I Guess Her Mother has Pneumonia

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Behind the Nursing Home Curtain

I Guess Her Mother has Pneumonia

A daughter told the story of her mother having pneumonia at a nursing home except the story wasn't about the pneumonia. This was a story about being abandoned by the doctor who is assigned to her mother. It would be a stretch to say this is "her mother's doctor" because the system makes it all but impossible to have a relationship with the doctor of your choosing if you live in a nursing home. The daughter who visits every evening for after dinner "tuck-ins" told me her mother had vomiting, diarrhea, a temperature over 101 degrees, and low oxygen. She spoke to the nurse and then she ran into the doctor in the hallway and said, "My mother is vomiting." She heard the doctor say, "I know they told me. She should have a light meal," and then watched the doctor continue on her way, away from her mother's room. Imagine the feeling of being left in the wake when your mother is sick.

Nursing home culture does not hold doctors to the standards of hospitals and clinics. Doctors at nursing homes don't actually have to create and maintain a doctor-patient relationship. They are assigned impersonally. Patients and families are given hard sell to accept what they are assigned, then encouraged to lower their expectations because, after all, nursing homes are full of nurses around round the clock. Furthermore, the people who give out answers in nursing homes know better than all the daughters for all of the old people under their roof. This is not a partnership of trust but a game of throw it and see if it sticks. Doctors in nursing homes can, and often do rely on what a nurse tells them. In other words, the weakest link in the making a correct diagnosis and accurate prognosis is not the qualifications of the doctor, but the second hand "data" from a nurse, who holds no license to diagnose, passed on to a doctor who is doctoring at arm's length.

Like many people in nursing homes, this mother can't tell anyone her symptoms. Without a symptom history and without a physical exam the doctor's diagnosis can only be based on a poor quality x-ray and blood work which will be available when it's available unless the report is lost, in which case it will be available later. Without a symptom history and exam, the diagnosis can only be "antibiotic deficiency." So pick any antibiotic as a condiment and tell everyone it's for one or another infection even though cystitis, pyelonephritis, pneumonia, cellulitis, meningitis, cholangitis, and colitis are distinct in their bacterial cause and some antibiotics won't treat the specific bacteria or even get through the blood stream in to the particular infected body space. The level of diagnostic certainty required to pass the lower-your-expectations standard of care in a nursing home is crossed fingers, throw a dart blindfolded, and breathe a sigh of relief when the patient gets better despite a worst efforts diagnostic evaluation.

A day or two later, as the story continued the daughter read the x-ray report and said, "It said 'mild' and a bunch of words I don't understand." I hesitated to tell her that pneumonia is not diagnosed by x-ray and that she should not feel reassured by an x-ray report that is 'mild' because the severity of pneumonia and prognosis to survive it is based on other factors.  When it's your mother, it is important to know her chances of getting better. No one has told her if the prognosis is, "your mother has a high likelihood of getting back to her old self," or "this is going to be close, so call in your brother."

It's four days after the daughter ran into the doctor assigned to her mother. It would be a stretch to say this doctor takes care of her mother because the doctor has yet to examine her mother, make a diagnosis, discuss the meaning of the x-ray, reassure her that blood tests are ok, or tell her the likely outcome.  This is not one daughter alone with expectations that the doctor be at the bedside and lay hands on her sick mother, or to answer the pressing question of what her health future holds. We all know the real standard expected is, "If it was your mother how would you want the doctor to explain it?" This daughter was told she has to wait until the sixth day after being left in the wake of a receding doctor who said, "I know they told me." I guess her mother has pneumonia.

Thyme N. Haff

2014 September 27

Abandoned

[uh-ban-duh n] verb (used with object)

1. to leave completely and finally; forsake utterly; desert

2 to give up discontinue; withdraw from

Banner photo from Lillie McFerrin Writes

Hot sauce photo by Kate Gibbs

 

IF I WAS YOUR MOTHER BY BON JOVI

If I was your mother 
Would you let me hold your hand 
Would you say you were my baby 
Would you always be my friend 

If I was your mother 
Could I teach you what’s right 
Could I tell you stories 
Maybe tuck you in 
And kiss you sweet goodnight 

Tell me what I got to do 
To make my life mean more to you 
I could get so close it’s true 
If I was your mother 

Would you always believe me 
‘Cause I’d wake up in the middle 
Of the night 
Just to see if you need me 

Tell me there’s no mother 
To who you’re telling your secrets 
And would you tell me 
‘Bout all the boys you been 
Bringing home to meet me 

Tell me what I got to do 
To make my life mean more to you 
I could get so close it’s true 
If I was yours 

Mother, mother 
If I was your 
Mother, mother 

When love is blood 
You’re never on trial 
Love don’t get deeper 
Than a mother and child 
Oh baby, I got to get that 
Close to you 

Tell me what I got to do 
To make my life mean more to you 
I could get so close it’s true 
If I was yours 

Tell me what I got to be 
To make you a part of me 
There’s no one else you’d ever need 
If I was your 

Mother, mother 
If I was your mother 
Mother, mother 

Mother, mother 
If I was your mother 
Mother, mother

Lyrics by Bon Jovi