Wednesday

I apologize for the suspense, truth be told I fell asleep in the chair with the laptop in my lap.

Since today was a contiuation of yesterday, I will let you in on my disgust.

Before I begin, my comments about the medical profession are not meant to be a comprehensive indictment of all doctors, hospitals, or administrators, but instead a microcosm of our particular situation. We have had wonderful support and received definition from physicians who are following this blog, especially early on when we were unsure of medical jargon or protocol. Jim Pat Bell has been especially helpful and sincere with us. We are grateful for his friendship and professionalism.

So here is the deal as best my memory and emotional convulsion will allow me to recall.

Let me go back to Monday and the supposed confab with doctors and rehab liaisons in looking forward towards Dad's next step.

I reported that not much was accomplished. We did have a long Q&A with the pulmonologist who has been on board since the outset. We asked him to get the ball rolling in determining if Dad's condition was to the point of getting out of the acute care hospital to a long term acute care facility. What condition is keeping him in the current hospital and what will be the defining criteria for him to meet in order to move on? He said that he would start the process. We didn't bother to ask what that would entail and I guess we were a little astonished at the blitz of activity that would take place on Tuesday.

It concerned Mom when they took Dad for a full xray and ordered a unit of blood. The xray was part of the thorough assessment of Dad's capacity to move on. The blood was because because Dad's hemocrit or hemotocrit level is low. The percent of red cells is low.(I think).

After all of this, SNAP, we are scheduled to move out tomorrow. Well, I can't tell you what kind of slack jawed amazement this caused. Mom told me over the phone that Dad was moving on Wednesday, and I came unglued. I began asking her if she had done this and asked that and who gave the order etc. She was still trying to process the xray and blood. Poor mother, I am going off on the idiocy of the situation, as a some what less than rational, compassionate, understanding confidant and she, bless her heart, is trying to decide what clothes and shoes he is going to wear. That is where I left you last night and the essence and context of the final paragraphs of last nights post.

Now to the source of my aggravation and our collective bewilderment.

I asked for a list of doctors that are on record, those that have made notations on the official chart. The list (and I am not yet convinced that it is complete, we saw two new ones yesterday) had 10 separate physicians of various specialities and affiliations. I can conservatively estimate that the number that we have seen is easily twice that many. Most just come in the room, asked Dad how he is doing, listen to him breathe, tell him he has a crackle in his left lung, ask if we have any questions, and leave without committing to a definitive answer and referring us to their colleagues. Dad finally started telling them that they were supposed to tell him how he was doing. Apparently, the pecking order in these "doctor groups" is well intact. The chief sends out his minions so there is an appearance of diagnosis and care. The egos are big but evidently very fragile. The nurses have been amazing. Everything of substance for our assimilation has come first from the nurses and confirmed after rigorous cross examination of a doctor.

Decisions by committee.
We are always encouraged to get a second opinion, and it is a good idea, but this carousel of "care" is dangerous. On more than one occasion, a doctor has come in to evaluate Dad and order meds or other procedures that were already prescribed and accomplished by another physician. This indicates to me that somebody ain't paying attention. Who knows what? When did they know it? What are they doing about it? When are they going to tell us? We know who is charging, we just don't know who is in charge.

Thanks to my sane sibling.
Nancy was less than thrilled with the lack of consideration and consultation about where we were being referred and when we were set to leave. I told her I was going to find the hospital administrator on Wednesday and give him what was left of my mind. Because her expertise in networking, she knows one of the officers of the hospital administration and gave him a call on Tuesday evening. When Mom and I got to the hospital this morning, the Director of Case Management was in Dad's room. She was there to suture up the loose ends. We expressed our grievances about the medical menagerie and quizzed her about the previous days daze. We also asked for a solid assessment of the rehab options. After making calls, reading Dad's record, and consulting with a rehab rep we finally got some solid facts to base a decision on.

We decided that Dad could get the best care at Regency in Springdale. The facility is on the sixth floor of the Springdale hospital and they have a cardiologist on staff as well as full service medical care and PT. There is a Regency in Fayetteville but it is not staffed with cardiologist and they do not make rounds there. The Springdale unit is the only facility that Dad would qualify for in their system. I asked if we could stay at WRMC through today just so we could decompress. The Director agreed and said that she would arrange transportation for Thursday to Fayetteville. I just shook my head and said, whoa wait a minute, I thought we had decided on Springdale. She called the Regency rep into the room and discovered for the first time that Dad did not qualify for the Fayetteville site. Finally, we are all on the same page and we are comfortable with the decision......not so fast.

I went to work feeling that we had accomplished what we set out to do. I came home for lunch and got a call from Mom. One of the cardiac surgeons had come in to assess Dad and told mother that he needed to go to Fayetteville Regency. He would have the cardiologist of record come by and arrange Dad's release. At that moment, I nearly became his next patient. He had managed to perplex Mom all over again. I told her that I wanted her to call the Case Manager immediately and get the Regency rep, the surgeon, the cardiologist, and the hospital administrator in the room and I would be there in five minutes. (like that was going to happen). By the time I got there, the case manager had gotten hold of the surgeon, he had eaten a helping of crow with Mom and Dad and we were back on track. I am still irritated, I want to know why he was opposed to the only sane option.

Nothing more dangerous that someone with authority but no accountability.

Tomorrow is a new day.

Now a brief on Dad's day.
He had a busy day. He got a new IV port, he took a long walk (about 30 feet), had lots of visitors and late this afternoon, his heart went into a normal rhythm. He was sleeping soundly when I went in tonight, having quite a dream. He woke up when they came to check his vitals. He gave me peace with his understanding of all of the days events. We had prayer and I left him laughing.

God is good.