Why am I being treated like a bad daughter for refusing a chest x-ray at the ER?
OK, so mom's ALF called at 11 pm to say they were sending her to ER because her sugar was low (paramedic said was at 24). She is a type 1 diabetic. I arrive at the ER just as they as unloading her from ambulance. I go into the entrance asked to wait in waiting room while they settle her in. Fine right. Only have me wait about 10 to 15 minutes, the ER was very busy.
I go back and the nurse tells me her sugar is now 117, but she is not talking. Which I try to say that is normal for her with her dementia. I notice there is a list of test ordered on the wall for her (CT scan, ultrasound and chest xray). I ask the nurse if all that is ordered for her. He said that since she was unresponsive the doctor order to see why her sugar was low. I said this happens as a result of her not eating, can we not do the tests. He says he can send the doctor over.
10 more minutes. Dr. comes over and immediately goes into how no one was here and she was unresponsive and the test were to help figure out what was going on. I say OK, I am here. She has dementia and this is what mostly happened. He interrupts me say well she is unresponsive. I stop and says yes but I rushed here to answer questions and am here. I am ok with CT scan to make sure she did not have a stroke, but why the chest xray or ultrasound? Xray to make sure she does not have fluid on lungs. I said she is here for low sugar, not a cold or cough or chest pain. He they said well she was foaming at mouth and could have shallowed some fluid and that could be on her lungs. Really can't we treat the diabetes? Dr then says well you can refuse but if she gets pneumonia later that is on me. My response was, that was just rude of you. NO xray or ultrasound just CT scan and can we get her some snacks to see if I can get her to eat something to stabilize her sugar. His response, I guess she will eat it. Seriously, because I question you. No one asked he a history or wanted to hear anything I was saying.
I did get mom to talk to me, but she was very combative, which I know means her sugar is still low. Nurse finally brings snacks and checks her sugar and it is dropping again, now at 74. Dr. comes back to tell me what the nurse just told me and that mom has a UTI which could also be cause the problem so going to get her IV for sugar and antibiotics. Me being angry at this point, say I know about the UTI she was being treated at the ALF, if some one would bother to actually speak to me and ask me her history and what has being going I I would have told you. P*ssed off Dr. is like well this is why we run tests and she could not answer. Serioulsy I am her and no one is asking questions. He then says he would like to admit her to her this in control, but I don't have to if I don't want to. I am being a a**, I should just let them run up a huge bill and run every test because she can't answer them. Ask some thing and I will answer you. Jack A**es! Oh course she needs to be admitted, I am not trying to deny her care, just unessary tests.
CT scan done, no sign of any new damage. Another doctor comes over to tell me she is being admitted and then asks me is there any history they should know about. Finally what should have been done over an hour ago. He does ask me what type of diabetes, I say type 1 and he questions if I am right, because doesn't sound right. Really, what is wrong with this place this evening? His also ask why no chest xray, my answer because I don't feel it is nesscary to treat her condition.
He then trys to listen to her chest and mom throws a fit about him taking away her covers because she is cold. Another reason not to do extra test her response is combative, come on.
So, 3 am I leave as they admit her and hope the Dr's on the floor are more willing to listen.
Am I wrong or this horrible person for not just letting do whatever? Just feeling so annoyed
25 Answers
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When mom was healthier and ended up in the ER, my stance was "I'm not a doctor; do the tests and tell me what you think should be the treatment plan".
So, since I know why her suagr is low, lets take care of it instead of trying to figure out why. She should could have had an IV and antibotics an hour earlier if they would have listened to me and most likely been able to have been discharged.
Sometimes the family does know better and what is going on. Honestly, asking her history would lead to faster treatment instead of just running test because.
I think with us, as a family, this is why we ended up with the "no transport" order. ERs are not good places for elderly dementia patients.
I am no longer trying to keep my mother alive. Anything that can't be managed by the RNs and Nurse Practitioners at the NH is going to take her.
Hospital ER's are quickly changing. I do volunteer work at a local hospital and I am seeing more security changes. Last year when my Dad was brought into the ER after a fall, I was asked to wait in the ER waiting room after I was through with Registration.... say what? I had on my hospital badge as I had been doing volunteer work there for over 20 years, same with my Dad when he was younger. New rules.
I am the same as Barb above, I just sit back and let the doctors and nurses do what they think needs to be done... and I answer any questions and give information they might need. Yes, the test can be time consuming, but an updated baseline is always good to have. Dad didn't mind the tests.
It seems like once in a blue moon, we will run into an ER doctor who doesn't want to listen. In that case, I find the nurse assigned to the patient to be more receptive.
Did the Assisted Living/Memory Care send along a medical history of your Mom? When my Dad went to the ER, the Memory Care nurse handed the EMT's all the paperwork.... so the EMT's and hospital had a list of Dad's medical history and what meds he take daily. Plus the hospital already had on file Dad's Medical Directive, who was his POA, etc. so thankfully this hospital wasn't on bypass because the ER was too full.
Is it possible that this is a signal that your mom DOES need NH care?
A story:
Three weeks ago, my husband was feeling kind of "blah" and when I asked about specifics, he said that his urine was dark. It was already 6 PM and it was not one of our doc's late nights, so I suggested we go to the Urgent Care place around the corner. Get him on antibiotics quicker, right?
So we go, and yes, there is blood in his urine. The doctor said "Mr. S, if you were a normal person, I'd just give you antibiotics and send you home. But you're on blood thinners, so we need you to get a blood test tonight. Not tomorrow. You need to go to the ER. I'm sure it's nothing, but we need to make sure".
So, we could have ignored that advice, right? We could have filled the script for antibiotics and gone home and gone to bed. But if we had, my husband would likely be dead.
We got to the ER and they drew blood. His INR (the number that folks on Coumadin live and die by, which should be between 2 and 3) was 17. They sent him via ambulance to the hospital. There isn't much literature on folks whose INR is about 10. Because they have internal bleeding, brain hemorrhages and the like, and they die.
I'm so glad that I didn't argue with either the urgent care doc or the ER docs, who did a CAT scan to check for internal bleeds before they sent him off.
For me? I will literally have to be bleeding profusely from some heinous injury before I'd ever be willing to step foot in one again. Ever.
Don't feel bad about this -- your mom is ok, that's the most important thing. Your questions were reasonable; the dr sounds like a jerk.