What caused Mom's broken sacrum? - spread the blame...

Mom's flat on her back in the hospital, full of painkillers and unlikely to sit up soon - if ever again. Her prognosis is poor and my instincts tell me she will live a while but won't come back from this incident.  I've been racking my brain trying to understand the "one" thing responsible for Mom's broken sacrum and thus her excruciating pain and poor prognosis.  After days of guilt, I've come to realize that it's a combination of things  that caused this, though that doesn't make my sense of guilt go away.

The "fault"  lies with all of us who SHOULD have noticed Mom's increasing pain and thus her vulnerability and worked to PREVENT a break or fix it as a hairline fracture.    The primary cause of this break is Mom's age and physical condition.  She's 90 with has bad osteoporosis. This fact alone should make anyone more careful as they move her and more sensitive to her complaints of increased pain. For years she's refused to exercise, to take calcium or vitamin D and small estrogen supplements to maintain bone strength.  The brake could have occurred if she sat down too hard or was constipated and had to strain during a BM.   Mom asked that aides, my neice and myself rub her lower back to help her pain.  The location where she wanted us to rub was very near her sacrum.  We, in our attempts to help her, might have aggravated her break without knowing it. 

I feel some responsibility for her current state because I didn't visit for nearly two months. I live 7 hours away and didn't want to drive through snow and ice.   Had I gone there, I'd have listened to her; I'd notice her pain.  Had I asked questions, had I understood that her pain was increasing, I could have pushed for an MRI earlier.  Had I called the nurse at night instead of just calling Mom to visit, I might have known something was up.

I blame my brother because he lives in Mom's home town and got 2 calls about her being "assisted to the floor" after her wheelchair rolled out from under her as an aide sat her down. He didn't call me, he didn't call the doctor.  He just told the nursing home aides TWICE to fix the brakes. After the 2nd "assist to the floor", the nursing home used a portable x-ray to look at her hip but never looked further to her back. This is an elderly person with KNOWN osteoporosis - it's absolute neglect NOT to look at BOTH hips and her back.  I'd have insisted on an MRI then - 5  weeks ago when her pain was controlled with tylenol and rest.  Obviously the break was not as bad then and perhaps something might have been done that would cause her less pain and NOT cost her life. 

I blame the nurses and aides at the nursing home for their failure to simply pay attention.  I'm REALLY angry about this and plan to complain to the state after Mom passes away.  After learning of these "assists to the floor", I visited her. I spoke with the night nurse on 2/18 who told me that she's noted an increase in Mom's pain for 8 weeks - that's 2 MONTHS and no one did a thing.  The night nurse DID HER JOB; she wrote down her concerns so the DNS - director of nursing services - could see it and take action.  Yet, there are NO reports to her doctor, NO calls to family until something happens that might be a liability to the nursing home.   When something DID happen - the brakes on the wheelchair failed, they called the family to fix it when the chair belongs to the nursing home!  They KNOW this yet they called my brother anyway.

I blame her doctor for insisting that she be in this particular nursing home because "none of the others communicate with me as well."... Hmmm... I hope he'll reconsider THAT opinion NOW that they've caused my mom a painful death.   I blame him for a failure to act sooner, he waited two weeks to order an MRI and during that time her pain became worse. Thus the trip to the ER and the failed attempt at a, literally, heart stopping MRI.

I know I need to let this go.  I know that my regrets don't help Mom now but by talking about it, by making people aware, I hope something positive will come out of it.  My Mom is suffering and I am so sorry.  I want so badly to prevent this for someone else.  Listen to their pain and act to prevent problems as soon as you can.