Another night of horrors! At about 10 pm two men on the "lift team" came into the room to turn Linda in her new bed. There was no nurse with them and no nurse in the room, a fact which the hospital administration admits is a breach of protocol. Apparently when these fellows turned Linda they disconnected the tube feeding line from her feeding tube. Two hours later the nurse discovered that she was lying on chux pads and bed linens soaked in the feeding liquid. They changed the linens and reattached the tube feeding bag to the feeding tube. An hour later the connection was still leaking and Linda was once again lying in a pool of the tube feeding liquid, called Peptamen AF. This despite the fact the nurse had taped the connection together when she put it back after the earlier incident.
At 1:58 am today, Linda complained to the respiratory therapist who was in the room giving her a breathing treatment, of the sudden onset of pain in her right flank - remember it is her right ling that collapsed multiple times, and her new liver is on her right side. His response was "I'll look for your nurse as soon as your treatment is complete." When I suggested he might push the call button to summon Linda's nurse without waiting the 10 or 15 minutes for the treatment to finish, he couldn't locate the call button, and I had to press it for him.
During the next two and a half hours, three different doctors were identified to me by name by the nursing staff as responding to my insistence that a doctor see and assess Linda for this new pain rather than just prescribing narcotics over the phone and going back to sleep. None of them ever showed up. At 2:45 am a resident from another unit came to look at Linda, and said she was "going to get her chief" to help figure out what was wrong. She promised the two of them would return promptly. This was the same doctor who was first on the scene the night Linda's chest tube was ripped out of her by the nurses moving her from one bed to another. This doctor, Dr. Batiste, left Linda's room at 2:52 am, never to return. I was told later by the nursing staff that she left the unit in tears after calling the chief resident, who refused her request to come in and see Linda.
At 3:21 am I noticed that the taped together feeding tube connection was still leaking, and asked Linda's nurse to turn off the feeding until the leaking situation could be corrected, which she did. By this time there was a large area of redness over the portion of Linda's abdominal incision which had been in contact with the bed linens soaked with tube feeding liquid. The area near the insertion point of the chest tube on Linda’s right side towards her back had also been covered by the linens soaked with feeding liquid, and was also reddened.
At 3:38 Linda became more agitated, and I asked her if she was still in pain. Despite having her airway to the vocal cords blocked by a cuffed tracheotomy tube, she shouted the word "YES" so loudly to me that she actually made an audible, intelligible sound. I again complained to the charge nurse that we had been waiting for some physician to assess Linda's sudden onset right sided pain for nearly two hours, promised three doctors by name, and no doctor at all had examined and evaluated Linda's situation. She came into the room on her cell phone with yet another of the transplant service doctors. I described Linda's hours of torment to him myself, and he assured me some doctor would come to examine her "in the next hour or so."
Up to this point the assistant administrator on duty - an RN - had been telling me that Dr, Tector couldn't come to see Linda because he was involved in a surgery at Riley Children's Hospital down the street. At 3:50 am the charge nurse informed me she had just spoken to Dr. Tector on the phone, and that he was on vacation out of state. At 4:05, when there was still no physician who had examined Linda, I again spoke to the charge nurse, who asked if it would be all right to have Dr. Shah - the one who botched the chest tube reinsertion procedure and caused the cardiac and respiratory arrest that put her into a coma - come and examine Linda. She told me "He's 15 minutes away." I very reluctantly agreed, as it was apparent no one else cared enough to show up.
At 4:29, nearly double the promised "15 minutes away," Dr. Shah appeared and examined Linda. He had a chest X-ray done to check her lungs, and an abdominal film to check the position and patency of the feeding tube. He flushed the tube and it seemed to him to be working. He also did an abdominal ultrasound to see if there was fluid building up in her chest or abdomen, and found none. He hung around long enough to tell me the X-rays showed nothing abnormal, and then he left.
At 7:40 this morning, as the doctors showed up in the TICU to begin their morning rounds, I pointed out to the charge nurse that we still had no answer as to the cause for Linda's right flank pain, nor had Linda been given anything at all for five and a half hours to treat the pain. The night shift nurse who was about to go home came in and injected 0.2 mg of Dilaudid directly into Linda's central line, and Linda immediately fell asleep.
Linda is resting comfortably now, but there is still nothing to tell what is causing her pain on the right side.
The negotiating session with Clarian risk management, hospital management, defense lawyers and insurance company has been scheduled for 4:00 p.m. Tuesday August 3 in a conference two floors up from Linda's hospital room. I'll be putting on a business suit and necktie for that meeting.
When I related this sequence of events to the doctor and nurse practitioner who came around on regular rounds this morning, none of the nurses had told them about any of it yet. The nurse practitioner told me maybe the problem was a poor match between the fitting on tubing that comes attached to the Peptamen AF from Nestle and the fitting on the feeding tube they put into Linda's intestine. I inquired whether that wasn't something the surgeons should have thought about when deciding which feeding tube to put into Linda, before they operated on her, he didn't have an answer. He just recoupled the tube from the bag to the feeding tube port and taped them together. I guess health care practice is like health care legislation - patched together with duct tape!!
As I sit here writing this at 10:30 in the morning, more mistakes are happening before my eyes. Linda's feeding tube has three ports - one for inflation of the balloon that holds it in place on the inside of her stomach wall, a second which empties into her stomach, for administration of her medications, which are better absorbed in the stomach than in the intestines, and a third which empties into her small intestine, for feeding. The nurse just disconnected the feeding bag from the feeding port and started injecting Linda's medication into her intestine. I told her the medication was supposed to go into the stomach, and she left to phone the doctors to check whether I am correct. Turns out I knew exactly what the doctors wanted, as they told me that was why they selected this particular variety of feeding tube for Linda. Now, we need to figure out what to do about the medicine that was injected into the wrong tube.
I don't understand why I have to be the one to clarify to the nurses what it is that the doctors want regarding Linda's care and treatment.
No comments:
Post a Comment