Daily Kos

Thanksgiving scene I shouldn't have to witness (healthcare diary)

Mon Nov 26, 2007 at 11:55:02 AM PDT

Fresh of one of the most family-oriented holidays of the year, I'm sure all of you will know exactly what I'm talking about with the following scene:

Half a dozen extended family members crowded in a small living room trying to accomplish a task nobody really knows how to do. At least twice as many proposals as people. And somehow everybody gets to thinking that if they just repeat their idea often enough, at loud enough volume, it will become the best idea. Total chaos. "Too many cooks," as they say.

Except we're not arguing about how to tell if the turkey is done, or what the best route to the movie theater through holiday traffic jams. We're arguing about how you're supposed to put an I.V. into somebody's arm.

Yes, that's right. An I.V. In my father-in-law's arm. He needs his daily super-dose of intravenous antibiotics to rid his heart valve of a nasty infection that almost took his life just a couple weeks ago.

It started with what seemed like a bad cold. Eventually he grew so weak that he was bedridden. But he still went to work painting houses. He would have his workers drive him to the worksite, then he would lie down on a paint tarp on the front lawn and do his best to continue to direct things. My generation finds this to be utter lunacy, but we also know his generation is just like that. He survived a war--barely--during his childhood, then moved to America to offer a better life to his children. Living through a war close up does something to people. It makes them to go work when their hearts are all but failed.

Eventually all he could keep down was Pedialyte and we finally persuaded him to go to the hospital. Heart valve infection, very lethal (for obvious reasons), massive intravenous antibiotics needed, after the infection clears up evaluate for permanant damage that would require surgery. After a short stay in the hospital, he is cleared to leave and finish the course of I.V. antibiotics at home.

As you already know, this is where the story gets heartbreakingly frustrating.

At first, he had a nurse that would come daily to hook up his I.V. and monitor him for the approx. 20 minutes it took for the antibiotics to drip down through the tubes into a catheter in his arm. But apparently the company that employs the nurse was having issues with my father-in-law's insurance (a private supplement to Medicare). My father-in-law tried to sort it out, spending endless precious Thanksgiving-weekend family time on the phone, on hold. Partly because who the heck can figure out that insurance B.S., and partly, I'm sure, because English isn't his first language, it didn't get sorted out.

So the nurse stopped coming. On her last visit, she tried her best to teach my sister-in-law what to do. But my father-in-law wasn't there at the time (she came unscheduled, who knows if her employer even sent her or if she just took pity on us) so it couldn't be a complete demonstration.

And that brings us to the day after Thanksgiving.

We're in the living room at each other's throats about how to put an I.V. in my father-in-law's arm. Oops! I dropped that! Now what? Do you think if I wipe it off with this alcohol wipe it will be ok? Bubbles, look at all those bubbles in the tube, there were never any bubbles in there when the nurse did it, were there? Sh*t! The liquid's all over the floor! Damn it, I thought I saw the nurse do that to prime it.

Then we get back to those pesky bubbles. Somebody suggests that if you flick the tube where a bubble is with your finger, the bubble goes away. Some other people start in on flicking different parts of the length of tube, while others are still arguing about the spill and other ideas for fixing the bubbles. Then somebody else yells out that, hey, the flicking thing just makes tons of microscopic bubbles. Others look at their segments and, sure enough, all that all the flickers have done is make tons of little bubbles. More arguing and blaming. Somebody yells from another room something about what they just read on wikipedia about I.V.s. The surreality of practicing medicine using wikipedia is making my head spin. I turn away.

Then I notice that the 2 year old is missing. Arg! Can't find her anywhere. Finally find her cowering under a blanket upstairs in my in-law's bed. She's crying. I try to get her to say what's wrong but she won't. But I know. "Harabaji's going to be ok," I tell her. She blankly repeats it back, but she's far from sure. "Harabaji need to go to the doctor," she says. "Doctor fix it all better." Due to some birth defect problems with her brother, we've had plenty of talks about how doctors "fix it all better." If only it were that simple. (By the way, insurance issues for her brother are the subject of a previous Calitics diary, rant: I hate my health insurance co.)

My FIL is still alive so I guess we did alright. (Everyone says first few minutes after they finally hooked him up were, well, tense. Thankfully I missed that part, upstairs consoling the 2-year-old. sigh.)

People, if you watched Sicko and bawled through at least part of it (who didn't??) then you know I'm not the only one who has had to witness an awful scene like this. You know that more than one 2-year-old has been traumatized from absorbing the worry of the adults around her. All this agony was caused by the fact that congress chose to privatize the Rx part of Medicare, thus leaving my FIL's care in the hands of corporations with every reason to deny care and hedge up the way with Kafakaesque policies. This is America! We are so much better than this!! When are we going to fix this? What will it take? What can we DO?? Give me your ideas because I need to get this anger out by DOING something or else I'll go crazy.

cross-posted at Calitics

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Permalink | 37 comments

  •  That's horrible, reid fan. (12+ / 0-)

    I hope your FIL gets better QUICK. No one should have to go through what uninsured and underinsured people do in this country!

    "I will fight for my country, but I will not lie for her. " -- Zora Neale Hurston

    by blueintheface on Mon Nov 26, 2007 at 11:59:37 AM PDT

  •  I am sorry (4+ / 0-)

    to hear you are having such a hard time.  May god bless and give you strength until we can fix this mess.

    Sicko pissed me off to no end and I cried buckets at the end of it.

    BTW which reid?  Andy or Harry?

  •  Thank you for sharing. Our healthcare system is (6+ / 0-)

    a scandal.

    Best wishes to your FIL and to your entire family in your efforts to care for him.

    Some people fight fire with fire. Professionals use water.

    by Happy Days on Mon Nov 26, 2007 at 12:08:22 PM PDT

  •  Take him back to the Doctor (13+ / 0-)

    It's a really bad idea to start IVs if you have no clue what you are doing. As I was reading I was thinking Please God, tell me they cleared the line of those air bubbles. At the very least they can administer the IV on an outpatient basis in an office or at an ER, plus they can also look at the catheter site to ensure it hasn't infiltrated or become infected. (I'm guessing he has an IV catheter in).

    •  yes he has a catheter (15+ / 0-)

      After going through what we did I really, really can't imagine us trying to actually start the IV with the needle and all that, yikes!

      The whole time I just kept thinking, what country are we living in that I am seeing this. It was crazy. I hope they can get on the phone today now that the back office people are back from vacation to sort it out and get that nurse back over. You're right, she was there for so many reasons more than just to hook up the tube. She also checked the catheter to make sure it was ok, took his temperature and blood pressure to make sure that the antibiotics were still effective, etc. There's no way we should be doing all of that on our own.

      The purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. --Calvin & Hobbes

      by reid fan on Mon Nov 26, 2007 at 12:13:20 PM PDT

      [ Parent ]

      •  Sadly (13+ / 0-)

        HMO BS far too often results in people being 'taught' how to do things that should ideally be done in hospital by trained personnel.  During a rotation on a med surg floor I had to teach a mother how to pack a wound on her son's rear end that was big enough to stick a fist inside it, because he was being discharged as he had 'stabilized'.  Despite being an athiest, I was praying inside that he didn't wind right back up in hospital a week or two later with massive infections...

        Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

        by drbloodaxe on Mon Nov 26, 2007 at 12:41:33 PM PDT

        [ Parent ]

        •  oh my (7+ / 0-)

          That was one thing that really hit me in Sicko was how happy the British system doctors were to know that they would be able to take care of all their patients. I can't imagine the stress of working in a system where you are forced to do things that aren't right by your patients. Bless you for doing your best is such a crazy system. I really hope we don't have a big exodus of great talent from the industry before we get a chance to fix it up. I know from friends of mine it has already started happening to some extent.

          The purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. --Calvin & Hobbes

          by reid fan on Mon Nov 26, 2007 at 12:45:51 PM PDT

          [ Parent ]

          •  Well (9+ / 0-)

            I'm just entering the field.  Finished up classes, about to take the state licensing exam for RN, but yeah, burnout rates are kind of harsh, and staffing is generally lower than it should be.  The California nurses have the right idea in pressing for mandatory staffing so that no nurses are assigned too many patients at once.  There are studies that show a clear connection between the nurse to patient ratio and the number of fatalities in hospitals.  The more patients a nurse has, the crappier the care they're going to get as he/she has to zip from room to room.

            Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

            by drbloodaxe on Mon Nov 26, 2007 at 12:50:52 PM PDT

            [ Parent ]

          •  How this works in the UK (2+ / 0-)

            Recommended by:
            reid fan, sima

            My husband got a massive infection in his leg about 2 years ago that blew it up to double-size and needed IV antibiotics to clear it up for about 2 weeks. We live in the UK, so I thought you might like to know how it worked...
            Twice a day, a team of two nurses came to our house and hooked him up to a portable IV in the living room. Then we sat and had a chat and a cuppa while the antibiotics went in. Each time they checked his BP and took notes on how the leg was doing. They noted that doing this at home was best as little problems like this can turn into MRSA on the wards.
            End of story--problem cleared up.
            The bill: £0.
            And that's the way it should have been for you too.

            PS: Back in the USA, I spent a month packing his nasty emergency appendectomy incision a couple times daily. It was OK... but I really do draw the line at anything involving needles!

            Political Compass says: -8.88, -8.67
            "We never sold out cos no one would buy."--J Neo Marvin

            by expatyank on Tue Nov 27, 2007 at 08:39:08 AM PDT

            [ Parent ]

        •  Yep, shoulder surgery (2+ / 0-)

          Recommended by:
          reid fan, Dar Nirron

          and a steel plate to hold the shoulderblade in place, screws in the tuberosities and the humerus had a groove drilled down the side for the insertion of a metal rod to hold the two pieces in place. Went in one morning and checked out before 12 noon the next day and came home with bloody bandages and a dozen pages of instructions.

    •  Air bubbles, not as bad (5+ / 0-)

      (I've learned) as you think. My husband had part of his kidney removed for renal cell carcinoma, and I did the same freak-out when I saw air bubbles in the IV bag. The nurse told me it was no big deal.

      That you all had to quick become medical professionals is horrible and ridiculous at the same time, reidfan. Our not very healthy health care system stinks. Hope your FIL's situation gets straightened out.  

      •  She's probably right there (4+ / 0-)

        A few small bubbles here or there in the line aren't going to do him in.  When nurses 'flick' the tubing, it's because the sensors on the IV pumps freak out over any air at all, so they're trying to get the bubble past the pump.  It's where you have actual gaps in the fluid that you'll see the nurse remove the connector to the saline lock and either run the liquid out til the gap is passed, or carefully run what's in the tube back up into the bag to restart it carefully without wasting fluid if it's a small infusion such as a 50ml bag of antibiotics.  Still, no bubbles is better than some.

        Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

        by drbloodaxe on Mon Nov 26, 2007 at 12:47:22 PM PDT

        [ Parent ]

  •  Hang in there (4+ / 0-)

    My sister has to self inject her daily MS medication and it is brutal.  She and her husband have gotten pretty good at it, but it took a while.  

    Good Luck to your family and hang in there. let's hope for better health in 2008

    "The woman's life is misery; for God's sake, people, at least give her a few good songs". NYT review of The Color Purple

    by arogue7 on Mon Nov 26, 2007 at 12:14:40 PM PDT

  •  Call you DOCTOR! (13+ / 0-)

    He needs this medicine or it will re-infect the heart. Your Doc. will probably be furious and he will call the home health agency and get things straightened out. He needs a nurse to start this Medication or your family has to be trained  over at least a week and observed while doing the procedure. You cannot get all the air bubles out of the IV line, don't worry about it. It just gets absorbed in the blood stream. You don't want the whole tube filled with air but a few bubbles won't hurt. Good luck and don't take no for an answer from the Home Health Nurses. If they took him on as a patient they are responsible!

    "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

    by Owllwoman on Mon Nov 26, 2007 at 12:29:02 PM PDT

    •  thanks (7+ / 0-)

      That's a really good idea to bring the doctor into it. All of us yelling at each other all those ideas, and nobody thought of that...sigh. I'll call and tell them. I think part of the problem is they need someone forceful to help them understand what they are entitled to, like you just did. Being not totally comfortable with the culture they are I think often too hesitant to demand things (and let's face it, the medical system can be totally intimidating even to native, highly-educated, loud-mouth people like me).

      It's such a dangerous combination--corporations who are trying to make it hard to get care, with people who aren't sure what they are entitled to or how to go about insisting on it.

      The purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. --Calvin & Hobbes

      by reid fan on Mon Nov 26, 2007 at 12:37:04 PM PDT

      [ Parent ]

  •  We need a revolution (9+ / 0-)

    We need to storm the Capital and White House with pitchforks or something.

    As long as the insurance companies give so much to politicians, and pay lobbyists a fortune, the only way to change things is through massive opposition.

    Today Dick Cheney is in the hospital to have his heart checked, there is no reason your FIL should not get care that at least provides medical professionals to administer IV drugs.

    I agree with other posters, call the doctor and see what he/she can do to fix this mess.

    And tell your FIL to take a few more days off. I know what you mean about that generation, but it is too soon to work it seems to me.

    01-20-09: THE END OF AN ERROR

    by kimoconnor on Mon Nov 26, 2007 at 12:45:58 PM PDT

  •  Call and send this to your congresscritter (9+ / 0-)

    and send a certified letter to the insurance company, with a copy to your local Attorney General's office, outlining what's happened and telling them you'll hold them responsible for any adverse effects of them cancelling out on the nursing services over a holiday weekend.

    •  thanks for your support (5+ / 0-)

      These are the kinds of things they really need to hear right now. I think they've badly internalized the idea that this mess is their fault for some reason or other, and so they are hesitant to make a big stink about it.

      I've been trying to convince them that this is just NOT. RIGHT.

      Thanks for your support, all the commenters.

      The purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. --Calvin & Hobbes

      by reid fan on Mon Nov 26, 2007 at 12:50:12 PM PDT

      [ Parent ]

  •  It's not right but it's very common (7+ / 0-)

    My husband was released to me as stabilized.  He had a MRSA infection, complicated with a pseudomonas infection, and needed vancomycin twice a day, administered through a PIC line.  He also had two huge infected incisions in his leg from compartment syndrome.  They were 14" long each and so deep that you could stick your hand through his leg.  It took about 45 minutes to bandage him morning and evening.  I was supposedly trained to do all this, but I was scared to death the whole time.  Twice a week he would go to the local hospital for debreding--at that point I could breath a sigh that someone was going to bandage it correctly for at least that one bandage change.

    One rationale for releasing him (and others like him) as rapidly as possible is that he would be more likely to get other infections in the hospital than at home.

    He healed, eventually.

    I thank the VA though.  They supplied all the bandages, which his regular med plan would not do.  Between the catheters, the saline solution, the acetic acid solution, the irrigation kit, all the rolls of Kerlix, the wound packing tape, etc, etc, it would have run about 100$ per day for bandages alone.

  •  My wife is disabled, (3+ / 0-)

    Recommended by:
    splashy, reid fan, kurt

    and she has a feeding tube installed, when it does not fall out, and a urinary catheter, and a port-a-cath installed in her chest.

    When she needs iv antibiotics at home, we get, from Medicaid, (If you recall, Medicaid was Dr. Howard Dean's choice for universal health care), the tubes filled with sterile saline solution, the tubes of antibiotic prescribed, and tubes of heperin.

    First, a tube of saline is threaded onto the access line, and pushed in, to flush the existing heperin.

    Next, the actual antibiotic, which had been kept refrigerated, is warmed in my hand a minute or so, and pushed in slowly, over the course of about two minutes.

    Next, more saline to push the medicine all the way in.

    Finally, more heperin, to prevent clotting in the port-a-cath.

    I think it is very simple and easy.

    But the fact remains, important medical care like this must be taught to the person or persons who will be doing it, with bubble questions answered, until the people involved feel confident.

    And there should be a backup nurse on call.

    We keep hearing about too many er visits in this country.  One of the reasons we have so many er visits in this country is the lack of alternatives for situations in which we know a person will not die right away for lack of immediate care, but we are not sure how long the person can hold out, or what to do in the meantime, between now and the next doctor visit.  I have been through this situation so many times with my wife.  We are not sure what to do, we cannot get in to see the doctor for more than a week, so we end up at the er.

    Medicaid even refused to pay for one of her er visits.  We do not know why.

  •  If you want to do something productive, join the (1+ / 0-)

    Recommended by:
    Silent Lurker

    effort to force Kongress to call an Article V Constitutional Convention.

    When this is finally called the Convention will be able to propose amendments to the Constitution and if and when those proposals become ratified in the normal manner by three fourths of the states, they will officially become the law of the land.

    We can have National health Care like the rest of the civilized world just by making it a constitutional requirement.

    Go here to learn more about an Article V Convention

    http://www.foavc.org/

  •  Learn how to bitch effectively. (2+ / 0-)

    Recommended by:
    reid fan, wilderness voice

    Call the home nursing service. Ask to speak to the supervisor on duty. Tell them what happened, and let them know you are extremely angry. You want action now to insure that this will never happen again. Drop hints that you might want to sue them. If you don't get anywhere, demand to talk to his supervisor so you can get some action. Mention that your second cousin is a malpractice lawyer you have been talking to.

    You'll get action.

  •  yep no surprise (2+ / 0-)

    Recommended by:
    reid fan, geez53

    We had a similar experience where the insurance refused to cover a visiting nurse so we had to learn how to insert IVs into veins withered by months of IV drugs. We had to carry our father, who had weighed 215 lbs not so many months before to the bathroom as he now weighed 95 lbs. I slept at the foot of his bed for a month waiting for him to need some of the lemon flavored swabs that were the only thing he could tolerate to keep his mouth from breaking out into raw ulcers.
    Some help would have been nice but insurance has to go by guidelines and guidelines say you die in a hospital or a nursing home but never your own home. We ignored the carriers and did things the way families have always done things.
    Twenty years and more have passed and things are more like they were than ever before.

    •  My Uncle F was "allowed" to die in the peace (2+ / 0-)

      Recommended by:
      reid fan, sima

      and comfort of his own bed, but only because my Aunt P was a retired head nurse at the local hospital. She could do everything but prescribe his morpine based pain killers (which he finally gave up in favor of a more effective "herbal remedie" that my cousin learned how to aquire. :[  ).
      I was happy for my uncle to get his final wishes, but pissed because he, my aunt and my cousin had to jump through so many mindless hoops and expose themselves to so much potential liability.

      If McCain is the answer to America's problems, then the question must be ridiculous -David Paterson NY Gov.

      by geez53 on Tue Nov 27, 2007 at 04:43:38 AM PDT

      [ Parent ]

  •  Sorry to come so late to this discussio, but must (1+ / 0-)

    Recommended by:
    reid fan

    vent on this topic.
    I'm not voting for ANY candidate for any office until they:

    1. Make this their number one domestic priority. The whole country is ready for and needs universal coverage.
    1. Makes whatever plan they have affordable for ALL of us. Not asking for a free ride, but I've kind of gotten used to eating at least one meal a week.
    1. Will vow to use Special Forces Units against any insurance ceo or lobbyist who gets in the way, regardless of how big their campaign checks were. Use of deadly force would be authorized. Okay, Okay, rubber bullets and Tazrs then.

    If McCain is the answer to America's problems, then the question must be ridiculous -David Paterson NY Gov.

    by geez53 on Tue Nov 27, 2007 at 05:08:29 AM PDT

    •  special forces LOL (1+ / 0-)

      Recommended by:
      geez53

      #1 and #2 are no joke though. I really feel like it is pitchfork-mob time on this issue. Politicians are way behind the curve and need some wake-up. Everyone I talk to is miserable with the current state of affairs and while some are unsure about single-payer even the vast majority of those seem genuinely open to learning about different options. This is just my impression from random conversations around here, but I live in a very Republican area.

      The purpose of writing is to inflate weak ideas, obscure poor reasoning, and inhibit clarity. --Calvin & Hobbes

      by reid fan on Tue Nov 27, 2007 at 01:15:26 PM PDT

      [ Parent ]

  •  IV's started (0+ / 0-)

    next time call 911, and ask for an ambualnce crew. An even better solution, cal the nearest fire station explain the problem and ask can they come over. WE often do things like that just cause we can.

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