This is by no means a
complete list of conflicting information and messages I got from the doctors
and staff at VMC.
January
13: Dr. Michael Hori comments that “they” have done a heck of a
job with Mark (he thinks they have performed well). Valley has no antibiotics
to treat Pseudomonas.
What
did the University of Washington say?
Ticarcillin/clavulanic acid was the best choice. Does Dr. Michael Hori prescribe this? NO, and Dr. Michael Hori was “in charge” of prescribing all antibiotics for Mark.
January
1: The UW study said Ticarcillin was susceptible in 64 Pseudomonas and 64
intermediate Burkholderia. Mark is given Zyvox (Linezolid) which wasn’t even
listed as being an antibiotic to be considered; Mark never received
Ticarcillin.
January 4: Dr. Michael Hori talks about the Zosyn (Piperacillin/Tazobactan) and hopes that since Mark was given this one in the beginning he hopes the bacteria don’t show any resistance to this. This drug is not even listed in the sensitivity study.
January 14: I ask in our family conference why Ticarcillin/Clavulanic Acid was not given to Mark when the UW sensitivity study says this may kill the bacteria. Dr. Michael Hori says he doesn’t want to use an older penicillin when a newer one had potential (against what the UW says on sensitivity).
Antibiotics stopped when the “new bug” Pseudomonas is found:
December 10: Dr. Michael Hori stops by I ask if the Tracheotomy cultures came back, he says they are positive, I ask if it’s the same bugs in his lungs, he says yes. I find out the next day from Dr. Richard Wall that it is a new bug pseudomonas, not the same one as told to me by Hori. Dr. Michael Hori tells me that these bugs are common in patients that have been in the hospital for many days. Antibiotics are now off. Why on earth did Dr. Michael Hori stop the antibiotics?
Dr. Fung comes back by this time looking very concerned at 2:20 pm. I asked him earlier why the antibiotics were stopped when they found Pseudomonas growing in the Tracheotomy culture. Dr. Fung says he called call had called Dr. Michael Hori; they will start the antibiotics again.
Make up your mind, correctly:
December 4: Dr. Michael Hori wants to use Mirapenim (for MRSA?). I ask why, then he says he doesn’t want to use it. Dr. Michael Hori starts mentioning other drugs and I ask him to spell them, he doesn’t. I have to ask the nurse to spell it out.
Is Dr. Michael Hori a GI in disguise??
January
7: Dr. Daniel O’Neill says the liver biopsy
shows blockage of the ducts which is most likely caused by medications.
Where
is the infection? It’s in Mark’s lungs!
November
16: I ask if they figured out the
mystery infection, Dr.
Suzanne Krell
tells me “the pancreas is infected”
January
10: Bob Chapman, Rn announces that it is official that
Mark has respirator assisted pneumonia (according to some measurement). Bob
Chapman, Rn
any
idiot knew this right after VMC intubated Mark.
Burkholderia: (mind you that Burkholderia was discovered after the second intubation at bedside by Dr. Stephanie Nunez when the equipment – mid-November)
December 4: Dr. Lindy Klaff says “a couple days ago a culture came back and Mark now has Burkholderia in his lungs” - she says don’t look this up on the internet because it’s usually on found in Cystic fibrosis (kids in their lungs).
December 4: Dr. Lindy Klaff says “a couple days ago a culture came back and Mark now has Burkholderia in his lungs” - she says don’t look this up on the internet because it’s usually on found in Cystic fibrosis (kids in their lungs).
December
6: Dr. William Park says the bacteria, Burkholderia,
could have been in Mark’s lungs previously and now surfaced because of all the
antibacterial drugs.
January
3: Jed, the Rn, comes by today and says Burkholderia is extremely rare
January 14: Bob Chapman, Rn says Burkholderia lives in healthcare settings
January 14: Dr. Michael Hori says that Mark had Burkholderia in his lungs (Mark got this in Nevada back in 1998) and had it before he arrived at VMC.
Brain dead / Comfort Care to begin / Mark wakes up!!
December 12: Dr. Joy Zhao (VMC neurologist) tells me that Mark’s EEG made her concerned; there was little brain activity the first night, only a little more today. She says that this could also be a metabolic issue. I mention septic shock and sedation issues. Dr. Joy Zhao says Mark might be brain dead.
December 22: Dr. Richard Wall said Mark is septic again (BP and usually fever are the indicators) and that he is having an inflammatory response. Mark’s prognosis isn’t good. He isn’t responding to anything and neither is his immune system. There is nothing more they (VMC) can do. They discuss moving Mark onto comfort care (remove respirator, stop meds, stop dialysis, etc.) today at 6:00 pm.
December
22: At ~ 1:30
pm Mark wakes up and is responsive! He is licking his lips on
command and answering questions. Dr.
Richard Wall
comes in and is surprised. Dr.
Richard Wall
says the approach will now be aggressive versus comfort care. So, the approach
wasn’t aggressive in the first place?
Lungs:
December
18: Dr. Amy Morris mentions Mark’s lungs sounding good, I
mention the clouded x-ray on Mark’s left lung and Dr. Amy Morris says it will take a while for the
x-ray/lungs to clear.
Decembe
19: Dr. Amy Morris comes in and says Mark’s lungs have taken a
turn for the worse. She uses a generic term of ARDS. I remind her of what she said yesterday
(lungs sounding good, x-rays take a while to clear up). She just looks at me.
G-Tube Seals or no seals - that is the question:
January 11: Family Conference: Dr. Christopher DiRe says the G-tube is placed correctly. Gina (my sister) asks questions about there being seals around the tracheotomy and the G-tube; Bob Chapman, Rn says that no seals are on them so does Dr. Suzanne Krell.
January 14: Family Conference: Gina asks the question again about the seals on the G-tube and tracheotomy again in our family conference; Dr. Michael Hori said there should be seals.
January 14: We ask why there is a tremendous amount of bile coming out of Mark’s G-tube incision. Bob draws a picture of a stomach, makes squiggly lines coming down and out from the stomach. Bob then says the bile coming out of Mark’s incision is because the bile “3rd spaced” from his stomach into his abdomen. There is no research available on the internet to prove Boob’s theory; Qualis (the Medicare auditing agency) also wants to know.
January 14: Gina makes a note on her “daily log” that “there is a dime size hole open around Mark’s G-tube. She can see Mark’s insides.”
Autopsy: No G-tube seals were present
3rd Spacing of stomach bile?
January 14: We ask why there is a tremendous amount of bile coming out of Mark’s G-tube incision. Bob Chapman, Rn draws a picture of a stomach, makes squiggly lines coming down and out from the stomach. Bob then says the bile coming out of Mark’s incision is because the bile “3rd spaced” from his stomach into his abdomen.
March 25: I cannot (after much research on the Internet) locate anything on this type of 3rd spacing. I received a phone call (based on my formal complaints to the regulatory bodies) and Qualis (for Medicare audits) wants to know who told me this.
January 11: Family Conference: Dr. Christopher DiRe says the G-tube is placed correctly. Gina (my sister) asks questions about there being seals around the tracheotomy and the G-tube; Bob Chapman, Rn says that no seals are on them so does Dr. Suzanne Krell.
January 14: Family Conference: Gina asks the question again about the seals on the G-tube and tracheotomy again in our family conference; Dr. Michael Hori said there should be seals.
January 14: We ask why there is a tremendous amount of bile coming out of Mark’s G-tube incision. Bob draws a picture of a stomach, makes squiggly lines coming down and out from the stomach. Bob then says the bile coming out of Mark’s incision is because the bile “3rd spaced” from his stomach into his abdomen. There is no research available on the internet to prove Boob’s theory; Qualis (the Medicare auditing agency) also wants to know.
January 14: Gina makes a note on her “daily log” that “there is a dime size hole open around Mark’s G-tube. She can see Mark’s insides.”
Autopsy: No G-tube seals were present
3rd Spacing of stomach bile?
January 14: We ask why there is a tremendous amount of bile coming out of Mark’s G-tube incision. Bob Chapman, Rn draws a picture of a stomach, makes squiggly lines coming down and out from the stomach. Bob then says the bile coming out of Mark’s incision is because the bile “3rd spaced” from his stomach into his abdomen.
March 25: I cannot (after much research on the Internet) locate anything on this type of 3rd spacing. I received a phone call (based on my formal complaints to the regulatory bodies) and Qualis (for Medicare audits) wants to know who told me this.
Discharge
Planning?
December
2: Dr. Richard Wall asks Michele about Mark’s discharge
plans being worked. This is when we discuss Nursing Homes ~ skilled in
tracheotomy and dialysis.
Don’t give Versed ~ Give him Versed
December
8: Dr. William Park goes against what Dr. Lindy Klaff ordered and says “he is fine with
giving Mark Versed (Midazolam).”
Diabetes?
November
9: Dr. Arthur Sullivan says in dictation
that Mark has diabetes – Mark did not. Note the time from this link that Dr. Arthur Sullivan has been “practicing”
medicine.
Prognosis:
December
31: Dr. Suzanne Krell says Mark is still very ill and is getting
worse, not better. Prognosis isn’t good.
Bilirubin:
December
4: Dr. Frank Thomas: Bilirubin going up is most likely
caused by the TPN, part of the sepsis process, it’s ok.
CT Scans (abdominal):
December
12: Dr. Ajay Kundra: will do a CT of the abdomen next
week to review size/condition of the liver and pancreas.
Heart rate:
December
21: Today Mark’s heart rate falls into the 60’s, respirations slow to 12. The
nurse pulls out the syringe of Atropine to get his heart started and called Dr.
Richard Wall.
The heart starts beating normal again.
December
30: Mark’s heart rate drops into the 20’s this evening. These are notes from
some time ago I just erased from the white board: Deb Sullivan 2471, Susan
Crist 3399, 136.2 kg on 12/28, Amikacin for pseudomonas.
December
31: Today is a bad day in the ICU. It’s almost like they didn’t staff with the
proper amount of nurses. Mark’s heart rate drops into the 20’s today (during
dialysis) and sounds the alarm. The nurse doesn’t even come to the room
(finally around noon-ish). I go and look for Bob and/or Tina and both are gone.
December
31: Dr. Suzanne Krell doesn’t want to put Mark on more
drugs that will regulate his heart rhythm. She mentions the term “self
recovering heart rate” which is why the nurses didn’t come to the room when the
alarm sounded (he would recover as he did previous – at least that is the
hope). In an
ICU?
January
3: Dr. William Park is the intensivist this week. During rounds
the nurse mentions Mark’s heart having Brady’s into the 20’s and 30’s and V-tec
with tremors.
January
5: Heart rate into the 20’s ~ evening nurse gives him Atropine and Narcan
January
7: Rounds with Dr.
William Park:
He wants to
know why he wasn’t called when Mark’s heart stopped beating last night; they
don’t know.
Hospital stay and rehab:
November
9: I was told Mark would be in the hospital for 2 days (ER doctor).
November
15: Mark’s rehab is discussed today
November
17: I was told in a severe case of pancreatitis Mark would be in the hospital 1
– 2 weeks (Dr. Suzanne Krell).
Mark could be in the hospital for up to 6 months (other GI's)
December
2: Dr. Richard Wall asks Michele Bohl (Social Worker) to
start the discharge process (looking into homes/hospitals)
December
6: VMC schedules appointments for Long Term Adult Care or Nursing Homes
(LTAC’s) to meet with me in the hospital
NOTE FROM
TV READER BOARD IN HALLWAY:
COUNTS #
OF DAYS IN ICU
COUNTS #
OF DAYS SO PATIENT CAN TRANSFER TO ANOTHER FACILITY
WHY THESE TYPES OF METRICS?
You need to learn to read doctor"s writing better. What you think is "tainted cultures" looks more like "monitor cultures," and What you note as "pancreatict duct eval" is referring to a possible "pancreatic duct stent."
ReplyDeleteGood catch – and you must be a doctor! I’ve edited the page…thank you. Is that all you found?
DeleteAs a side note, why should I learn to read a doctor’s hen scratching – if I misinterpreted his handwriting don’t you think that other VMC staff would do the same (and they are in the healthcare industry)? When a doctor’s handwriting is so bad maybe they should have to type in the information into a computing system so other staffers don’t misinterpret? Your thoughts?