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Mishpacha 12/31 p66: Hands of an Angel - Dr starved patient



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Post Wed, Jan 07 2015, 12:58 am
This story is horrifying.

Quote:
On November 23, 2013, my 91-year-old mother walked into the hospital with a dangerous blood clot in her leg. At the time, she was also suffering from dehydration, which likely affected her mental acuity.

Upon admission to the hospital, she was asked to sign an affidavit stating that she did not want extreme medical intervention to preserve her life. She signed the document. But the next day, after she had received intravenous fluids and mind was clear, she asked to retract that statement.

The hospital didn't accept her retraction.


Quote:
This meant that the only nutrition she was receiving was glucose and water, by IV.


The author and her family sent emails to the doctor and even got a lawyer requesting a PEG feeding tube. In the end:

Quote:
She never did get the PEG, because during her second dialysis treatment, she passed away. She had lived for two months on IV sugar water - longer than most other people her age would have lasted - but eventually, her body gave way to starvation.

I cry as I write these words, because even if my mother was destined to die precisely when she did, she should not have had to die such a cruel death.
shock
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amother


 

Post Wed, Jan 07 2015, 1:01 am
My grandmother died of starvation before the cancer got her.

There is an organization these days that deals with elder care.

I believe they are chayim aruchim.
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JMM-uc




 
 
    
 

Post Wed, Jan 07 2015, 7:03 am
Horrible story. Do you think the name of the dr is his real name?
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carpediem




 
 
    
 

Post Wed, Jan 07 2015, 11:19 am
So sad.
That's one of the reasons why it's so important to have a health care proxy.
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mirror




 
 
    
 

Post Wed, Jan 07 2015, 1:48 pm
JustMeMyself wrote:
Horrible story. Do you think the name of the dr is his real name?


I don't know. But somewhere in the story it mentions that this is taking place all over the United States thanks to Obamacare.
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Barbara




 
 
    
 

Post Wed, Jan 07 2015, 2:09 pm
OPINIONATED wrote:
I don't know. But somewhere in the story it mentions that this is taking place all over the United States thanks to Obamacare.


Nothing in this story makes sense. Period.

First. The order is freely retractable.

Second. No "extreme medical intervention to preserve her life" doesn't mean "feed only glucose intravenously." To the extent that it has any meaning (and I suspect that the poster was using the wrong term), its a do not resuscitate order. Or an order not to place her on life support. I'm just not imagining any possible reality in which someone is given dialysis, but not nutrition. ETA -- and if someone WALKED into a hospital, and the only problem she had was a blood clot in her leg, why did she need a feeding tube, and why did she need dialysis?

Third. No hospital is going to deny nutrition to a fully cogent person. And she would need to be fully cogent to withdraw the order.

Finally. This has nothing whatsoever to do with Obamacare. Nothing. Nada. If the article said it, its nothing but right-wing political lies.
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sky




 
 
    
 

Post Wed, Jan 07 2015, 2:25 pm
my grandfather was in hospice care many years ago (long before Obama care). they provided by default only an IV (no food or oxygen). We request a feeding tube and oxygen to keep him comfortable but not to keep him alive. They were very accommodating.
In the end my grandmother decided to "force feed" my grandfather real food. He actually became much more coherent after that and I have wonderful, but sad, memories of the time we also spent together in the hospice. my grandfather lived a few more weeks, comfortably, much longer then any doctor predicted. I believe had oxygen and food been withheld he would have died almost immediately.
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amother


 

Post Wed, Jan 07 2015, 2:30 pm
I absolutely believe every part of this story. My DIL's family went through a very similar situation with her grandfather-except they managed to "finagle" his feeding tube to get reattached (through a very unorthodox manner, but they did it.)

Barabara is right in that it does not really have anything to do with Obamacare, rather with the new culture popping up around the healthcare system in which life does not have much value in old patients or patients with other issues (like dementia, etc.)

The only connection there may be to Obamacare is that, now that the payment structure is changed, hospitals may be under more pressure to discharge their patients faster. But the blame really lies with the value system that healthcare providers have.
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doctorima




 
 
    
 

Post Wed, Jan 07 2015, 6:20 pm
Maybe I missed it, but I don't believe the article even said what country this happened in, and certainly didn't say anything about Obamacare, which has nothing to do with it.
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Miri1




 
 
    
 

Post Wed, Jan 07 2015, 6:46 pm
Barbara wrote:
Nothing in this story makes sense. Period.

First. The order is freely retractable.

Second. No "extreme medical intervention to preserve her life" doesn't mean "feed only glucose intravenously." To the extent that it has any meaning (and I suspect that the poster was using the wrong term), its a do not resuscitate order. Or an order not to place her on life support. I'm just not imagining any possible reality in which someone is given dialysis, but not nutrition. ETA -- and if someone WALKED into a hospital, and the only problem she had was a blood clot in her leg, why did she need a feeding tube, and why did she need dialysis?

Third. No hospital is going to deny nutrition to a fully cogent person. And she would need to be fully cogent to withdraw the order.

Finally. This has nothing whatsoever to do with Obamacare. Nothing. Nada. If the article said it, its nothing but right-wing political lies.


You need the whole article, not just the excerpts. There was a progression of events here.
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Mama Bear




 
 
    
 

Post Wed, Jan 07 2015, 9:53 pm
They first put in a nasogastric tube which the patient pulled out as it was uncomfortable. and the doctor refused to put in a PEG tube. by then the patient was pretty much out of it from the confusion and near-starvation and he didnt feel it was worth it.

I personally believe they couldve done much more with the right askanim and liaisons. But I have no idea where they live.
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amother


 

Post Thu, Jan 08 2015, 12:16 am
The problems cited in this story (having dealt with the hospitalization of my elderly mother and some similar issues) are more likely related to health insurance companies and their policies rather than Obamacare.

Dehydration definitely causes delerium and incoherence, as does something as simple as a UTI. If my family didn't have a geriatric social worker and someone who knows the eldercare healthcare world, my mother certainly would've died in that hospital. She went in from an accident, into one of the most respected hospitals in our city. Things got so bad that after two days, I called her primary care physician (a geriatrician), and told him what was going on (he didn't have privileges at this hospital, she was taken by ambulance), and he told us to get her out of the hospital and then bring her to the ER at the much smaller, less prestigious hospital where he had privileges. We did so, and she got better BH, and MUCH better care.

They should've taken their mom out of that hospital, but most people don't know that's even an option. I certainly didn't.

You have to have a health care proxy, but also some seichel and some people who know the system who can advise you.
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eschaya




 
 
    
 

Post Thu, Jan 08 2015, 1:12 am
As soon as I read this story I was so upset... no, not because of the content but because of the distrust for medical professionals that it sews in a society already distrustful of healthcare.
I am an ICU nurse and I've worked in more than one hospital, and I can tell you that the writer was highly confused. I don't blame her; she was under stress, dealing with the death of a loved one, and in an environment that is very unfamiliar to her. And it is possible that there was a case of treatment that was not as it should in addition. But much of what she claims as "facts" and many of the details she provides are so highly unlikely and false too. The situation as she writes it would not happen in any hospital. There is no such thing as patients not being allowed to change their code status or decisions for care. Patients and families change their minds on a daily basis... and the healthcare professionals are obligated to follow their wishes. Will there be some doctors who try to convince a family member towards one way or another? Of course, but the final say belongs to the patient or proxy.
And just because an NG tube is pulled out... why, we can reinsert them and reinsert them all shift if need be. And if a patient keeps on pulling out a tube we may choose to restrain the patient or ask that a family member or sitter stay with the patient to prevent this from happening. We don't decide to starve a patient because she pulled out her ngt. It just doesn't happen.
I can imagine that a doctor would refuse to put in a PEG... not because he wants to starve a patient but if he feels she is too unstable and can die on his table. Like the doctor in the story, I've seen surgeons refuse to take a patient to the OR "until she is stable". As evidenced by the fact that the patient in the story died during dialysis before she could be taken to the OR, the surgeon was right for deciding the patient was not stable enough to be taken to the OR.

These stories by justifiably hurting, but clueless, family members worry me a lot. How many people, after reading this story, will decide not to go (or take their loved one) to a hospital when they are very sick because they have "learned" that medical professionals are out to hurt or kill us? I am afraid that the the storyteller and writer will have on their hands the blood of clueless women who read this story and decide not to get treated. Writers have an obligation not to resort to sensationalism but to research well and determine what the facts really were. I cannot fathom this happening in any hospital (even the most dingy, shoe-string community hospital), especially not in the big medical center the storyteller claims. There was so much missing in the story, and so much colored by the storyteller's tinted glasses.
Hospitals and almost every medical professional aims to be compassionate, caring, and pro-life. True, there are many who have opinions regarding end-of-life that are different than the halachic perspective, but it does not come from a bad place and NO ONE IS OUT TO KILL OR STARVE PEOPLE.
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amother


 

Post Thu, Jan 08 2015, 8:38 am
Eschaya, I think you should send your post to the editor of mishpacha. It is very clear and well written. I am a geriatric professional (community based) and also feel like the story has holes. What I fail to understand is why the family didnt switch doctors. If you are unhappy with the doctor treating you, dont you have a right to request a different attending physician?
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mommygmer




 
 
    
 

Post Thu, Jan 08 2015, 9:04 am
amother wrote:
The problems cited in this story (having dealt with the hospitalization of my elderly mother and some similar issues) are more likely related to health insurance companies and their policies rather than Obamacare.

Dehydration definitely causes delerium and incoherence, as does something as simple as a UTI. If my family didn't have a geriatric social worker and someone who knows the eldercare healthcare world, my mother certainly would've died in that hospital. She went in from an accident, into one of the most respected hospitals in our city. Things got so bad that after two days, I called her primary care physician (a geriatrician), and told him what was going on (he didn't have privileges at this hospital, she was taken by ambulance), and he told us to get her out of the hospital and then bring her to the ER at the much smaller, less prestigious hospital where he had privileges. We did so, and she got better BH, and MUCH better care.

They should've taken their mom out of that hospital, but most people don't know that's even an option. I certainly didn't.

You have to have a health care proxy, but also some seichel and some people who know the system who can advise you.


Everyone has the right to change hospitals I have a family member who was in the hospital for 2 weeks and getting sicker every day (she was really young ) for a gallbladder removal which should be in and out. Askanim came and had her removed to a different hospital and she was out in a few days.
After hearing how terrible a hospital was in treating my grandmother before she died at 72 when I was a young child. I told my mother not to send my grandfather to the same hospital when he was having problems and was in and out of hospitals. in the end my grandfather died in the 2nd Hospital at the age of 93 wile the staff tried to revived him at least 3 times they did everything they could for a really old man.

You have to make shore your family member is in the best hospital that cares.
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Mama Bear




 
 
    
 

Post Thu, Jan 08 2015, 2:37 pm
amother wrote:
The problems cited in this story (having dealt with the hospitalization of my elderly mother and some similar issues) are more likely related to health insurance companies and their policies rather than Obamacare.

Dehydration definitely causes delerium and incoherence, as does something as simple as a UTI. If my family didn't have a geriatric social worker and someone who knows the eldercare healthcare world, my mother certainly would've died in that hospital. She went in from an accident, into one of the most respected hospitals in our city. Things got so bad that after two days, I called her primary care physician (a geriatrician), and told him what was going on (he didn't have privileges at this hospital, she was taken by ambulance), and he told us to get her out of the hospital and then bring her to the ER at the much smaller, less prestigious hospital where he had privileges. We did so, and she got better BH, and MUCH better care.

They should've taken their mom out of that hospital, but most people don't know that's even an option. I certainly didn't.

You have to have a health care proxy, but also some seichel and some people who know the system who can advise you.


This is not the first or second or last story about doctors refusing to treat elderly patients. one of the magazines had a whole feature on this lately.

also, this family wanted to trnasfer the patient but the hospital repeatedly told them that no hospital would take a person in this condition.

again, I dont know where in the world this story took place, bc in NY you'd have askanim on the case in no time.
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