FOREWORD

Newsweek's Periscope on "Hospital Horrors" (August 8, 2004) reports that needless deaths in hospitals averaged nearly 200,000 per year for the period 2000 to 2002 (over twice that recorded in 1999!). It complements John Stossel's 20/20 TV report on "Trial Lawyers" (July 23, 2004). He points at the fear of malpractice suits for physicians and hospitals imposing needless tests, unwarranted surgery, and extensive procedures as "protection". And a Chicago Tribune article on Elisabeth Kubler-Ross (August 26, 2004) cites her "On Death and Dying" where the five stages of grief --denial, anger, bargaining, depression, and acceptance--are generally accepted. She advocates the rights of dying patients to end their lives at home, aided by compassionate care, without unnecessary medical intervention.

Following is a documentation of events as they progress leading to the death of Diane Richards at Louis Weiss Memorial Hospital on Friday the13th, 2004. Her written words, as an alert patient and a knowledgeable Registered Nurse, makes one poignantly aware of the situations cited in the paragraph above.

For the record, doctors involved in 2002 at Louis Weiss Memorial Hospital were William A. Applebaum, Nelson Kanter, and Jon Beacher. Hospital CEO was Edward Cucci.

In the 2004 episode at Louis Weiss Memorial Hospital, William A. Applebaum, Allan Pollack, Nelson Kanter/Maribe Bangayan, Roland Curran (Evanston Hospital), and Robert Balk (Rush Presbytarian) attended. Hospital staff included CEO's Stephen Patz, Tracey Rogers. Susan Nick, Anne Solak, Liz Kurien, Sandra Yule, and nearly 2 dozen unidentified "residents." Other physicians/radiologists/consultants include; Dr. Rosenson claims no involvement.( If true, I apologize for its inclusion. Was obtained through Dr. Applebaum.) K. Malic, Heidi Huck, Amjad Sheikh, Ian Cohen, Gabriel Angries, Gregory Foldstein, Donald J. Hebel, Ronald L. Weinstein, An M. Kieran and Vijaya Morankar.

Currently available billing and medical records include providers; Fitzimmons Surgical Supply, Ursala Sadamczyk, Diagnostic Radiology Specialists, VHS Genesis Labs, Allan Pollack, M.D., A R Imaging S C, Rush Presbytarian St. Lukes, VHS of Illinois, Inc., William A. Applebaum, Weiss Physicians, University of Chicago, West Suburban Cardiologist, Ltd., Respiratory Medicene Associates, ENH Faculty Prac ASC, Wm Anasthesia, LLC, and Shea Cardiology Consultants.

 

Ted Erikson
September 1, 2004

____________________________________________________________________________

A DYING DIATRIBE ©2004

By

Ted Erikson and Diane Richards*

1226 E. Madison Park, Chicago, IL 60615;

Ph: (773) 268-1226 or e-mail: umbra1226@aol.com

(* Deceased)

 

Prologue:

Following time of death at 3:59 P.M. on Friday the 13th, 2004, I shared a small vial of Diane's favorite brandy that was to celebrate her recovery and discharge from the hospital. It was not to be. As I despairingly trickled the spirits down her throat, I could only cry. I drank the remaining drops.

Later, I was reading the first (sample at bottom) of her many notes (italic text); "I don't have very good vibes about any of this...Don't think it's cancer recurrence." A successful cancer operation in 1997 and an emergency hospital admission in 2002 for COPD complications (caused by an unresolved bacterial infection) preceded this episode,

__________________________________________________________________

1/8/04, Thursday

The heart of this story began on December 26, 2003. A mild sore throat lasting less than 48 hours seemed to signal transient laryngitis. But after 16 days of being unable to speak, her PCP (primary care physician) referred her to an ENT (ear-nose-throat specialist) on today, January 8. She was diagnosed with a left vocal cord paralysis of unknown origin and could not talk. For the 37 days that followed, her words are copied as directly written (she was also a copy editor) on as many pieces of paper (some undecipherable because of weakness and shakiness). A CAT scan of neck and chest was ordered for Friday, January 9. Afterward, "I think today was a bit of a cop out. Either it was bad news he didn't want to pass on, or he didn't really understand."

1/15, Thursday

Today's appointment with ENT doctor did not disclose CAT results and referred her to a RP (resident pulmonologist). Later, at home, "Thoughts re complaints about ENT M.D. Spent considerable time reading radiologist's report. Shared no information from that report. Scheduled another look at vocal cord with video. Said paralyzed cord may have gotten worse since one week ago. Does that mean that it is more paralyzed? How paralyzed is paralyzed to begin with. Passing the buck. If he doesn't understand the CAT report or does not feel qualified to pass on results, that's OK, but please own up to any lack or reticence for whatever reasons."

1/19, Monday

Consultation with RP: A bronchoscopy was suggested to determine status of nodules evident on CAT. An X-ray was also done that day. Later, in a discussion at home: "Reasons for not wanting to see RP are that I find him pessimistic and depressing as well as not terribly interested in me, the patient. Maybe his partner is more forthcoming with information and more upbeat in outlook. Even if prognosis is the worst possible, certainly there are ways to improve quality of life, e.g. the 10-week (3-days/week) exercise program at another hospital. I am willing to "talk" to anyone. I am not willing to be talked down to or to be dismissed as just hopeless."

Discussing the situation, I brought up her hospitalization in 2002. "My last clear recollection of that was Christmas Eve 2001. My O2 saturation was 68-". And then she summed up the intervening period. "The nebulizer treatments do work (lasting 4-2 hrs) however, the medication may no longer be effective and may have to be changed. Remember, I didn't start using/needing the concentrator until last March or April. Until then I was good with nebulizer 4-5x/day and Advair twice/day. I didn't use it all for awhile." It was agreed that all records from 2002 to present should be collected and taken to another hospital for a second opinion. "How hungry? There is lamb from last night (potatoes and asparagus) I'd like scrambled eggs (I'll make). Just make appointment. Don't talk now -"

1/22, Thursday

At the second hospital this pulmonolgist and his assistant reviewed history. They also concluded from inspection of CAT scan, and X-rays that a bronchoscopy is required to identify the shadowy nodules in upper left and lower right lungs. A PET scan may also be required. Possible causes were discussed. At home afterward, she wrote: "Why didn't this M.D. ask about asbestos?? Both are teaching hospitals and will want to do all the tests that they can get away with. Main reason not to go to Hospital 1 is a bad experience last time as patient. Does it have PET access? Good reason to go there -PCP in case anything goes wrong. I don't know if he has admitting privileges at Hospital 2. We can call office to find out....Then let's get me well. "

1/23, Friday

The next day after a fitful night sleeping. "~ 4-5 a.m. I woke up and was able to speak a little. What happened?". We proceeded to try to make sense from the CAT scan and X-ray negatives. " After seeing the X-rays, it's obvious something not good is going on Re: sudden need for continuous O2 since last March-April ---Possible to have picked up something like a fungus from my mother's place? / I'm not 100% sure the bacterium was specifically identified 2 yrs ago. I have a feeling they never did find out specifically. / I know the surgery was for a malignancy. The other stuff is mentioned because it isn't know how long some of this stuff can just hang around." We decided to go for the bronchoscopy at the original hospital and I called the RP who scheduled it for Wednesday, January 28.

1/26, Monday

We went to the hospital for blood work preliminaries for the bronchoscopy.

'1/27, Tuesday

Early in morning, RP called, saying. 'Come in immediately. Anemia identified with hemoglobin ~5! Needs a blood transfusion'. Got there about 9:30. Her thoughts before I left. "When the biopsy is done depends on Hb level -Tests will be done Monday. Colonoscoy is being done later as outpatient for insurance coverage - I think - Admission for the biopsy will be on a surgical service/ & surgeon has not seen my films yet, and I'm sure he has other cases scheduled. (Also, I need to meet him, too!)/ Funny with the Rover spirit - I keep thinking how frustrating for you when iMac kept rebooting then shutting down over and over and over. / Don't run out of memory until I get fixed."

Some time after I left. "E exactly why are you here? Assume more labs to be ordered & follow-up? Would a blood test show any! Why my Hb so low? It was 53 when I got here. Last checked last year Good. I also have an L paralyzed vocal cord.

Returning at 9:30 P.M. I brought flowers. The emergency blood had been done just before my arrival, nearly 12 hours after admission! "Seen by residents right away/ seen by DNA right away/ 2 hrs to be seen by nurse/2 hrs for Bands (Rn didn't know how to put on)/ 3 hrs blood draw/ Blood started at 9 P.M./ Requested nebulizer at 4 A.M. -Given 65 min later"

1/28, Wednesday

I arrived early for bronchoscopy that was scheduled for 8:45 A.M. "Dearest Ted, I will have nurse call you as soon as I am settled. They also will be instructed to give you any information over the phone. That's all I can do for now. You know as much as I do. Don't waste time worrying about what isn't known. You can tell Sharps about low hemoglobin of undetermined origin. / I drove myself to all the tests in 1997 - It gets lonely. Put on some pressure for the Best Buy stuff. Stay out of my stuff. Bring peanuts. I love you, too. D. Don't want to keep valuables here - If they need the numbers they can copy from record." I left and returned after a swim to find her in reasonable shape after the bronchoscopy.

1/29, Thursday

The RP and PCP were there when I arrived. Awaiting check by an anemia specialist. "How use of Advair? Can cause Candidiasis!"/ I'm being discharge now without knowing anything certain/ That's why I want to stay until tomorrow - To see report and..."

1/30, Friday

Today, she reported: "Obtained tissue from bronchoscopy negative. But not able to extract all necessary with this method. Recommends biopsy. Hemoglobin to 9.9 after 3 units of blood and Fe tabs vitamins. 2 units Tue-Wed, 1 unit Wed He wants another unit given but decided to give by mouth instead (Pills, not blood)/ Some reasons NOT to take prednisone. Hyperglycemia, hypokalemia, candidiasis, appetite, nausea (interesting combination!), headache. / Side effects range from unpleasant to life threatening. All are treatable (to a point). Unfortunately, many of the treatments carry their own adverse side effects. It becomes a spiral of dependency -physical and psychological - and, in the end, may not enhance quality of life all that much." She was discharged for weekend. Scheduled for another blood test on Monday

1/21-2/1, Saturday & Sunday

Her comments in conversation at home. "I don't call getting a test or X-ray "involved". / Sometimes a quarter-size plug of clear mucus. - Usually starts with a tickle in throat. It's tiring though. / Your tea water is on. / 1. Lung tissue does not regerate, unlike some other tissues 2. O2 is tolerable. Lack of stamina is not. It is believed that exercise may improve stamina. 3. Drug therapy is palliative, not curative. Side effects must be considered. 4. I don't know about surgical, other chemical, or radiologic treatments. / Pick a veg. I forgot to tell them about my nasusea and headaches."

2/2, Monday

We arrived at hospital about 8 A.M. and not admitted for an hour. " Preadmitted for work-up labs prior to biopsy, especially to check hemoglobin. When biopsy done depends on labs. Colonoscopy to be scheduled out patient as of now but may be done (after biopsy) in hospital. I DIDN'T DO IT ON PURPOSE!"
After I left, these notes. "Please call home and tell Ted that he left his canvas bag in the lobby. Will trade peanuts for bag. Hemoglobin 10.2. Will see surgeon today ~ 4 p.m. Biopsy may be done tomorrow afternoon or certainly Wednesday. /How much notice would I have?"

And later in the evening, 2 February 2004 Apparently Pushotawanny Phil saw his shadow so we'll be seeing 6-8 more weeks of winter. And After talking with Surgeon this evening I'll be lucky to see 6-8 more weeks of winter. Don't recall being this depressed before. In 1997 it was....OK, there's a cancer, here's the stage, here's the location, here's the treatment. Let's do it! And it was done and over except for a fading memory and a 14" scare. With this, today, and the very scary biopsy on Wednesday, my gut feelings are not good. I don't want to be sick. It's so unfair to Ted. This should be a fun time for us. Why did everything fall apart so suddenly? How did my needs change from well-managed with nebulizer treatments & Advair to such dependency on O2.

It would be nice to blame it on Florida mold or something, but that seems doubtful. This is so depressing not being able to talk - to Ted. I'm tired of having needles stuck into me. They don't even deliver a newspaper! Right now, everything sucks!"

2/3, Tuesday

On visit the day before biopsy, I came with Umbra and news that Tom Knight had died. "Her cataracts look worse. / I'm not planning to run off and join Tom/ 1 A.M. Woke me up to start IV, 3 A.M. Woke me up for nebulizer, 5 A.M. Woke me up for EKG, 5:30 A.M. Woke me up to draw blood. SOME SCHEDULE. / Did you read where swimmer Eleanor Holm died - She was disqualified from Olympics because of partying. / They should be fined for putting on a totally tasteless show - I've seen blatant groping at the Oscars- so what/ How about the new cigarette tax - 4.5% Stroger never saw a tax he didn't like. He should try cutting back on his own spending.
The biopsy will take about a hour - overnight in ICU. Then back here -maybe this bed." She asked me to get her Polygrip and toothpaste as she nervously paced the wardroom."

2/4, Wednesday

Early morning. "Please call my home and tell Ted Good Morning for me. 538-4454". Getting call, I called back and in a barely discernable whisper. " about 1 P.M. -You should get here about 10:30"

Arriving before 10:30, she was not in room. Staff finally directed me to surgery prep. Awaiting surgery scheduled for 1 P.M., we played some chess on my laptop. At 2 P.M. an anethisist came and said something to her that I could not hear. " 45 min to turn room around. Thorascospy. / Don't leave the laptop in the room (372) because my roommate has gone home and there is no one to watch it/ After it's done, about S (surgeon) will talk with you - I'll be in recovery 2 hrs then to ICU or my room. Go on home. / Then I'll call you tonight and tomorrow."

To S before surgery. "Pain management - As I recall thoracic procedures result in pain big time. Will PCA be available?"

And after surgery, I found these notes in VERY shaky and partly illegible writings. "I *** could *** apparently*** biopsy *** may not have...It all went \down hill. I was coughing up brown stuff...want to check chaos...." "This is no thing ^comfort ****/ The throat hurts/ "Sometime today just isn't good enough. / Get going the *** late/ Do not want **** Versed OK / Feels tight ****I just had a treatment/"

2/5, Thursday

I found her as a TB suspect in ICU isolation. She was on ventilator and in pain. AP came with residents on their rounds about 11 A.M. My suggestion to give anti-fungal medication (not life-threatening) was dismissed by AB. Protocol requires confirming type. So much for gambling on blastomycosis...or?. Then I found this note, " I was furious that the doctor who did the needle biopsy did not have the courtesy or guts to see me face to face to explain what happened.

2/6/, Friday

"S was here yesterday - so was PCP - Both seemed inclined to think that it is neither cancer nor TB but some fungus or other type of infection. Regardless of what they think what the pathologist finds is what cou8nts. Report should be in this morning. I asked S about having picked up something in Florida and he shrugged and said 'It's possible' RP has been away. Have you ever had a skin test for TB? The right lung has 3 lobes. He didn't remove a lobe - just the warts. Both said my voice sounded better - Still low and without much volume but more than a whisper. They are residents (used to be called interns) They barely knew what to ask me. You gave me your old fungus!"

2/7-2/11 Saturday-Wednesday

Order uncertain, during times I was not there. Extubated on Sunday, re-intubated on Tuesday, re-extubated on Wednesday, and again re-intubated. Shaky writing off and on. "Lasix given with the foley?OK. Stings - maybe medicine needs to be moved - upper back sort after 15 hrs. I would like to sit on edge of bed or in chair for awhile. Ventilator also painful in mouth and throat. And is making me gag. Just skip the drug and use something else. So does versed. I don't want Xana* Am I NPO? No ice chips. I'm no surgical....BURNS. DRY MOUTH .. 4 hoursWhat is me? How long. The back hurts. I need move - my back hurts. Something fell."

"I'm very sorry, but I'm going to have a bowel movement - You might pass on in report regarding 'tube feeding' - ensure can cause diarrhea. I'm a Rn, and I believe I can understand whatever you will be telling me. My lung Ca was 1997. I DON'T WANT TO SITUP. They haven't been around about the CPAP? NAUSEA - SOB. Chest feels tight on *** still SOB SOB NAUSEA DO I GET A NEBULIZER TREATMENT? I can't breathe normally, regularly HEADACHE. NAUSEA x1 - no problems Problems only concern is ensure gives diarrhea MESSY MESSY"

"When can it come out? CPP was done yesterday - Was this re-intubation necessary or convenient. I've heard that PCP didn't OK. I'M a Rn who trained at Cook County. I know that teaching hospitals love their Cash cows. I was one last time until my husband said 'no more'. Question: Why was the CO2 level allowed to get so high? I was calling out that I couldn't breathe. The night before last on the unit I called for a nebulizer Tx than later - about 1 hr later - called for nurse who never showed up. Obviously, another nurse did. I was having trouble then. Maybe for some other procedure L&D Pediatric ICU."

"There was a lack of response that time in distress - I still would have resulted in being intubated again. But Rn response not the best. CPAP attempt again today? I slept not great. Especially since so many amateurs have used up some very good veins. Even cash cows dry up. The sooner we get started the better. How is it doing? To live on? I'm not being unreasonably crabby about being stuck so many times with no results." {An aside comment) On Wednesday in ICU, I witnessed 3 attempts to draw blood by one who called for another for a couple of more tries. Then another was called for a total of at least six (6) attempts!}
"How am I doing? Better than yesterday? Breathing doesn't feel right. Mouth and throat very sore. Frequent headaches. Then why not have started yesterday - for a full day? I'm going to have a bowel movement soon. There should have been a.....this thing hurts. They're talking about tomorrow now! What was my latest Hb (11.7)."

"They want to put in NG tube - The one nurse took pity and let loose my arms so I could move a little. T hey march in, ask questions you obviously can't answer, then say don't moue, and leave the room. Jon swam for Z Brick - No, Im still pissed - Did you ask? My BP was low so they pumped me full of fluids - now they're giving me Lasix to get rid of the fluid. OK GIVE ME MY MILK SHAKE NOW NASAL-GASTROP TUBE - TO FEED, MEDI INTO STOMACH WHEN UNABLE TO SWALLOW. 12 MORE HOURS I'M OUTTA HERE. THAT'S THE ONLY WAY IT WORKS APPARENTLY - I JUST DIDNT WANT YOU MORE SHOCKED AT MY APPEARANCE - I DON'T KNOW HOW I LOOK - SUCKING MY BRAINS OUT. THAT WHAT MUMMIES HAVE DONE. WANT TO TAKE OUR O2 TANK MY PORTABLE?"

"Dx - appears to finally be histoplasmosis - Don't bet the condo - Now they want to insert OG tube (through mouth to stomach) for medicine that has to be in gut. Fungus is result of something. I'm being told that it's for medicine mainly, food secondary. With the ventilator out GONE I can have back... I DON'T NEED OG TUBE! They're talking about CPAP trial - That was done yesterday. Getting Lasix. HOW LONG TRIAL? I'm feeling rather tired and hostile today. I heard the O2 was not the problem as much as the CO2. OG or NG tubes? Which is less traumatic to me- Status -More CPAP? For some time I was getting albuterol alone - at home. I use atrovent as well for nebulizers - Does that make a dife..... Are my teeth there."

2/12, Thursday

I brought a dozen roses. Her PCP was there and I listened with horror as he chastized her for smoking!. After he left, I found these (from the early morning hours, I think.) "Saliva suddenly -- why - why - What is it for. Is there a better way - nose, mouth, it's still unpleasant. Do PCP and RP concur with insertion of OG tube? I'm asking because I was told that PCP did not OK this intubation. / Days were used up stuffing me with TB meds = This procedure can wait a few minutes or hours until my spouse and I see the docs. / IT'S NOT OK -NONE OF IT/ Who is inserting the tube? How many times have you done this with no problems?"

2/13 (Friday the 13!)

To someone before I arrived. "All he sees is me being hurt. They haven't had CPAP on very long - I was on it yesterday and... Could I have something for headache? / FOR WHAT? THAT ARM TOOK 6 HITS (sticks) THE OTHER NIGHT. / Sometimes an isolated transient angina type pain - not particularly related to any particular activity. No family Hx heart problems although one uncle had bypass surgery at age 88. (over) Yes bilateral ankle edema, L greater than R. Gone in morning. No personal HX HTN."

No writing for me at 3 P.M. . She was in pain, black/blue bruises from many failed blood draws. As I talked, she seemed pensive. Upon seeing my daughter's crocheted "flower child", she gasped, turned very red, O2 level dropped to 70, alarms went off, and stopped breathing. A half-hour of intensive efforts were failing. When asked whether they should continue, I said, "Let her go!" It has been 7 years of intermittent pain and suffering.

Epilogue

As I left the hospital, I wondered whether the autopsy would identify a drinking problem from the brandy that I had poured into her throat. With heavy heart I am going through her stuff, an accumulation of 68 years. Recalling one note that said, "Stay out of my stuff!" which referred to what I started to do in 2002, when she seemed certain to die after several weeks in ICU. I hope she won't mind this time. She is gone, although in fitful sleeping that night I could swear that I heard her voice saying, "The water will talk to you" .... several times. Diane came home a week later in a 5-1/2" x 5-1/2" x 7" high urn weighing 10 pounds. Her ashes await a memorial service in the spring to be dispersed into the waters from whence she came. Hopefully her spirit may intersect with all swimmers as they go by, a sport for which she was a staunch advocate. I have documented this troubling event as closure for me and to possibly benefit others. This is a near final attempt.

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Diane's Notes

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