DEBORAH SHAW: THE LAST THREE DAYS OF MY FATHER’S LIFE

"I wish I had known what to do to save my father. He was admitted to the hospital on midday Wednesday, November 10, 2004, suffering from a severe blood infection (sepsis) that was due to leukemia. Less than 24 hours later, after being given intravenous antibiotics and a blood transfusion, he was walking around again, joking, and entertaining visitors.​

However, by Friday, he was noticeably tired and coughing. Doctors were not alarmed by his cough. I was. By 7 p.m. that night my father was also alarmed, because he knew what it felt like to have pneumonia—he had a bout of it that spring.​

Also, along with his bad cough, he had pain in his shoulder blade. That often occurs from a lung infection. We had the nurse contact the on-call doctor repeatedly, but the doctor refused to come in to the hospital. By 2:30 a.m. Saturday morning, I had given up, after pleading, threatening, and cajoling the Nursing Supervisor. Nothing helped. We were watching my father die.​

Finally, the regular doctors and nurses came in on Monday, but they could not work fast enough to reverse the damage that occurred over the weekend. My father, just barely 73 years old, was dead by 1 p.m. Tuesday, only 3½ days after our first plea for help, 2½ days of which we relied on weekend and night-shift personnel. Those doctors, nurses, and the hospital had completely failed us.  If Only I had known about the Rapid Response Team."

This is how Kerry lived for 18 months after his methicillin resistant Staphylococcus aureus (MRSA) infection.

MEET KERRY O’CONNELL, AN INFORMED AND EMPOWERED PATIENT

Kerry O’Connell, fought a courageous battle and he won. His experience with a healthcare associated infection helped get laws passed in his state to protect other patients. Here is a abbreviated version of his story.

"October 30, 2004 was a glorious fall Saturday high in the Colorado foothills. I was up on a ladder painting away with only one more side of the house to finish. As I climbed down 17 feet to move the decrepit ladder over, I noticed that its broken legs were digging into my new asphalt driveway.

It was then that I embarked on the stupidest act of my entire life: I placed some cardboard under the legs. After climbing back up, I made two passes with the spray gun then found myself lying face first on the asphalt unable to breathe.

I endured multiple surgeries overt the next four months.  Somehow my faith in doctors was still stronger than my faith in God, and (in August) I went full steam ahead with elbow capsulectomy to restore range of motion in my very stiff elbow.  This resulted in a very serious MRSA infection. It took two months, four more surgeries, and many gallons of vancomycin to kill the bacteria in my arm.

When we were confident that the MRSA was gone and the nerve graft was not going to work, (with great determination and great terror) I asked the doctor to perform tendon transfer surgery.  On December 9th, (as) I lay in the pre-op center...the physician’s assistant and doctor could not quite remember which tendons we had agreed to move. By this point, I had become highly informed (so) I handed them my spreadsheet, pointed excitedly (to the right tendons), and prayed.

God had finally tested me enough and allowed this surgery to work. I spent another 4 months in physical therapy and wound up with a 70-percent elbow and a 60-percent hand, which works pretty well considering that 10 of the 40 muscles in my arm will never work again.

What completely astounded me during my 18 months was the medical community’s reaction when things go wrong. Taking responsibility is out of the question. The best they could muster was to weakly blame the manufacturer and hospital staff while sending me truly outrageous bills."

Kerry’s message to consumers and how he has become an empowered person:
“It appears that this profession, which was founded on love, has been totally consumed by fear and greed. In response, I started writing letters, giving speeches, and supporting legislation to try to remind physicians how to love their patients when things go wrong."

TERI’S STORY: GUILT TO EMPOWERMENT

“I’ll never forget Thanksgiving 2004, because it was the last Thanksgiving we shared with my mother, Barbara. She died the next day from a healthcare-associated infection. However, it took me three years of living with guilt until I would find out that was the cause of her death.

Two months before that Thanksgiving, she had been diagnosed as having bladder cancer, for which she underwent surgery six weeks before her death. The surgery was a complete success, so there was no need for either chemotherapy or radiation therapy afterwards.

Before her cancer surgery, my mother was the picture of health. She was a registered nurse who had worked at a blood bank for the last 14 years of her career. She walked daily for exercise, enjoyed gardening, and was a very active 70-year-old woman.

On Thanksgiving, six weeks after her surgery, my mother began complaining of nausea. She didn’t have fever, diarrhea, or vomiting, so I thought she might have food poisoning. I called her surgeon, who didn’t seem alarmed. He never suggested that I should take my mother to ahospital, but the next morning, I took her to the hospital myself. She died there 10 hours later from a massive infection.

This began my search to find out what went wrong. How had she acquired that infection? How could it have been prevented? It was only after I requested her autopsy report that I learned the results from her laboratory culture. It was a MRSA infection that took my mother’s life, not the cancer for which she sought treatment. MRSA stands for methicillin-resistant Staph aureus, or what we now know as a “super bug,” because of its resistance to antibiotic treatment.

Looking back at my mother’s ordeal, I now realize many things that would have been helpful to know and steps that could have been taken to prevent the tragedy of her untimely death. Like most people, we assumed that reputable hospitals take every precaution necessary toensure that their patients are cared for in a safe and sanitary way. After our mother’s death, we found that this is not always the case.

In retrospect, I now understand what should have been done to reduce her risk of MRSA infection. She had an incision from her surgery that required dressing changes. Knowing what I know now about the dangers of healthcare-associated infections after surgery, particularly MRSA, I would have insisted that greater precautions be taken to ensure that proper sterile techniques were used during each step of her care. We would have insisted that each person entering my mother’s hospital room would be required to wash or sanitize his or her hands and that all equipment in my mother’s hospital room be adequately disinfected.

Had I been informed about the dangers of that type of infection, I was convinced that my mother would be alive today. Knowledge is power, and unfortunately, I wish that I had the knowledge then, so that I could have protected my mother from the thing she feared the most: a hospital error. I appreciate this opportunity to share her story.”

If Teri had a checklist, she would have known how to be an advocate for her Mom.

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