Thursday of last week I received a call that my sister, the oldest of the family had been rushed to the hospital. I have not seen her in a couple of years, we differ and argue on most everything. But she was not married and I was the closest relative, and of course regardless of interaction she is my sister and I love her. The tale of what happens after this call is tragic. You see my sister was poor, no excuses much by her own design and effort, but alas over the years she has managed money poorly. She relied on both Medicare and Medicaid for care over the last 20 years or so.
We had many arguments about her health and my perception that she was being taken advantage of and proper care and recommendations made based on her status for care.
So to the story and I will try not to editorialize so others can give me opinion so I can better understand.
I arrive at the hospital on Friday morning early, to find her in intensive care with an extended stomach, and a mask to assist breathing. She is unable to communicate and no one is sure if she is aware or not. She is struggling to breath.
I meet with the attending, who tells me they want to put her on a ventilator, that she has a blockage in her colon and her kidney's have stopped working and she is not making Urine. Her blood pressure is too low and she was just discharged from having a stint (shunt) put in two days before being rushed back in this condition. I am asked to speak with the kidney specialist, the GI and the surgeon.
What follows are the exact conversations:
Kidney doctor tells me she had weak kidney's, and the dye used in the angiogram is very bad for the kidney's and likely caused the kidney's to fail as it was used for the procedure days before. He said based on where she is dialysis will not solve the problem, and since they use massive blood thinners for the stint, she may not survive the simple surgery of putting the catheter in place to do dialysis. He was very clear this was a last ditch effort if we proceeded to do this.
Next the GI tells me the blockage can not be solved without surgery, nothing he has done is working, that we need to talk to the surgeon.
The surgeon tells me and I quote, "I have never seen anyone who has had so many surgeries in the past and the scar tissue likely has caused the blockage, but she will not survive the surgery unless the blood pressure is stabilized and of course those massive blood thinners are a real concern as well.
I was told that unless she made urine and unless she was able to fight she would pass in a day or two. Now she was 70, she passed two days later. I had given a no resuscitation order if her heart stopped, with no direction from her.
So, what I summarize is the following, because she was on Medicare and Medicaid someone did numerous surgeries on her for hernias and other issues, throughout the years. One can only guess if these were needed or not. You see she was not full developed mentally to make these decisions on her own, but refused to listen to others trying to help her. Then a dye was used, despite the fact that she was on medicine for weak kidney's which caused the kidney's to fail, again I guaranty she was not able to understand the risk or the consequence when presented with options. I have to assume the cardiologist had to make a difficult decision regarding the heart and explained the risk. And finally two days after discharge she was rushed back and died.
I have to wonder, did her financial status make her a target for unnecessary procedures, did Medicare rules force the hospital to release her before ensuring she was stable and no complications were present?
Is this the system of healthcare we want, where if these decisions were made based on a system of care delivery mandated by bureaucrats looking only at the bottom line in cost?
Is this what end of life care looks like?
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