Nancy De La Zerda
“I’m hungry! Pleeeease, get me out of here,” my mother pleaded.
“They’re trying to kill me!” But Mother was in a hospital, and hospitals don’t kill patients, we thought. Still, my siblings and I desperately consulted staff hospitalists, nurses, dietitians and even a “floor manager” regarding Mother’s complaints of hunger, despite the fact she was being tube fed. They all assured us she was receiving enough nutrition.
The admitting hospitalist doctor then called in a psychiatric nurse to declare Mother “delirious.” Soon, she was subdued with powerful psychotropic drugs, against our repeated objections.
Months after her death, I was finally able to obtain Mother’s hospital records. The records supported what we had witnessed and suspected: We had been lied to consistently by hospitalists and staff. Our precious mother was systematically shepherded to a forced, horrifying and undignified death in a hospital, a place we trusted to help her. Perhaps the most unspeakable revelation was that she was, indeed, starved and dehydrated while she pleaded for her life! “Severe protein malnutrition” was noted on her medical record before the end of her first week hospitalized.
Each day, it seemed, she had to be treated for new complications created by what the hospitalist had ordered the day before. It felt like a diabolically orchestrated plan. Once it was in place, there was no escape. The admitting doctor saw to that. He used every power at his disposal to overrule our objections—from manipulating nurses and staff, to repeatedly overruling Mother’s appointed Durable Power of Attorney for Health Care (DPAHC) surrogate decision makers (calling in hospital security, city police and adult protective services to do so), and, finally, even to filing a legal detention to keep Mother in his hospital.
Meanwhile, she grew sicker each day until she was on life support. Even then, he ordered more surgeries and procedures, until he ran up a total of nearly half a million dollars in revenues for his hospital. Hospitalists, I understand, are paid according to how much they make for the hospital, not how many lives they save. Mother had been to the same hospital twice before with her primary care doctor as the admitting doctor. The tragedy this time was our allowing a hospitalist, that is, a doctor contracted by the hospital, to be her admitting doctor.
She was weak and congested, so we had taken her to the hospital’s ER, where she was treated and released to their Telemetry Unit for what was supposed to be a “23 hour” observation period. That night—February 17, 2011—after a breathing treatment, Mother ate dinner and chatted with my sister and a lady who shared the semi-private room. My sister advised the hospital staff that Mother was highly sensitive to most medications and asked them to hold off any more treatments for the rest of the night so Mother could sleep. My sister left the hospital at 2:30 a.m. to get some much-needed rest.
I arrived at approximately 9:00 a.m. the next morning to find Mother in full Code Blue status, surrounded by nurses and a hospitalist doctor insisting to my sister they hadn’t given Mother “anything.” Her blood pressure dropped dangerously low and she was unconscious. We agreed she be taken to the hospital’s ICU to be resuscitated.
I’ll never forget how the ICU nurse narrowed her eyes and asked, “Are you sure you want her resuscitated?” “Of course,” I said. “She’s just reacting to some medication, I’m sure.” She shrugged and began her work.
Later, I realized she had attempted to save us from the horror she knew awaited, or “business as usual” in that hospital. I thought about her warning look many times over the next three and a half hellish weeks as Mother was shepherded to a horrifying death.
When I reviewed the records, I quickly scrutinized every detail of Mother’s first hours in that Telemetry Unit. What caused a woman—albeit a bit frail, congested and 87 years old, but one who had gone to a Valentine’s dance just days before—to go Code Blue? Had hospitalists administered medications that sent her blood pressure plummeting? Or were they truthful about not giving her “anything” as they insisted?
What an eye opener I had! Within Mother’s first 24 hours in the hospital, five different hospitalists ordered medications, blood tests, EKGs and other procedures for her; yet other than the ER doctor, only one of them visited her.
At about 9:00 p.m. on the night she was admitted, the hospital scheduler denied a blood pressure lowering medication ordered by the admitting hospitalist. Records show that by 9:52 p.m. the same night, a different hospitalist ordered a similar medication to be administered the next morning. Despite the fact that Mother’s blood pressure was not elevated, she was given an injection of the pressure lowering medication at approximately 8:30 a.m. the next morning. That explains the Code Blue situation I found her in.
We were lied to from the beginning. Records prove medications and procedures ordered by hospitalists indeed made Mother worse. I felt what happened to Mother must be an oft performed practice of milking patients’ insurance while bringing about certain death. Unbelievable?
Not so. I researched the Internet directly after Mother’s death. There it was. More evidence than I cared to face. But I learned that in our home state of Texas, where strict Tort “reform” laws were passed in 2003, there have only been two cases filed on behalf of anyone labeled “very elderly,” i.e., those over age eightysix. Mother had all the right stats for greedy hospitalists to see dollar signs. She was 87, fully insured and had a “full code” status; that is, she had no “do not resuscitate” (DNR) directives on file.
All along, the admitting hospitalist dehumanized my mother in many ways. He rarely visited her and never spoke to her directly. She recovered from the reaction to blood pressure lowering drugs, but several days on a ventilator with little or no nutrition left her weak. After she had eaten soft foods for several days, she failed an informal bedside swallow test. My sister—Mother’s primary DPAHC surrogate decision maker was in the room at the time of said test, and strongly objected, claiming the dietitian had “shoved the food into Mother’s mouth while she was talking.”
By now, the hospitalist had found my sister to be a thorn in his side for calling on hospital administrators to make the hospitalist “show himself” and discuss Mother’s case with her. He had not visited Mother’s room for several days. When my sister objected to the swallow test findings, he called hospital security, city police and adult protective services and claimed she had tried to “manipulate test findings.”
He asked that the entire family be banned for 24 hours. A community liaison person for the hospital stepped in and allowed my youngest sister to stay at Mother’s side. The tube feeding began. The hospitalist called in an infection specialist who ordered three antibiotic drips for Mother, ostensibly as a precaution because another patient on the same floor had died of an infection.
Records show Mother never had an infection. Instead, the antibiotic drips she was given led to fluid collecting in her lungs. The admitting hospitalist then ordered all fluids cut off. Within five days, she went into shock and wound up on life support.
But the degradation continued with relentless doctor-ordered surgeries and invasive procedures until Mother appeared corpselike. While my siblings and I debated when to place a DNR order in our mother’s medical records, we were told he objected because she was “too well.” Meanwhile, he refused to speak to any of us. By then, he would only recognize the sole male offspring as mother’s legal surrogate health care decision maker. He telephoned my brother for approval on procedures. Once, when my brother hesitated, he admonished, “Either she gets the CT tomorrow or you make funeral plans! It’s up to you!”
The hospitalist ordered the breathing rate on Mother’s respirator set higher than normal. I witnessed a most horrific sight: my mother, lying lifeless, her chest heaving, mouth opened wide, panting through a huge tube shoved down her throat.
Finally, even hospital medical technicians refused to conduct some of the procedures the hospitalist ordered. They sent her back from a third surgery to insert a PICC line (a line for injecting medications) because of blood clots. He ordered them to suture the line to the aorta instead. When he ordered a CT scan of her abdomen, the nurse protested because Mother had diarrhea. He ordered they insert a “balloon” in her anus in order to proceed.
I called the ICU in the wee hours of March 12th to demand to speak to the admitting hospitalist. “I want his phone number,” I insisted to the nurse on call.
“I wouldn’t want to see a family pet the way I saw my mother panting tonight. I swear, I think he’s trying to induce a heart attack.”
She was gone for a while and returned with his number. “You have legitimate concerns,” she confided.
Her words echoed in my head two hours later when I got the call from my brother that our beloved “Mamita” was dying. Records show that about an hour after I left a message at his answering service, the hospitalist ordered a lethal dose of morphine.
My siblings and I are left with a hollow feeling, a dread that our having trusted a hospital led directly to our mother’s death. I struggle daily to push back memories of Mother pleading with us to take her out of the hospital. I know in my heart that we did all we could and realize we were up against a deadly routine that plays out in many hospitals. I hope that my sharing our experience may help others from getting caught up in similar snares of unscrupulous practices.
[Nancy De La Zerda, Ph.D., is a native of San Antonio, Texas, and taught at both the university and high school levels for several years. Her mother’s death and the family’s experience with hospitalists were featured in a lengthy article published in the San Antonio Current on December 7, 2011. This article was originally published as a First Hand Report in the PRC Update (2012, Vol. 26, No. 2), a publication of the Patients Rights Council, headquartered in Steubenville, Ohio (www.patientsrightscouncil.org), and is reprinted with permission.]
[This article was printed in Lifeline Vol. XXI, No. 2 (Summer 2012) Read in PDF.]