What About Recovery

By Lenore M. Buckley, MD, MPH: For More Info, Go Here…

Last winter, my brother Tom, a 68-year-old kidney transplant recipient, traveled from New York to Virginia to visit his new grandson. Within a week of his arrival, he developed a fever with nausea and vomiting and was admitted to the local medical center for possible sepsis. His wife called a few days later to reassure me he was improving, the cultures were negative, and the doctors thought he had a viral illness.

On the evening before discharge, Tom complained that he could not breathe. When I arrived the following day, he was sedated, on a ventilator, and receiving broad-spectrum antibiotics and intravenous fluids. An extensive work-up revealed no pulmonary embolus, infection, or lung infiltrates. The physician who made the decision to intubate Tom the night before told me the blood gas showed adequate oxygenation, but he was worried that my brother couldn’t keep up the work of breathing. “Could he have been having an anxiety attack?” I asked. “Maybe,” he acknowledged.

It took 2 days and a lot of pushing to get Tom extubated. He had not eaten for days, his serum albumin was dropping, his kidney function deteriorated, he developed anasarca from the intravenous fluids, and he was intermittently delirious. But none of the tests indicated an active infection and the nephrology consult team was optimistic he would regain his kidney function

Within a few days, he developed multi-drug resistant sepsis from the urinary catheter that had been left in “to get his fluids balanced” and then his dialysis line clotted. The decision to transition to comfort care was made and, a few days later, my brother died in a quiet room with windows overlooking a park, surrounded by his family.

Aspects of the hospital environment that I had gotten used to—the lack of privacy in shared rooms; the cold, uneaten, and unappealing food left on trays at the bedside while patients were at procedures; the constant noise in the hallways; and the emotional distress of patients who were confused or delirious—were now intolerable to me. I left the hospital each day as quickly as possible, writing my notes at home or back in my office.

I found myself asking questions I hadn’t asked before. Why is it acceptable care if the physical therapist doesn’t come every day but not acceptable care if antibiotics are not given daily? Or acceptable to miss meals all day waiting for procedures that are often canceled? Why do the alarms go off in the patient’s room if it is the nurse who should be notified? For debilitated patients, why can’t testing and procedures be done in the afternoon, so the mornings and evenings can be used for physical therapy, optimizing nutrition, self-care, rest, and time with family? Why does medical treatment trump recovery?

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