Sunday, October 07, 2007

The State of Health Care

2 weeks ago my husband was hospitalized for pneumonia as well as blood in his stool. Jim is 82 and in good health. He does, however, take Coumadin, a blood thinner, because he has atrial fibrillation. Upon his admission many blood tests were required, as well as x-rays of his lungs. They did not, however, collect a stool specimen to identify whether he was truly bleeding internally. The doctors simply did a digital exam and ascertained that since his stool was black, he was bleeding.

When one takes Coumadin, it is advised to have a Pro-thrombin time blood test taken. Today it is commonly called INR, International Normalized Ratio. This is the rate at which one's blood clots. A normal PT is between 2 & 3. When Jim's was taken, his PT was 44, which meant he had water, not blood flowing in his veins. It certainly could explain why he was bleeding internally.

The doctors claimed the inordinately high PT was due to his fever and pneumonia. Needless to say, they immediately started to treat the high PT. However, they simply missed on his admission papers that he had pneumonia and was to be treated with I.V. antibiotic immediately. We waited all that 1st day, no antibiotic. At 8:00 p.m. they advised that I would have to leave. I foolishly assumed they would start the antibiotic that evening.

After all, they had already run a line for an I.V. and had started giving him plasma. Upon my return the next day, I asked him if they ever gave him an antibiotic. He simply did not know, so I went to the Nurse's station to inquire. The head nurse was sitting at the station so I asked, "have you started my husband's antibiotic"? She looked at me as if I had 2 heads and replied, "no antibiotic was ordered, it is not on the Dr's admission sheet". When I suggested that they may have overlooked it, after all he was admitted with pneumonia, she said "we wouldn't miss that".

Of course, they did. I stood there and asked to see his admission form. Of course, our Doctor had ordered antibiotics to be started immediately. It was now 24 hours later. After a lot of excuses as to how they missed wasn't written in the right place...the pharmacy should have picked it up, etc. I suggested that they order the antibiotic immediately and start administering it. Had I not been there to advocate for my husband, who knows how long he would have been in that bed without antibiotics for his pneumonia.

On Thursday the Gastroenterologists did an endoscope to see if they could find bleeding in his stomach. By this time he had been give 6 pints of plasma and they still could not get his PT down. However, they decided that as long as he had been on liquids all week and had found nothing on the endoscope that they would do a colonoscopy on Friday. So that evening they had him prepare for his colonoscopy. If you have not had one you don't know how miserable the prep is. The test is easy, you are under light sedation. The prep is horrid.

Add to this he is schlepping around a large IV machine with minimally 4 bags of IV on it and he is weak from both the pneumonia and only a liquid diet for 5 days. On Friday morning I called the Nurse's station to see if he was back from the colonoscopy. They told me he had gone down, but it wasn't done.

I called my husband to ask why they didn't do the test. He said "the doctor told me there is something wrong with my blood and they don't want to take any chances so they were calling in a hematologist". By Friday morning, he had received 10 pints of plasma and the doctors had been telling me he was severely anemic. When I heard that they were calling in a hematologist my heart started to race.

In my 1st life I was a Medical Technologist. My specialty was abnormal hematology or only those cases that did not have normal blood. So upon hearing that a hematologist had been called, along with all the plasma he had received and the fact that he was anemic and they still had not found the source of the bleed, or tested his stool to see if blood really was present...or if it was the blueberry blintzes he had eaten Saturday night that turned his stool black...I was certain they were suspicious of a serious anemia, Pernicious or Hemolytic Anemia...or that his spleen was not producing red blood cells or that he had a leukemia. I got in my car and raced to the hospital for fear of missing the hematologist.

I shouldn't have rushed. The doctor didn't come in until after 3:00 p.m. When he arrived and I expressed my concern about why he was called, he told me "it's only because his PT is still too high". It would have been so easy for the GI doctor in the morning to simply say, "your PT is too high, I don't want to take a chance that I may nick you and you will bleed". Instead, he had to frighten us by saying, "there is something wrong with your blood". "I am calling in a hematologist".

It is incredibly important that we know our bodies. That we ask questions when we are uncertain about our care. Most importantly, we have to remember that doctors are not G-d's, but human beings who are not always right and don't always do the right things.

On Saturday, they did a colonoscopy on Jimmy as well as an upper and lower GI. They never found the source of the bleed. Of course, they also never tested his stool to see if he really was bleeding or if it, in fact, was the blueberry blintzes on the previous Saturday. By Monday, one week after being admitted to the hospital, his pneumonia was much better and his PT was coming back to normal, so they discharged him.

However, I believe that enormous stress could have been prevented, as well as unnecessary testing, if only they had done 1 simple test...for occult blood in the stool. You see, by Wednesday, the 3rd day he was in the hospital, his stool had returned to it's normal color.

One has to wonder how many people are killed in hospitals every year because they have no one to speak for them and the nursing staff misses something on a chart. Doctors do, what may be, unnecessary testing because they don't do the right test to begin with, or patients are just ignored if there is no one with them to continually question what is being done.

Health care is costing us millions of dollars per year. One cannot be without insurance and yet our insurance determines how much doctors should be paid. Perhaps this is why the care we get is not always the best care.