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Sometimes with older patients I wonder if it is intentional neglect. My sister's 97 yo GFiL went to the hopital for something minor a couple years back and never came out alive. I can no longer remember what it was he had, but I remember we were all furious that they were denying him some pretty basic treatment for it. The Drs. said he was old, his time was up, and his body was shutting down. I suspect that insurance companies come in to play for many of these decisions. I know I was not alone in feeling that he was dying because they would not treat him, not the other way around! Just a few weeks earlier, he was staying with my sister who had just moved to Elk Grove. He usually lived with his daughter due to transient dementia. He was upset that my sister would not allow any fish in her house (Old Norweigan who likes his Ludefisk), so he stormed out the door to take a walk to cool down. My sister knew he would not want her to follow, but she was worried about him losing his way in a place he had never been to before where all the houses look the same, so she went outside to wash the car. When he came back a little while later "What, you worried I'm gonna get lost or something? Well, my hearing may be lousy, but my mind is as sharp as it ever was!"
Remember the man who called me Friday who lost his wife on Thursday? He came in today to file an extension, and he said that even though the Drs. knew his wife was dying and in severe pain fro the last 10 days, they would not give her any pain killers because they dropped her heart rate too much and might kill her! She had kept her Canadian citizenship for the healthcare coverage, but in the end, she was too ill to make the journey.
I think that sometimes we don't give enough credit to healthcare workers. If a person is in the hospital, you can guarantee they are seeing at least two nurses in 24 hours, one or two hospitalists, and possibly specialists, social workers, CNAs, etc. Most of these people got into it because they care. Many CNAs earn not much above the minimum wage, yet they clean up vomitus, change adult diapers, give bedbaths, do bedpans, etc etc etc. Nurses do that and more. .. sometimes medical procedures are uncomfortable and it sucks for the medical staff and the patient, btu without it healing is impossible. For example I have seen on multiple occasions where turning a patient every 2 hours is required to maintain skin integrity (in some cases, what skin integrity is left) and promote circulation and healing. Despite strong pain meds, this hurt the patient. In some cases, if they weren't turned, the wounds would be deadly. They have the choice- turn or not.... and sometimes we can't medicate them enough to remove all the pain... just to dull it.
That said, it is great if people have loved ones or caring friends to act as healthcare advocated in a healthcare setting. It does make a difference.
My own grandmother was sent home on hospice in early May, 2008. I flew out to help with her care, and she was in constant pain. The problem was she suffered from an intestinal blockage and pain meds are constipating,.. and mroe constipation would increase the pain and increase the risk of the blockage turning into a rupture and leading to sepsis. My grandmother is still alive today.
At that time I wanted nothing more for her than pain control and, hopefully, a relatively pain-free death. Had she been given the pain medication needed to keep her comfortable, she would have probably been stuporous, unable to communicate, and would not have made the partial recovery which enabled her continued life. Meanwhile, through all of this,
I held her hand for hours on end while she writhed in pain and moaned about how much she hurt. It was very hard on everyone... and it was a careful balancing act to try to dull the pain somewhat yet try to encourage bowel motility.
Mistakes are made, yes,.. but I think most people do want the best outcome possible.
I'm afraid that's what we'll have to do at some point, and I don't know how I'll bear that.
