for her treatment, and I expect them to earn it – though I didn’t say this.

The doctor was flustered. She, like most doctors, is not used to anyone questioning them. She filled me in on a lot of the details of the treatment, after I insisted on hearing them. Before I hung up the phone, I was given assurances that they would be doing everything in their power to bring my mother back to normal.

My mother is almost ready to be discharged from the hospital, but just a few days ago I thought maybe she was going to die. I certainly got the feeling that those in charge of her care would have been very much OK with that.

I’m writing this because the same situation could happen to anyone. Don’t let doctors browbeat or convince you that the best course is doing nothing, or even death, if you don’t think that’s the case. It’s not their decision, it’s yours and that of the hospitalized person.

We hear a lot these days about end-of-life care, but the assumption being made is that someone is truly at the end of his or her life. That is not always the case. Just because someone is old and has a difficult illness, that does not mean that they should be just allowed to die.

Postscript: Each time I visited my mother in the hospital, she was groggy and wanted to sleep. Well, I got a call from a hospital pharmacist today, asking if I had information about one of my mother’s medications. One of them is a med she takes for a relatively minor disorder, but which she always said made her very groggy. It turns out some doctor had ordered her a dose of this med that was three times greater than her usual dose. This was probably the cause of her sleepiness and grogginess in the hospital. The pharmacist said that she would make an immediate change in her dosage.

Update: When I went to visit my mother, she wasn’t eating much, because she felt bad and nothing appealed to her. Almost worse, the stuff they were trying to feed her consisted of things like applesauce and cranberry juice. I don’t think that’s exactly optimal for someone in critical care who won’t/can’t eat. So I went back the next day armed with whey protein and fed my mother, and strongly suggested to the nurse that she give her more after I left. My sister did the same next day. In her coming recovery, she’ll be drinking a lot more of that, along with (probably) n-acetylcysteine, vitamin C, omega-3, possibly tocotrienols, etc. I’ve yet to figure it out exactly.

 

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14 comments
Steven says April 28, 2015

consider vitamin C for your mother.
http://lpi.oregonstate.edu/mic/vitamins/vitamin-C
Russell Jaffe
Linus Pauling
People can fully recover from strokes. My thoughts go with you and your mother.

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Shawn says April 29, 2015

I learned that in hospitals and nursing homes, if a patient is ornery (or uppity) sometimes they are given drugs which make them very drowsy and confused – no need for the staff to receive any talk-back.

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Dr. George Morris says April 29, 2015

An unfortunate but all too common experience. I had the same issues with my 98 year old grandmother who had lived on her own including cooking for herself until she had a heart attack at 93.

At one care facility after reading her chart I realized she hadn’t been fed or given water in over 2 days because she was so drugged up she couldn’t feed herself and the attendants didn’t care to try or write that on her chart! Unsurprisingly she made a 90% recovery after cessation of the narcotics they had her on and when they resumed feeding her and giving her water. Basic human decency would solve a lot of these maltreatment issues in my opinion.

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Toddy Cat says April 29, 2015

Never, NEVER, NEVER! let doctors convince you to “no-code” a parent unless you are absolutely, utterly sure that it’s the right thing to do. This happened in my family, and I literally regret it every day. You did the right thing, DM, and may others heed your example.

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Ed says April 29, 2015

P.D. thanks for a great site. I recently spoke with a Dr. friend of mine about the economics of hospital stays and the financial incentive for the bureaucracy to move patients out or curtail their stay. I always thought that hospitals make substantial sums by providing treatment, so the more treatment, the greater the return. But I understand from him that the return on a hospital visit is limited. That after 5-6 days, the patient becomes a financial burden on the hospital. That the administrators become involved to “manage” the care and encourage drs to move patients out or “along”. Drs who do not conform are identified as not being team players and they find it hard to succeed. He asked me what I knew about the massive increase in palliative care doctors on staff at hospitals providing comfort to patients at the end of life – care which is not reimbursed by insurance companies. Why do hospitals pay to have drs on staff who are there to hasten death and who earn no revenue for the hospital? They are there to manages costs. They, along with drs and administrators who help family to understand the patient is suffering and probably no longer useful, do not have you mother’s interest in their hearts.

I am totally passing along what I heard from him. So, it’s hearsay. But it is food for thought. Best.

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P. D. Mangan says April 29, 2015

Thanks everyone for comments.
Steven: I will consider vitamin C, thanks.
Shawn: yes, I’ve rad this, it’s common for old people to be placed on tranquilizers and, more worrisome, antipsychotics in order to make them less of an annoyance.
Dr George Morris: Thanks for sharing the story of your grandmother. “Basic human decency would solve a lot of these maltreatment issues in my opinion.” I agree. Frightening though what they were doing to your grandmother.
Toddy Cat: Thanks for your support. It’s too bad you have to live with that kind of regret. But, it is often difficult to know what to do at the time it’s all going down.
Ed: thanks for that insight, which is all too believable.

And please see above for a post update.

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    Sam says May 3, 2015

    There’s some controversy over whether Linus Paulings vitamin C theory works for heart disease or not. I’m not sure what the answer is. One of Paulings research associates said that mice fed large amounts of vitamin C were at risk for cancer. I’m assuming that this was because it suppressed the normal oxidation used by the body to kill dead cells. He was fired.

    If you’re going to use Vitamin C is would be very wise to look into “Lypo-Spheric™ Vitamin C” . The Lypo-Spheric is so small it goes directly into the bloodstream. Normal vitamin C can cause severe diarrhea to get the blood stream levels in the range where significant results occur. You supposedly can get intravenous levels of vitamin c into the bloodstream with the Lypo C. There’s a commercial product and you can make your own.

    There was a case in New Zealand where a guy had his lungs completely and the doctors were about to unplug him. The family insisted on intravenous vitamin c and it pulled him out. Their doctor then insisted on removing the C. He of course went down. The family used the commercial Lypo C to pull him out so they believe in it.

    Maybe best would be high doses then none alternating.

    For making you own Lypo C you can use Chinese ultrasonic generators or I found that you can buy used ultrasonic generators on ebay of much higher power. Link

    http://www.ebay.com/bhp/ultrasonic-cleaner

    The little small around $30.00 do work but take longer and are a bit of a pain. I kept looking at the cleaners and bid on one like the link below and got it for 100 bucks. Around 500W. It actually makes my stomach queasy to be around it. I keep it in another room when it’s running. Run it about 30 or 40 minutes. Maybe stir a couple times. Works great. You can tell the more powerful one works better because any Vit. C not encapsulated you can taste the bitterness. With the more powerful you mostly taste the lecithin.

    http://www.ebay.com/itm/L-R-2014-Ultrasonic-Cleaning-System-Unit-Cleaner-Holding-Pot-Lid-Fuse-holder/251942015371?_trksid=p2054897.c100204.m3164&_trkparms=aid%3D222007%26algo%3DSIC.MBE%26ao%3D1%26asc%3D20140407115239%26meid%3D097b20d2cf0b45c9960c26b326e766da%26pid%3D100204%26rk%3D1%26rkt%3D29%26sd%3D201168624240

    Link to commercial Lypo. I have no financial interest in these guys in any way.

    http://www.livonlabs.com/cgi-bin/start.cgi/liposome-encapsulated/lypo-spheric-vitamin-c.html

    Search for DIY Lypo just goggle “How to Make Your Own Liposomal Vitamin C”

    Lot’s of recipes. I suggest if you make some you use granular lecithin. The jelly type just makes a big gloppy mess.

    Reply
      Sam says May 3, 2015

      Sorry missed a part “…New Zealand where a guy had his lungs completely..” filled with some type of infection. He couldn’t breath as his lungs were full of fluid. The C knocked this infection out.

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Dave says April 29, 2015

As someone who faced these issues with my mother 20+ years ago, it is imperative that people understand you must be your own advocate, or advocate on behalf of loved ones, when it comes to dealing with doctors and hospital staff. Ask tough questions and demand answers, and keep asking until you get someone who responds.
You did the right thing, and you are correct in observing that most doctors and medical staff are not used to challenging questions and inquiries.
Keep pushing.

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RA says April 29, 2015

My father had an emergency that required him to go to an ER recently. The lead doctor running his care didn’t work for the hospital, he worked for the HMO group to which my parents paid their Medicare HMO premiums. This bias became clear to me when that doctor made decisions that were very much about the money. Example, he ordered my father booted out of the hospital room and sent to a rehab facility even though father wasn’t ready to go. This was because the HMO didn’t want to pay for another night in the hospital. Things like that. The rehab facility was clean and the workers tried, I’ll give them that, but they were a bit understaffed and weren’t catching on quickly enough to the issues my father had while staying there. That’s a whole other set of stories. Looking back now: if my mother and I had not repeatedly agitated on my father’s behalf, he might not have made it home.

Takeaway for me: I’m divorced with no kids and not much of a relationship with my nephews and nieces due to living far apart. So chances are good no one is going to be around to advocate for me when it’s my turn and I need that help. They’ll probably keep me alive until my estate is drained, then kill me off. Maybe I need life insurance after all, just to make sure my funeral is paid for. Scary thoughts …

Hope your mother gets better

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Laguna Beach Fogey says May 5, 2015

I’ve had some experience with this in recent years. I’m convinced there’s a racial and cultural angle to this, that the Bolshevik establishment means to hasten the passing of old(er) White people as individuals and as a demographic.

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Kristi says May 7, 2015

WOW. This is really sad. I am a nurse at a hospital and do all I can for my patients. BUT, we are frequently understaffed and that means less care for patients. When a nurse has 5 or 6 patients and the tech has 20 or 30 by herself its impossible to care for a all patients in the manner they need. We may not have more than a few minutes to feed a patient. Not only are we understaffed but most of the time lack the equipment to do our jobs, or waste hours a day looking for pillows, pumps, SCD’s, and other items. Yes, complaints are made but nothing changes except the increase in job requirements handed down from management who haven’t been nurses in years.

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    P. D. Mangan says May 7, 2015

    Thanks, Kristi. Yes, I’m sure nurses are very busy, but I make no complaint about them. It was the doctors’ attitudes that worried me.

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Toddy Cat says May 12, 2015

“the Bolshevik establishment”

Nicely, and accurately, phrased…

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