Wednesday, March 26, 2008

Stealth Doctor Explained

Roze Room called today to see if I indeed want to cancel them.

I said yes, the deed is done. Though the doctor who paid a stealth visit at 6:30 pm last night sounded really kind and accurate in her assessment of Mom's situation, Dr. Rosen and I made the decision at 5:30 pm to move to Skirball Hospice. I talked with Skirball. I can't call them and Dr. Rosen again and tell them we want Roze Room.

Besides, I don't want a hospice that pays two stealth visits in one day, one putting a hold on milk products and the other starting them up again. Neither one called me to let me know the decision, ask for input, explain, etc.

I said I need to talk with this mystery doctor to ask why she didn't call me before, after, or during the visit--and to hear what her assessment of Mom is.

I was wondering if Roze Room sent her over to protect themselves on the last day of their six-day stint as the hospice service. Was she there to correct the stop-milk order, so they wouldn't look so bad? Maybe in case of a lawsuit? Was she intentionally avoiding a conversation with me?

A few hours later Dr. Ana Cartmel called and explained. She said she has 18 years of experience as a hospice physician and teaches physicians and residents.

Last night she had another patient to check on who lives on Mom's floor. After working with the other lady, she realized Mom was nearby and decided to pay an unplanned visit. Because she had to rush off to speak at a nearby facility at 7 pm, she didn't call me afterward, as she normally would have done.

After hearing this, I realized she was a good doctor paying a visit out of kindness. I asked her to tell me what her assessment of Mom was.

"She just looks very weak, tired, but extremely peaceful and also comfortable. Her lungs were not congested--they were totally clear, though earlier in the day the home health aide had listened and found her congested. The aide spoke with Renee, the RN, who placed the "Hold milk products" order and called me afterward.

"It was not a stop order--a hold just for the moment, until someone could assess her further.

"My assessment is that she is probably aspirating frequently on the liquids and maybe on her own saliva. Her whole body is becoming weak, and the muscles in her throat and mouth are weakening as well.

She is probably getting some liquids or foods into her lungs, and this could cause them to sound wet and congested at one time during the day, but totally clear hours later.

Over a period of time I would expect her to get pneumonia with the aspiration, and I expect she will go from this."

"Pneumonia, the angel of mercy," I said. "She always said it was a quick and easy way for elderly to die when they were sick. She was a public health nurse and taught nursing."

"How interesting that this was her profession!" Dr. Cartmel said.

"Yes. Pneumonia, much better than organ failure as a way to die," I said with this new view of her future.

She said a dietary consult should be ordered by the new hospice service--whether to have her on pureed food, etc.

She said to give her all the milk and Ensure she wants--milk is not the cause of her phlegm.

Also: Stop V-8--it's acidic and could be causing her nausea, esp. if given just before meals.

"If I'd known you were such a good doctor, I would perhaps not have changed her from Roze Room," I said. "But the decision is made. I don't want to call Dr. Rosen and have her change the referral she just made to Skirball."

Sad, confusing. Better if I had waited a few days before ending Roze Room.

But still--twice in one day I was not informed about a medical decision (hold milk products, don't hold them) and not given the opportunity to be involved in that decision.

No comments: