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Don’t Go There

December 10, 2012

Great article in one of the NYT blogs: http://newoldage.blogs.nytimes.com/2012/01/25/avoiding-surgery-in-the-elderly/.  It talks about the increased risk that elderly patients face when they are admitted to the hospital for emergency surgery.  Even routine surgery, like gallbladder surgery.

The author used appendectomy as an example.  Say your 85-year-old grandmother in her very nice skilled care facility starts saying she’s having belly pain.  Maybe she’s really with it and says politely “My stomach really hurts.”  Maybe she’s demented and rolls around clutching her stomach.  The nursing staff on (it’s nighttime) are used to giving baths and changing sheets.  They don’t know what to do and there is no one to ask, so they send your grandmother to the Emergency Room.  They do a CT scan because that’s what all abdominal pain patients get.  If she’s really demented they might have to sedate her or even intubate her to do the CT.  They see some “stranding around the appendix” and decide she has appendicitis.  They call the surgeon who says, OK, better take it out, it’s an emergency.  An intern calls you, you at 2 in the morning, says “grandma needs surgery, it’s an emergency” and of course you groggily say yes.  So grandma gets her appendix out, but she also has bad lungs and they can’t get the breathing tube out after the surgery.  Now she’s in the ICU, where she becomes combative because elderly demented people get worse mentally in the hospital and especially in the ICU.  So now she’s sedated.  Her wound gets infected, she ends up with pneumonia, and after a month in the hospital she finally passes away.

Now what if those nurses in the nursing home had someone to call at 2 AM besides an ambulance? What is someone could come to her bedside at the nursing home and examine her, look at her medications and what she had for dinner.  Evaluate her and mediate the situation.  Maybe your grandmother ate a bad oyster.  Maybe she’s not in pain, she’s scared or thirsty.  Maybe she has appendicitis or something else surgical but it can wait until morning when people that know her can come see her and talk to her doctors.  This would require someone, maybe a nurse practitioner or doctor, to not only be on-call but actively available to nursing home patients when things like this happen, which they do with frequency.  In my experience this is not the case.  Sounds expensive, I know.  But not as expensive as a month in the ICU…

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From → End-of-life Care

One Comment
  1. Wow. These stories are everyone’s education. I’m a layman—but everything you write here corroborates all my hunches.

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