Underwhelmed at St. Vincent’s

Nyel at St. Vincent’s 3-6-19

So far here at St. Vincent’s Hospital in Portland, it’s been a matter of hurry up and wait.  Nyel was ambulanced here from the Ocean Beach Hospital ER late Thursday night.  He had a badly broken hip.  His surgery took place Friday morning.  The surgeon called me during the procedure to ask if, prior to his fall, he had been complaining about his knee.  It was an inauspicious beginning.

The surgeon was unaware that Nyel has had two (ultimately unsuccessful) surgeries to repair his quadriceps which failed following a knee replacement in 2010.  “I just wondered if this break to his hip somehow caused an injury to his quadriceps,” he said.  Obviously, he didn’t get the patient’s medical history…

Since the surgery, Nyel’s blood pressure has plummeted to the point that they cannot safely have him stand so he can begin walking – an urgent priority, it seems, after hip surgery.  Over the last three days they have given him five units of blood, two boluses (intravenously delivered saline solutions) and encouraged him to drink fluids to the point that he felt sick and could not eat for two days.  All this to get his blood pressure up.

Broken Hip Repair

They have stopped getting him up to stand on the scales (because of lightheadedness from low blood pressure) but as of day before yesterday, he had gained 17 pounds of weight (from fluids) in twenty-four hours.  This morning: 25-pound weight gain over his ‘protocol’ weight at which point, in the normal course of events, his regular cardiologist wants him to double his ‘usual’ dosage of diuretics.  Here at St. Vincents, they have given him no diuretics, usual or otherwise – because of the blood pressure issue, they say.  “It’s a balancing act,” they tell us.

Since Sunday, I have requested that they bring a staff cardiologist in for a consult.  So far (this is Wednesday) that has not happened.  Because he has had congestive heart failure for five years and is on a strict protocol regarding weight gain from fluids, I’ve asked why they have stopped his regular regimen of diuretics.  “We are waiting to see…” is the answer.  “Could he please talk to a cardiologist?” I ask.   “Yes, we’ve noted your concern…” is the answer.  “Maybe today…”

First Steps

Always ‘The Plan’ seems to be “let’s wait to see if this transfusion (or this orange juice or this Gatorade) will help.”  They’ve taken hm off all pain meds and muscle relaxants though his pain level is elevated from muscle spasming.  “Analgesics tend to lower blood pressure.  Let’s see if eliminating them will help,” they say.  Each time I ask for a cardiologist’s input they say, “You have the absolute right to advocate for your loved one.”  (Duh!)  Somehow, my advocacy is going nowhere at all.

Nyel told me a few minutes ago that he’d like to be moved to the Seattle Medical Center where his cardiologist is.  If they can’t honor his request to bring a cardiologist in from another floor in this very hospital, I wonder what response he will get to the transfer request…

I keep thinking about the Hippocratic mantra, “Do no harm.”  I wonder where that fits into the St. Vincent’s picture.

19 Responses to “Underwhelmed at St. Vincent’s”

  1. mary g says:

    This is not great news but here are hopes for quick solutions to the problems. I suspect that UW Hospital is best for complicated issues, although it is teaching hospital. Not sure what Seattle Medical Center is. Well, his cardiologist would have privileges in some good hospital I presume. Can someone act as a medical advocate? Doctors have a way sometimes of dismissing distraught spouses. Document everything. It does sound like he would be better off elsewhere but there is the risk of transportation to consider.

  2. JOHN says:

    Best of wishes to Nyel.
    I remember what your mom called ‘the secrets of getting old.’

    The oath has been revised. ‘Do no harm unless the insurance agencies and big Pharma suggest it.

  3. Sara says:

    I am so sorry to read this. Hope and pray that Nyel sees a cardiologist soon. That is totally unacceptable.

  4. Caroline says:

    This blog is so disturbing, Sydney. Is there a hospital ombudsman to whom you can air your complaint about the absence of a heart doctor on the team? I assume you know to write down the time and date of each request and the name of the person to whom you spoke. I’m keeping fingers crossed for you both.

  5. Paul Brent says:

    Please give Nyel our best and tell him we are thinking the best for him. Paul and Lana Jane.

  6. It was painful to read this blog. I have spent a lot of time in that hospital. When patients at our dialysis center have low BP while on treatment, some of them take a medication called mitidrine. It raises BP. Dialysis patients can’t take fluids either because their kidneys don’t work. So it’s a similar challenge as Nyel’s. Are his labs normal with good kidney function? I worry about everyone’s kidneys. I’m hoping you’re getting better care now that a cardiologist is consulting with you. I am a pro advocate, but the hospital has a patient advocate. We’re thinking of you and Nyel with great fondness. Hoping for the best. xox

  7. Martha Wharton says:

    Remember that if you use Medicare you have the right to Request an immediate care conference. Everyone involved in the parient’s care and treatment is required to attend. Call out the big guns.

  8. Ann and Tony says:

    We are so sorry to hear that Nyel is not getting the support that he (and you) need! There are such great cardiologists at St. Vincents (at least I think that mine is!) and it’s beyond belief that they do not have one of them on Nyel’s team. I hope that by now this is all resolved in the easiest possible way! We are sending lots of love your way (Michelle adds hers to ours).

  9. sydney says:

    Thanks, Ann and Tony and Micha!
    We finally managed to connect with a grand cardiologist. First doctor here who actually “heard” what we are saying, recognized some of the terminology (Oh! You have a cardio mem? I’ll look in his UW Med Center records and see what his pressures have been.) etc etc. This orthopedics team only knows “pressures” to be blood pressure — no idea about the pressure in his heart relative to congestive heart failure. So, things are looking a bit better now — they are beginning to diurese him which is good but have taken him off all blood thinners with no “bridge” which is a mystery. I will ask the cardiologist about it tomorrow. I also intend to speak to the Quality Management people tomorrow (the patient advocates. Mostly, I want him out of here. Thanks for being so supportive!

  10. sydney says:

    Yes. We are doing that.

  11. Pat says:

    So sorry to read all this Sydney. I will follow this closely. My very best to you both.

  12. sydney says:

    Yes, his labs look good. His kidney function has been far worse in the past twenty years. They have watched his labs but don’t seem concerned about his heart pressures which have been of great concerne before. We see the cardiologist again tomorrow. (Meanwhile, he is accessing his cardio mems from the UW Medical Center). And we will be speaking with the Quality Management team (patient advocates.) Thanks for your concerns. It’s great to have so many people rooting for Nyel!

  13. sydney says:

    Thanks, Caroline. I hope to meet with the “Quality Management Team” tomorrow.

  14. sydney says:

    Sara — Thanks so much for your concern! The cardiologist was in this morning and will come back tomorrow. He is weighing in on the care plan and things are somewhat better. I hope we can get him out of here sooner rather than later. (On the other hand, it snowed here all day today. Didn’t stick but still… I don’t relish driving home on either 26 or 30 if it’s icy…

  15. sydney says:

    Hi Mary — Yes, the UW Medical Center (I mis-spoke when I called it the Seattle Med Center…). They have been great for Nyel but there is no reason this orthopedic medical team can’t pull in a cardiologist from here. They finally did just that today and we felt he was the first person to really “hear” us Meanwhile, I will be contacting the “Quality Management (Paatient Advocate) Team” tomorrow.

  16. Deborah Wells says:

    Hope you can get transferred to Seattle where his cardiologist is – I can see how frustrating it is where you are right now! Prayers & Blessings are being sent your way! Deb

  17. Beloved Cuz! Just returned from Miami to read your appalling news! OMG, poor old Nyel and YOU, Dear Heart. I am glad you have a good cardiologist now and that you have had Charlie to be with you for another of these episodes. Holding you in Love and Light…Always, KK

    Beloved Cuz, just returned from Miami to get your appalling news and crummy experience for both Dear Nyel and yourself… I’m glad that you had a fun time on your birthday and very glad that Charlie has been with you through another trying time. Can you use a visit and a meal out? Please let me know. Holding you all in Light and Love, KK

  18. Karin Marasco says:

    Thinking of you both!!

  19. Cuzzin Ralph says:

    Cuzzin Sydney, If there is hell on earth it must be having a loved one suffering in a hospital! Nyel, you fight right back and get the hell out of there soon!

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