Saturday, March 5, 2011

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.

Dead in the MRI and broken sacrum = long recovery IF mom can make the trip at all

In the past 5 days Mom’s died once, received 9 IVs and one epidural.   Last Friday, Mom was in so much pain that the nursing home insisted she go to the ER.  They called her doctor to meet her at the ER but he was too late to stop the ER doctor from attempting an MRI.  They did an EKG before the MRI but didn’t look at the results before giving her propofol (Diprivan) as a sedative.   Though they only gave her a small amount –about 1/5 the “usual dose” for an adult – it was enough to stop her heart.   If the ER doc had looked at the EKG, he’d have seen that she was in atrial fibrillation – her heart was beating erratically and not in regular sinus rhythm.    The technicians gave her epinephrine (also known as adrenaline) and did chest compressions to successfully restart her heart in normal rhythm.  

She was transferred to the ICU and hooked up to every monitor known to man and medicine.  I arrived in town to find her confused and begging for God to deliver her from such torture.  She was on a fentanyl patch and 2ml (milliliters??) of dilaudid (hydromorphone) every 2 hours.  The nurses in the ICU were great; they came in every hour to give her 1 ml and were quite attentive to her every need.  They even tried to feed her but she would not budge – she wanted no food at all.  On Monday she was in and out of it, she recognized us all but had a hard time focusing on a thought.  

The doctor developed a whole plan to administer certain drugs on Tuesday to complete an MRI to see exactly what was happening with her back and hip.  The results were poor – cracked sacrum, severe osteoporosis and arthritis that is compressing her sciatic nerve and causing extreme pain.  Tuesday was a rough day. She was terribly confused by the drugs and didn’t want to go into the MRI machine.   Luckily, she made it through just fine but the drugs she had to take made her feel awful well into Wednesday.   Every 5 minutes she repeated that “everything is backwards”.   It was as though she developed severe dementia overnight.  She told me that she saw God sitting next to her while I had some lunch.  All afternoon I had to share my chair with God.  It was the only chair so I had to sit on the forward part of the seat so that he had room to sit down with me.  If I tried to move back she’d correct me and tell me to leave room  for God.  She realized it sounded crazy and said she was embarrassed to tell me; she could not actually see God in the room but she was certain he was there.   As the day wore on, I wondered if it was metaphorical and if she really was trying to tell ME to become more spiritual; that I should make room for God...   What ever the purpose, we laughed about it a bit and she remembered it the next day on Wednesday.  

Wednesday morning Mom was less confused but still agitated.  She was scared and wondered why she had to suffer so; why they could not fix her pain and return her to “normal”.  She was tired of laying down and wanted to sit up but it hurt too much.   In the afternoon she went for an epidural and returned changed – more alert, more at ease and less agitated.  During the epidural, my brother and I sat nearby and heard her yelling out. We nearly cried, believing she was in pain.  Soon after the yelling the doctor came out and told us that she was yelling because they had to move her into a bath and it was cooler than she wanted.  On the way out of the epidural, again, she was asking “why” – “I’ve been a good girl, all my life… why must I suffer like this…”  It was hard to hear but she looked so much better that we still felt relieved.  

The “pain” doctor had good news and bad – the epidural went well but…. The fracture in her sacrum was worse than we thought, it was in pieces and healing was unlikely.  Generally, they could glue a crack with surgery but there is no way they’d put mom out again.  Given her osteoporosis, it might just break again soon anyway.   He said she’ll have constant pain for the rest of her life;  laying flat or sitting probably won’t hurt but moving up or down will.   So – how do we tell her that?  Having to tell her is worse than learning she had the break… dammit!  My poor momma!