Because of the doctor and nurse shortage here where i live (about 15,000!!!! people are without family doctors), they can only go to emerg. or a walk in clinic, we are lucky though, our family has 2 family doctors (and if one quits or moves on the other will take us on), anyways, this is very common here in Canada too, i remember one of Al's many,many stays in hospital, and the doctor forgetting i also remember a call at 12:30 in the morning when the doctor came in and told Al he could leave in the morning, Al asked if he could leave now the doctor said why not, and i had to go and get him right then and there, there was no waiting till morning. Also something else that might interest you here, if You discharge yourself, the doctor will drop you as a patient then you have to join the other people who have to go to emerg or walk ins. debbie

Did your mother inquire at the nursing station about whether or not Dr. X had made his rounds? It's ALWAYS a good idea to check to see if there has been a misunderstanding. Sorry that this happened to your Dad. But in the rush of seeing patients, errors happen. Doctors (and hospital staff) are only human but the staff should have been alerted so that they could have contacted the doctors for your mother.

If it's any comfort for you, his regular doctor very likely informed the second doctor in no uncertain terms that one of his patients had been missed. Doctors with heavy patient loads of their own when substituting for others have to be extraordinarily careful that things like this don't happen. There may have been some sort of emergency that messed up his usual routine. Doctors usually have remarkable memories, but no one is perfect.

Wow, I am so sorry that this had to happen to your parents.

But it's a good start on a discussion of the problems of patient advocacy in hospitals.

During Mother's last week, when she was in the hospital with pneumonia, I was there at about 6 every morning, which gave me a chance to talk to the night shift nursing staff, and I did talk to the nurse AND the aides every morning. The doctor would show up at about 6:30. And if I was away from the room even for a couple of minutes, he wouldn't wait for me, I was just out of luck. And sure enough, every time I snuck away for something (and I had to go outside the hospital to use my cell phone, which was for all but local calls), someone would show up. The priest, another visitor.

I was literally tied to the room. The doc would sometimes show up in the afternoon as well. I was there when the evening staff came on, and I'd leave after dinner to go home and rest.

If you are dealing with more than one doctor, or a multitude of tests or xrays, then you are even MORE tied to the bedside of the patient. Unless you make yourslef very well known to the staff, they won't call you. Remember that you are not the patient, even if the patient is completely unconscious. So it takes a lot of work to make yourself an advocate of the patient.

Missing meals (altho I asked for and got comp meals), no running down to the lobby for a STarbucks, no running outside to use my cell phone, timing every single bathroom break. And being there from 6 AM to 8 PM.

There honestly needs to be a better system, but if we are stuck with this, we need to know how the hospital operates and be there to run interference.

Jen, if your father should go back, I'll suggest that your Mother may not be up to the work involved with patient advocacy. Someone needed to inform every single nurse, aide, case worker, station nurse, etc, that you expect the doctor to release the patient. If you don't see a doctor by midmorning (when he's probably in his office), then you ask the staff to call on the doctor.

I found that the staff was on my side, but it pays to be really really nice to everyone on the staff, and make them your friends, and your partners in caring for your patient.

Whew. I am tired just thinking about it.

Anyone else want to add some thoughts on patient advocacy?

A Patient Advocate is often needed, especially for the elderly. Patients tend to expect 100% proper care, and it just doesn't happen. Even in the best hospitals, there will be a floor or a shift where one or two staff are out sick, or don't show up. This is the time that the quiet patient gets overlooked. There's no EXCUSE for it. It shouldn't happen, but there's usually a reason for it.

Thanks everyone. I am feeling better today with a better perspective.

My mom is a retired RN who in fact worked at this hospital. I'd be surprised if she just sat there all day and didn't inquire at the nurse's station. However, when you think "the doctor could be here any minute", there's a tendency to wait just another minute. Eventually, all those minutes can add up to a whole day.

My parents are very independent people and still quite healthy. They don't ask for help and didn't even tell us kids about the surgery until later that night around 10:00 PM. If they were more feeble and absent-minded, I would have been at the hospital yesterday to see that everything went well. If I even offered they would have turned me down.

I will get more details when I talk to my mom. My dad tends to be very inaccurate in relaying details, so I will count on her to fill me in. Perhaps she had already talked to the nurses or to someone else.

Fairgolde, I'm sorry for the loss or your mother and all you had to go through. How frustrating that you were tethered to the room like that! However, no doubt you can rest well in the knowledge that you did the very best you could and were there for your mother at that time.

Jen

Thanks, Jen. It was difficult, but I'm glad I did eberything I did. I have a lot of peace now, while my brothers, who all avoided visiting, are still bickering and depressed, etc. Funny how things work that way!

ABout your Mother... I'm assuming that she's been retired for at least 20 or 25 years. Things have changed a LOT since then. She'll need to be a lot more in-your-face if it ever happens again, and not her normal sweet self.

So this discussion isn't necessarily about your parents today, Jen, but at their ages, it can be tomorrow and their condition changes. But the discussion is also about all of us. What we go thru, helpful hints, and all that. So if someone else comes along and learns somehting from the discussion, that's wonderful.

There was a "My Turn" essay in Newsweek in the last year or so written by a woman who was helping her husband with a terminal condition. He had a number of different doctors and people doing tests, etc, and she was really pushed to the limit. It honestly is a terrible system. Heck, they could give me a beeper to call me back to the room. The doctors can let the nursing staff know more. But as it stands right now, many patients need an advocate to help them thru all this.

That's too bad, but that's not at all unusual, especially in a hospital without housestaff (interns and residents). And any surgery on an 86 year old is life threatening. A physician may make quick rounds very early to check up on a few patients, and then return in the late afternoon or evening to make rounds, write orders and d/c patients. No one every really goes home early and someone should have made your parents aware of that. Sending a patient home early is not always wise, especially someone your dad's age. All sorts of things happen during the day - fevers, an ileus, unexpected vomiting, unexpected severe pain. His own physician might not have let him go early. Better to make sure he's eating well, has good pain control and can ambulate safely without assistance.

I hope his recovery is uneventful.

and he will probably be charged for another day also!
Carolyn

Thank you for the additional comments. I feel much better now and realize I was probably overreacting the other night.

He is doing very well now with just a little pain and he's up walking around quite a bit. He is a very sturdy guy for his age and looks much younger than 86. My mom will see to it that he eats well and he has always been very good about doing what he needs to do, so fortunately she won't have to nag him much about that. :-)

But I think I learned something from this and if someone else did to, then I'm glad I posted my vent. :-)

Thanks all,
Jen

Advocacy... Mum's health "crashed" about 3years ago and she has been with me about that long. I have been to every appointment, every test, every surgery/recovery/rehabilitation. She didn't very much like my "intrusion" but it was clear to my brother and me that she was not capable of adequately relaying information to us. So...

Fairegold, I had not realized your mother died. I'm so sorry. I know that every one has their time, but it is always a shock, and a relief, and a sadness when it happens. You were good to her; being good and kind to people carries a reward we often don't fully appreciate until they're gone. :)

I have two things to offer: the actual medical services available to us are simply amazing. The "before" and "after" care, however STINKS. I have dealt with more nurses and doctors than I can count. Sadly, I have to say the quality of nursing is abyssmal; I made it a point to be polite and pleasant. But when they were unwilling to make time to discuss Mum's condition with me I lost whatever faith I had in the profession. When I watched a nurse drop an exam glove on the floor and then pick it up to PUT IT ON before changing Mum's urostomy I was horrified. "Were you planning on using that one?", I asked as she was preparing to do just that. She looked nervous and was even more nervous as I supervised the urostomy change... noting that is was done improperly. (I do it on average every 5 days, and have for 2 years now; I now realize I've FORGOTTEN more about the process than most RNs ever knew). The same nurse failed to raise the rails on Mum's bed and she got out of bed, confused. She fell hard, cracking her kneecap and badly spraining her wrist... all this followed a stroke. Why didn't the nurse have the presence of mind to realize a stroke patient doens't make good decisions and is a likely candidate for injury resulting from compromised decision making? HELLO? whatever happened to "common sense"? that's how "medical professionals" operate? Doctors. They're busy. They have a lot to juggle. Most have pathetic interpersonal skills. It's the rare jewel who has warmth, a sense of humor, and willingness to be direct and honest.

Here's what we did: every day either my brother or I would visit Mum. We arrived at varying times of the day, That way, we knew all the staffers and had a chance to find a sympathetic one. We brought notebooks with us, and we took notes, jotting down the nurses' names, the doctor's name, the time of the visit, etc.. We noted whether or not the urostomy pouch was full, half full, empty... whenther or not she was simply left the sit, hooked to a Foley bag. We noted her cleanliness, if her hearing aids were in, and if the batteries were dead. We brought our digital cameras and took pictures. (Those pictures were a real "hit" when the social worker at the last "rehab." place proved difficult about discharging Mum after 5 weeks... she was "approved" for 8! nothing like a creeping skin condition all over her back to give 'em a case of "the worries", lol).

Each of us called the doctors and requested information. We set up times to meet with them to discuss Mum and her condition/progress. Sometimes I did it, sometimes my brother did. Other times we did it together. We were polite, direct, and ON TIME.

Being an advocate requires that you be PREPARED, informed, and as polite as you can be; have your questions prepared in advance if you're able. You have to be patient with staff and understand that they DO have a lot to manage on a daily basis, but when you're faced with something unacceptable you have to be willing to be steely-eyed, icy toned, and simply refuse to accept the usual litany of excuses. Believe me, nothing gets the attention of staff faster. And when staff has really gone above and beyond, you must say thank-you and do something kind.

I can still the urologist's face when he saw Mum the first time. She weighed 84 lbs., was grey, slow, and sullen. He minced around the obvious reality, using "polite" phrases to avoid saying the obvious. I finally got out the chair, put my hands on his desk and looked him in the eye, "Look, doc., I am a busy woman. I have neither time nor patience for bulls!!t, get to the point.". He met my gaze and began the medical dictation of Mum's case... it wasn't good. He scheduled the next cystoscopy... when he saw her 6 weeks later, she had put on 12 lbs., had rosey cheeks, and he didn't recognize her. After the test, he spoke with me... told me I had done an amazing job with her, that he respected and appreciated my direct manner and willingness to pay attention to small details... as those are the things that make a difference when an elderly person faces a health crisis. He told me then that he had expected to learn of her death before that appointment.

Chelone's experiences and actions echo my own. My mother had a brain tumor, so I took care of her at home as long as possible, and then she had to go to rehab, finally ending up in long term care. Of the six months she was there, I can count on one hand the number of days I didn't go. And when I didn't, someone else did. I got to know all the staff members from the two shifts (I was not there on the 11-7 timeframe until her last few days) and they knew me as a fierce and staunch advocate. If I didn't like something, I spoke up. I questioned her medications. I stayed in touch with her doctor. I went to all of her appointments and procedures and took copious notes (I always had questions prepared ahead of time). I advocated for everything for her, even hiring a geriatic care manager to have another set of professional eyes on her. In short, I made it clear that nothing was going to slip by me on my watch. And that's what you have to do. It IS the quiet patients who will get overlooked -- and believe me, the nursing home patients who have family involved get better care. I went at different times of the day (fortunately I had a job nearby which gave me some flexibility) so they never knew for sure when I'd stop by.