Saturday, July 24, 2010

Patient Advocacy

When someone you love is hospitalized, you want to believe they are getting the best care available.  But what is best?

The care facility where my father has been for the last 20 months is good.  It's not in the Cadillac class, but it is clean, never reeks of urine, and the staff is caring and responsive.  There is just not enough staff to go around.  That's where we, the family, make a difference.  We spend a longer period of time with "our" patient, even on short visits, than staff has time to give.  We notice different things.  We are more likely to pay attention to subtle changes.  

On a visit earlier this week, I comment to my dad that I didn't like the sound of his cough.

"I think I have pneumonia." he said.  "Hurts."  

I asked where it hurt.  He rubbed his hand across his lower chest, near the bottom of his rib cage.  

Part of me said, "He a dementia patient.  How aware is he, really, of his body?"  Another voice said, "He is notoriously unable to accurately describe what his body is telling him."  And in the other ear, "But what if he is right?"  So on my next pass by the nursing station, I asked if anyone had commented on the quality of his cough, or if he had complained to anyone else about chest pain.  

"It may be nothing."  I told the nurse on duty.  "But I'd rather be a nag than miss something important.":  

How did we want to proceed?  "Understanding that we want him to be comfortable, let diagnosis and treatment be the doctor's call."  

Yesterday, he was asleep when I arrived.  There was a wheelchair next to his walker at the foot of his bed.  His clothes and his gait belt were in the wheelchair.  The PM shift had just come on duty.  No one, it seemed, knew about the wheel chair.  Except the charge nurse just going off duty.  He had been in the dining room earlier and got very weak.  He may have vomited.  He was too unstable to walk back to bed.  Hence the wheelchair.  

By the way, his doctor ordered an x-ray.  He does have pneumonia.  It's mild.  He's on antibiotics and a diuretic.  Apparently the combination is making him very groggy.  He had vomited.  He is refusing food.  He does that when he doesn't feel well.  

It could have been a lot worse.  If I hadn't commented on his cough.  If he hadn't complained of pain.  If I hadn't reported my observation to the nursing staff.  If no one else took the time to listen.  

Give thanks for all those medical folk who provide the very best care they can, often under stressful conditions.   Give thanks that they are there to do what we, the family, cannot.  

Don't forget to pray ......  

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