Archive for November, 2009
Wednesday, November 18th, 2009
Even Saturday Night Live is getting into the health care reform debate.
“The president wants to pass a health care bill so bad that he will literally sign anything. You can water it down however you like–as long as it’s a stack of paper with the words ‘health care’ on it he’ll sign it … we’ll [even] agree to a provision that makes it illegal to ever sue a doctor.”
A surgeon pays out $6 million because a post operative patient died from a blood clot to the lungs. The surgeon allegedly ignored risk factors for blood clotting, like the patient “being somewhat obese, taking birth control pills, [having] a personal history of asthma and hypertension and a family history of heart disease and stroke.”
We don’t know the facts of the case, but only one of the six factors listed above is a risk factor for blood clots.
The post-operative period is also a risk factor for blood clots. Measures to prevent DVTs are fairly standard and if those measures weren’t followed, then the doctor or hospital should be liable. But the description of this case is one of the reasons that defensive medicine exists. After a bad outcome occurs, lawyers with retrospectoscopes make up medical pseudodata to support their damage claims and give untrue statements like the one about the “risk factors” to a jury.
A child’s family gets an $11.1 million verdict because doctors and hospital didn’t properly check child for dehydration. The child had vomiting for several days, went to the ED, was there for more than 4 hours, and was discharged. The next morning, the child could “barely breathe.” Again, all of the facts aren’t there, but how does failure to check for dehydration in an infant well enough to be discharged lead to difficulty breathing the following day? Something doesn’t make sense.
A sign of the times. Hospital posting emergency department wait times on Twitter. But if you have chest pains or shortness of breath, don’t go on Twitter, you “should be calling.” And if you have insurance, just come right in.
Defense attorney states that homeowners could be held liable for influenza transmission during a cocktail party or during a child’s play date if they don’t warn guests about the possibility for illness. Then he cites a $40 million case where a school principal’s family is suing because the school didn’t provide a safe working environment for the principal and he got some viral illness.
Looks like at my Christmas parties this year, the greeting at the door will be “Let me get your coat. The disclaimers for you to sign before you enter the premises are on the table by the door. Please initial every paragraph. You can purchase individual face masks for 50 cents or 3 for a dollar. And don’t drink the antibacterial hand rinse.”
US Senator Lindsey Graham sponsored a “loser pays” bill for incorporation into health care reform. If only we could incorporate “loser pays” into tort reform.
We’re forced to pay so much attention to all the checkboxes and handwashing and smoking cessation advice so that we can brag about how our hospital has met all the quality measures created by some faceless organizations. In the process, we forget about paying attention to one thing: the human beings who are our patients. This article in the NY Times is spot on.
A woman uses a phony name to get IV narcotics, then ripped out her IV and left. q34q4 ce w
Ooops. Sorry about that. I passed out and my face hit the keyboard after typing that. I can’t imagine such a thing happening in real life.
After police busted her, papers found in her purse revealed she was visiting various medical facilities to swindle them out of drugs. t b787878787878787878787878
Ooops. Passed out again.
She was charged with a felony for her actions. We need more prosecution of fraudsters like this.
Patients with pain want to know why so many health care providers take chronic pain complaints with a grain of salt? Thank people like Kathleen M. Staples of St. Paul, Minnesota.
College student is stuck by hypodermic needle while getting change out of a vending machine on college campus. In other news, as a result of this incident, JCAHO has ordered the removal of all vending machines from hospitals as a patient safety measure so that incidents like this do not happen again.
One third of Americans die in hospitals. Woo hoo! There’s a news flash for you. Where else do you expect sick patients to go for treatment … the bowling alley? The average cost of a patient stay that ended in a patient’s death was more than $26,000, compared with $9,447 for patients discharged alive. Now if we could only stop admitting patients to the hospitals right before they die, we’d save $20 billion per year.
In other news, half of all people purchase groceries in grocery stores and one third of all intoxicated people are in bars.
I broke this week’s Healthcare Update into two parts. To read the other half, head on over to ERP’s place at ER Stories.
Posted in Healthcare Update | 71 Comments »
Tuesday, November 17th, 2009
by Mark Plaster MD
Some of the proposed health care reform bills that are currently winding their way through Congress contain an “opt out” clause for those states who do not wish to participate in the ‘public option’ insurance plan, which is simply an expansion of Medicare. First, why would any state opt out of a government handout? There are some states who are dominated by one or two powerful insurance companies who have tremendous lobbying strength in those legislatures. Those states might opt out to protect those interests. But a larger reason might be that the state government might see the hand writing on the wall. The future of government health care is an expansion of state Medicaid. If states feel that they can escape this flood of red ink in the future they may opt out of the gift from the government in the short run. It’s entirely possible that the federal government will encourage states to opt out, thereby relieving the Congress of the responsibility for the uninsured. Further, those states that do opt out will subsidize those that don’t. But to think that states will opt out because “we are doing just fine without your money” is naive. Politicians are short sighted. States will take the money.
We already have a model for opting out. It’s the private school system. If you feel that the public school system is not for your child, either because it’s not safe, the education is poor, or the social influences are not up to your standard, you can take your child from the public sector and place them in private education. You can ‘opt out’ of public education. In fact the state plans on a certain number of these privately educated children not showing up on the first day of school. However, taxes from their parents are counted on to support public education. Despite this cost shifting, inefficiencies in public education cause cause district after district across the country to teeter on bankruptcy. If all the privately educated children came flooding into the public school system to get what is owed to them, the system would collapse. Similarly, in most universal health systems there is a ‘private tier’, where patients dissatisfied with their health care, the wait, whatever, can go to a private physician. It serves as a pressure valve for the system. In many ways, the US has served that purpose for Canadian patients who can’t find the health care they need in Canada. But what would happen if there was no opt out for them. The demand on the system would likely bring about its implosion. The incoming President of the Canadian Medical Association made this observation recently.
So even though you can opt out of the service, can you opt out of paying for the ‘public option’? Can you opt out of the tax increases? Of course not. The current Senate bill includes a mandated payment by the manufacturers of medical devices, such as pacemakers, artificial limbs, etc. Similar to the penalty on tobacco companies, they are not allowed to pass this on to consumers of these products. But pass-throughs are inevitable. Costs of other items will go up and these costs will be borne universally whether your state opts out of the public option or not.
Just as you can’t opt out of the taxes to pay for the system, seniors can’t opt out of the changes to their Medicare. Many elderly have chosen the private health plans of the Medicare Advantage programs. Many of these are slated for big cuts. Despite promises by President Obama that everyone can keep their insurance if they like it, seniors will not be able to opt out of these changes to their plans.
While current plans may allow states to opt out of participation in government administered health plans, there is currently no provision for the young and healthy to opt out of insurance coverages that they do not want or need. In fact these premium dollars are seen infusion of cash needed to pay for the health care of the poor. This is the reasoning behind why all health care plans need to be ‘qualified’ by the government. Young healthy people tend to opt out of buying expensive health plans that they feel they do not need. Requiring everyone, young and old, those with healthy lifestyles and those without, to buy the same ‘qualified’ insurance plan will insure that there is enough cash.
In the end, how much choice will states have? How much choice will individuals have? Not much. And that is why the opt out provisions are so politically palatable. They ‘allow’ states and individuals to make ‘choices’ where there are essentially no other options.
Posted in Uncategorized | 10 Comments »
Monday, November 16th, 2009
As I was fixing the wiring in my basement, a thought popped into my head about another way to decrease costs of medical care in this country.
Get rid of prescription requirements for most medications and procedures.
How many people would go to the doctor for a sore throat if they could buy a strep test over the counter? If the strep test is positive, they go to the pharmacy and purchase some penicillin over the counter.
If you twisted your ankle and could walk into a radiography center and get an x-ray of your ankle for $100, would you bypass the emergency department?
If you could buy your blood pressure medication over the counter, would you keep going to your doctor for those $150 checkups? Would you even purchase routine insurance? Or would you stick with just “major medical” coverage?
I know that issues would have to be worked out with an open access system – such as preventing narcotic abuse and preventing antibiotic resistance due to people taking Zithromax for the flu or Levaquin for their coughs. Maybe we’d have to limit the number of CT scans or angiograms that someone may receive to keep down the radiation doses.
You can purchase an HIV test or a pregnancy test over the counter. Why can’t you purchase a strep test or mono test over the counter? It’s not uncommon for medications once available only by prescription to go “over the counter.” Look at all the acid blockers and at Prilosec as one example. Why shouldn’t most prescription medications be available to everyone over the counter? If it isn’t a controlled substance, people should have access to it. What harm is avoided by having a medical provider as a “middleman”?
In almost any other situation, if I choose to take care of a problem myself, I can do it.
If I want to cut my own hair, I get a pair of scissors, look in the mirror, and start hacking. I don’t need a stylist’s prescription to purchase scissors.
If I want to sue someone, I can go to court, fill out the papers, pay the filing fee, and play the lotto. I don’t need a lawyer’s OK in order to gain entrance to the court house.
If I need to fix an electric outlet, I can go read about it online, buy the stuff at Home Depot, then hope I don’t get the red and the blue wires mixed up. I don’t need an electrician’s permission to purchase conduit.
When I get in over my head doing any of these things, I either take my chances or I call someone who knows more about the problem than I do.
Why should medicine be any different?
Think about it. If everyone had open access to medications, medical testing, and radiographic studies, there would no longer be an issue of what is and is not “necessary.”
If a patient wants a test, then the patient purchases the test.
If a patient wants medication, then the patient purchases the medicine. Be a lot fewer “designer” prescriptions being filled if patients had to pay full price for them.
With patients obtaining their own tests, there would be less medical malpractice for failure to order testing. The patient wouldn’t need a doctor’s order to get the test. Worried about breast cancer? Go have a mammogram done. Worried about lung cancer? Go get an x-ray … or a CT scan for that matter.
If patients get in over their heads, then they can seek the advice of someone who knows more about the problem than they do.
Until then, I say let people have at it.
Posted in Random Thoughts | 43 Comments »
Saturday, November 14th, 2009
 The nurse while doing her rounds on the patient who had been admitted so that he could detox from his alcohol binges. His mouth appeared full.
“What are you chewing on?”
“Nothing” said the patient, his voice slightly muffled from the wad of gum in his mouth.
“There’s something in your mouth, what is it?”
“Gum.”
Then the nurse went to give the patient some medication into his IV line and noted that there weren’t any alcohol packets in the drawer. She walked out of the room to get some more and saw that the garbage can in the room was full of alcohol packet wrappers.
“Let’s see that ‘gum.’”
The patient tried to spit the gum into his hand, but pieces of it flopped onto the bed. Kind of whitish in color, a cloth consistency, bunch of neat little square pieces.
Mmmmmm. Tasty.
Just what we need – Smirnoff-flavored “gum.”
Only problem is that they make vodka out of ethanol, not rubbing alcohol.
Guess that would explain the nausea and headaches.
Posted in Patient Encounters | 7 Comments »
Friday, November 13th, 2009
 Now the Joint Commission has some competition from another medical professional society.
According to this LA Times article, the board of the American Marijuana Advocates, er, um the AMA, has put forth a statement that one of its goals is to “conduct clinical research, develop cannabis-based medicines and devise alternative ways to deliver the drug.”
The article quotes the AMA as stating that
“Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis,” and these trials were “insufficient to satisfy the current standards for a prescription drug product.”
The AMA also published a disclaimer that stated “This should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.”
Which leaves the whole issue not making sense. If they don’t endorse medical cannabis or legalization of marijuana, then why is their goal to “conduct clinical research, develop cannabis-based medicines and devise alternative ways to deliver the drug”? Do they want to do research in to “non medical cannabis” and “illegal drugs”?
In other news … the AMA Board also unanimously voted that batting one’s head with a sneaker could possibly be a sound way to gauge the effects of marijuana on one’s brain and that Mr. Hand was a real jerk when he stole Spicoli’s pizza in Fast Times at Ridgemont High.
Hat tip to the Volokh Conspiracy
Posted in Policy | 14 Comments »
Thursday, November 12th, 2009
Syringe thief causes brawl in ED. A suspect was seen combing through drawers and cabinets in the emergency department and was seen taking syringes. He tried to run and a “scuffle” ensued. Now he’s in the GreyBar Motel.
In other news, because of this incident, JCAHO has now mandated that mandatory syringe counts be performed after every shift and that syringes must now be locked behind the nursing station as a patient safety measure because patients could suck up toilet water with the syringes and squirt it in their mouths or they could use the syringes to suck H1N1-laden mucus out of their noses and squirt it at random patients walking the hallways.
More violence in the ED. Nurse stabbed in chest while taking care of suspected drug overdose patient.
In other news, JCAHO cited the nurse for failing to use “less restrictive” methods to restrain the patient and has now mandated that all sharp objects be removed from emergency departments.
Then there’s the hospital violence. A nursing assistant at Huntington Memorial Hospital in Pasadena, California got attacked at work by a violent patient, went to the emergency department, was discharged back to work, was attacked again, and was then turned away from an in-house worker’s compensation clinic. Later that day, she collapsed from a brain bleed and isn’t expected to recover. Did the hospital attacks cause her to have a stroke? Could literally be the million dollar question. Both the health insurer and the employer are denying responsibility for the significant hospital bill.
News stories here and here. The web site set up for donations to help her is here.
Long waits for ED care occur all over the globe. In Australia, one family waited “712 hours” for their daughter to be seen after having a seizure. Eventually, they left – “exhausted and angry.” During their time in the waiting room, their child celebrated her second birthday, learned to read, and took up crochet.
Cokehead trauma victim closes down University of Utah emergency department. Ummmm … sumdood was carrying five plastic bags full of white powder in his pocket and the first thing these ED personnel think of is anthrax? Yeah. OK. By the way, all those bags with little green weeds in it are full of oregano. I’m an Italian chef … really. Buon appetito!
Non-caffeinated Sprite gives you just as much of an energy kick as a Monster energy drink. Just ask this 12 year old – who, by the way, was the youngest person ever to present a scientific paper at the American College of Emergency Physicians’ Scientific Assembly.
Red Bull … that may be a different story. Six German states banned Red Bull Cola after finding trace amounts of cocaine byproducts in the bottles. So what if you’d have to drink “12,000 liters” of Red Bull Cola to get the equivalent buzz of one snort? It’s cocaine, dammit! Just don’t sell this stuff in Utah. Someone might drink it in the ED and cause a hospital shut-down.
This thing really is an emergency room. California can’t afford to keep their hospitals open, but they can afford to build some 1000 square foot mobile ER contraption that has capacity for medical staff to do x-rays, ultrasounds, EKGs and minor surgery. Now, instead of making patients endure unimaginable waits in the hospital emergency departments, the mobile ED has the ability to just drive by you if you’re waving for help.
Training with fake patients. Banner Health in Arizona has set up a mock hospital where “lifeless mannequins will bleed, burp and give birth.” Mannequins can suffer from such ailments as septic shock, GI bleed, pulmonary embolisms, medication overdoses, and breech births. To keep things as close to real life as possible, word on the street is that one of the mannequins has 10 out of 10 back pain for the past three years and is allergic to all NSAIDs, Ultram, Darvocet, Codeine, Benadryl, Compazine, and Droperidol … and his doctor is out of town.
When funding goes, so does medical care.
Odd request …. Someone posts a question on “IsItLegalTo.com” asking whether it is legal for hospitals to refuse to tell patients which doctor is on call in the emergency department. If you’re having a true emergency, does it matter?
Some people write blog posts to protest their perceived injustices, some people paint murals. NPR has a sad story about medical bureaucracy and treatment of a terminal cancer patient.
Posted in Healthcare Update | 6 Comments »
Wednesday, November 11th, 2009
Its been a while since I did a computer-related post. For those of you who didn’t read my old blog, I’m kind of a computer geek. I used to try to put up something every week or so about computer-related topics. Kind of fell out of that routine for a while, but something that happened to me last week prompted this post.
I purchased a computer from an online store several years ago and along with the purchase was included a copy of Microsoft Office 2003.
I have since upgraded computers, but still continue to use Microsoft Office 2003 on my computer as it is a decent program and suits my needs for presentations and word processing.
I was content with using Office 2003 until I got an updated message via Microsoft’s “validation” process telling me that, after six years of use, Microsoft’s powerful computers and the company’s due diligence had finally determined that my copy of Microsoft Office was … not valid. The serial number that is on the sticker on the CD that came with my computer from the store was really a serial number for a large corporation and somehow Microsoft knew that I didn’t work for the large corporation. I got a countdown of how many days were left until Microsoft was going to tell its Office programs to mark all of the programs I purchased as “not genuine.”
Microsoft recommended that I contact the store that sold me the program and “ask for their help” to ensure that the copy of Microsoft Office I purchased was genuine. Of course, since so much time has passed, the receipt for the computer and software I purchased is long gone, so I have no way of proving that I actually purchased the software – other than the disk and serial number sticker which I have kept.
How absolutely thoughtful and diligent of Microsoft. Create a “Genuine Advantage” program and make users install it. Have your program call home to check the serial number on my software for the past 4-5 years and certify that the software I purchased is legitimate. Lull me into a false sense of security. Then all of a sudden, after I have long discarded the receipts for my purchase, change your mind and then insinuate that I’m a software pirate, leaving me no way to prove otherwise.
But never fear. Microsoft had the answer to make sure that I was “protected against vulnerabilities that may exist in non-genuine copies.” I could “learn more” by clicking on a button in the “not genuine” notification. The link took me to a Microsoft store where Microsoft would gladly let me drop an extra $499.95 to purchase a “genuine” copy of Office Professional 2007 … at least for the next six years until Microsoft’s powerful and diligent computers could determine that the copy I purchased now was not valid and provided me with a button I could click to go to a Microsoft site where I could spend $1500 to purchase a “genuine” copy of Office Professional 2013. Oh, and you can do a search on eBay and get the same Microsoft Office Professional 2007 software for less than $100, but Microsoft’s powerful and diligent computers forgot to mention that.
So I did what every self-respecting person who purchased “not genuine” copies of Microsoft Office would do.
I told Microsoft to go pound sand.
I was going to install an old copy of WordPerfect office that came with another computer I purchased (who knows what Corel’s computers would say), but then I went to OpenOffice.org and looked at their latest office suite. I’ve tried out previous versions of the OpenOffice suite and the functionality of the programs were adequate, but lacking for my purposes.
I installed the beta version of OpenOffice 3.2 and have been using it for about a week. This program rocks. The developers of OpenOffice have really made a lot of great improvements. I haven’t tried Microsoft Office 2007 (and won’t be doing so), so I can’t and won’t compare Office 2007 to OpenOffice 3.2, but the OpenOffice suite has a good 90% of the functionality of Office 2003. You can open any Microsoft Office documents and save everything in Microsoft Office format as well so that those people who still want to pay large licensing fees to use Microsoft Office are still able to open the documents.
Oh, did I mention that the OpenOffice suite is free? As in pay nothing?
If you’re in a government office, a university, or any other business and spending money on Microsoft Office licensing, you should really reconsider your investment. OpenOffice 3.2 is prime time and there is a low learning curve for the transition between Microsoft Office and OpenOffice.
This link goes to the OpenOffice site where you can download the software. The latest version (3.0) of the suite has been downloaded 100 million times in the past year, so they have to be doing something right. I downloaded the Version 3.2 beta which means there may be a few bugs, but it is close to what the updated version will look like.
As a disclaimer, I have no financial interest at all in the OpenOffice platform. The above link goes to OpenOffice.org’s home page and has no tracking code. I am receiving nothing from them for this post.
It’s just a good program. Try it.
Posted in Computers | 48 Comments »
Tuesday, November 10th, 2009
 by Mark Plaster MD
The New York Times is warning that the urban patients may feel the pinch of the health care bill as it tries to rein in out of control health care costs. It notes that the goal of the bill is to cut Medicare costs by 15-30% by restraining the hospitals that cost the most. As it turns out, these hospitals are located mainly in urban areas like New York and Los Angeles. The bill will mandate that an independent body, such as the Institute of Medicine, will be tasked with studying then mandating that urban hospitals make changes in how they do business. Urban hospitals fear that they will be compared, as the Dartmouth group did, to the costs and utilization of hospitals such as the Mayo Clinic and other midwest institutions who have lower overheads and treat different types of patients. The real fear is that the IOM will recommend that the efficient hospitals will be rewarded with higher compensation while they are left with reductions. Wouldn’t that be a real kicker if the areas of the country that have supported health care reform the most,urban blue states, end up getting hurt the most by that reform.
Posted in Health care reform, Uncategorized | 10 Comments »
Tuesday, November 10th, 2009
 A 22 year old patient comes in with a positive review of systems (says “yes” every time you ask if he is having problems with a body system) … the Macerena (pain or other symptoms anywhere you touch your body while doing the dance) … whatever you want to call it.
Symptoms were present for more than 2 weeks and included cough, headache, fever to 100.6, runny nose, sore throat, weakness, loss of taste, increase in body fat (he used to be 10% body fat, now he’s at least 15%), funny looking diarrhea stools that float more than usual (including vivid description of how stool should slide right from rectum into the toilet bowl and his are not), abdominal cramps, episodic vomiting (with an episode of fretching while waiting to be seen resulting in the hawking up of a saliva loogie which he left oozing down the side of the sink), leg cramps and … I finally had to stop him. Enough is enough, Buddy. You’re 22, not 102.
Some “pale sickly looking little Chinese doctor” treated him earlier in the week for bronchitis and gave him Augmentin which caused him worse stomach aches and more diarrhea. Now he wanted a different antibiotic. And he also wanted to know what was wrong with him.
Oh yeah, and “by the way,” he had some family medical leave papers for me to fill out because he couldn’t go to work for the past two weeks and was probably going to need another week or so to get better. He couldn’t get in to see his regular doctor all week because all he can seem to do all day is sleep and by the time he can get enough energy to get out of bed, the doctor’s office is closed.
Yeah. I noticed how you had to be wheeled into the room by wheelchair.
His physical examination was … normal.
I even checked “unnecessary” labs on him and the labs were … normal.
You can get Motrin or Aleve over the counter. Here’s some Phenergan. Don’t shoot it into your arteries and don’t sprinkle it into your eyeballs for that matter. You’re cleared to go back to work. I don’t fill out family leave papers in the emergency department. You’ll need to muster up the energy during normal business hours to get to your family physician for that one. Have a nice day.
Two days later I get a call from the doc working in the ED. Mr. Macerena was back. Now he couldn’t go to work because the medication I prescribed him made him sleep all day. He needed a note. Oh, and I allegedly told him that I would fill out the medical leave papers for him, but forgot to do so. He wanted this doc to fill out the papers.
With an obvious sarcastic tone in her voice, she told me “I was just checking to make sure that you wanted the medical leave papers filled out and seeing what you wanted me to write for a diagnosis.”
In other words, she was calling to yank my chain. It worked. I felt like driving to work just to smack the guy.
“You’ve got to be kidding me. Rip those damn papers up. Right now. I want to hear the sound of tearing paper in the phone. Don’t worry, he’s too weak to do anything to you. Better yet … just casually walk up to him, then grab the papers out of his hands, run away, and shove them in the paper shredder. Then take his pills away from him and dump them in the toilet. No. Open them up and sprinkle them into his eyes. Then get me the phone number for his boss so we can settle this ‘I can’t go to work’ stuff once and for all.”
The doc laughed, thanked me, and hung up. Sure. She gets a kick out of it and now I’m all wired up for the next couple of hours.
Then I get another call from the hospital an hour later. Mr. Macerena had to be escorted from the premises by the police after threatening the doc that he was going to get his papers filled out and get his money back for the visit he had with me two days ago even if he had to wait for her shift to be over in order to do it.
If some people spent as much time working as they did trying to get out of doing work, productivity in this country would double.
Posted in Patient Encounters | 12 Comments »
Monday, November 9th, 2009
The nurses started riding me as soon as the patient’s chart hit the “discharge” rack.
A sweet little old lady was brought in because she had a “coughing fit” in the nursing home. The nursing home said that she was still coughing after a breathing treatment, so they called 911.
For her age, she was pretty healthy. She had osteoarthritis and a little bit of dementia. But her breathing was fine.
“You’re actually discharging a 93 year old whose doctor sent her in by ambulance with shortness of breath? You go, WhiteCoat! Better hope she doesn’t get worse.”
Ahhhhh. Fear of the bad outcome … the bane of an emergency physician’s existence. “She’s fine. We x-rayed her. Her oxygen level is normal. Her breathing is normal. If she gets worse, they’ll send her back.”
Still there was a lingering doubt. What if she did get worse?
Even though the patient was 93, she was still sharp as a tack. She was talking about her favorite football team and told me that she wasn’t sure why the nurses called the ambulance to begin with.
“You can’t get upset with them for being worried about you.”
She smiled and nodded her head.
When I went in to the room to tell her that she could go back to the nursing home, her mood improved.
“You mean I’ll be home by six?” she asked me in an excited voice while staring up at the clock.
“Well, it’s already ten minutes to six, so probably not by six. Maybe by seven.”
“Oh good! I won’t miss dinner.” she said.
A pile of clothing was sitting on the floor in the corner of the room. I picked them up and asked “Are these yours?”
“I can’t see,” she said, her head turned toward the other side of the room.
“These here,” I said, waving them a little.
“I can’t see.” She said again.
“Over here,” I said, holding the clothes up next to her bed. Maybe she had arthritis in her neck and couldn’t turn her head or something.
“I … can’t … SEE!” she said. Her voice had the distinct tone of annoyance.
“These!” I said firmly, walking over and holding the clothes in front of her face. I was starting to get annoyed, too. Then I noticed that her name was written on the tag inside of the shirt. “Oh, they’re yours. I see your name written on the tag.” I folded them for her and laid the clothing on the side of the bed next to her.
It was only when the nursing home van came to pick her up that I noticed she had donned dark glasses.
In the evening?
Well, Ethel had advanced macular degeneration.
They kind of missed mentioning that on her past medical history in the transfer records.
At first, I felt bad.
Then it reminded me of this Taxi episode (especially the last minute and a half).
I’m still giggling.
Posted in Patient Encounters | 4 Comments »
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