Today, I assisted a family friend during a medical emergency. My friend’s elderly mother had been hospitalized following multiple falls. In the realm of hospital medicine, this scenario is a common narrative. Falls often signal the start of a decline.
Seasoned physicians are aware to investigate urinary tract infections, electrolyte imbalances, dehydration, constipation, over-medication, and more. Delirium (a change in mental status that can present as either apathetic or agitated) is prevalent in older adults and demands meticulous management.
At some point, this elderly Spanish-speaking woman was given benzodiazepines, a category of sedating drugs known to provoke various complications in seniors. Subsequently, she ceased eating and drinking despite having been active and exercising at rehab just two days earlier.
Her daughter reached out to me in distress: “Mom hasn’t eaten or taken anything orally in twenty-four hours and I suspect she’s been mistreated at the facility; she has a new bruise on her leg and arm and is yelling and inconsolable. They administered Zyprexa yesterday, and she hasn’t been the same since then. I think I need to contact a lawyer!”
Me: “Is she receiving IV fluids? Have her labs been drawn today? Have you consulted with her hospitalist?”
“She had a small bag in the ER twelve hours ago. She has hardly urinated in the last twenty-four hours and what she has produced looks like tea. They’re asking me about CPR/code status and I’m so frightened. She was fine two days ago.”
We utilized FaceTime. My friend’s mom had a bruise on her calf that encircled it completely and a similar hand-shaped bruise on her upper right arm. She appeared unresponsive and lethargic. Her dry tongue was protruding from her mouth. Despite the daughter requesting fluids two hours earlier, there were none available. She missed the hospitalist’s rounds while stepping out for coffee. There was hesitation regarding fluid orders, citing heart failure risk, despite a history and physical exam showing clear signs of volume depletion.
My counsel to my stressed friend: Your mind is attempting to reduce this to a narrative of wrongdoing. That’s natural; however, your mom needs you to concentrate on the present. Keep your focus there. The other issues can be resolved later. If harm occurred (from medications, from rough handling), that can and must be addressed. But today we have a fragile woman who is dehydrated and not receiving timely care. That is the urgent issue.
Here’s the plan:
– Request the bedside nurse to contact the doctor.
– If there’s no reply, ask for the charge nurse.
– If they are unavailable, ask for the unit director or house supervisor.
Speak calmly and accurately. Over-exaggeration undermines trust. I provided her with specific terms to use: agitated delirium, acute dehydration, acute kidney injury, dry mucous membranes, decreased responsiveness, bolus fluids. I also reminded her: discussions about code status may be appropriate, but it’s premature for comfort care. And I proposed a psychiatry liaison consult for delirium support.
Her mother received fluids. Her familiar Spanish-speaking caregiver arrived and encouraged her to eat and drink. The nursing director paid attention and escalated her care. The situation is improving.
However, friends, this is how things can unravel in hospitals. Having an insider connection and advocate can truly make a difference. The right diagnosis, timely treatment, and correct timing… or the opposite.
Anyone can differentiate between a high- or low-quality restaurant. Yet even the keenest individuals sometimes find it difficult to discern high- or low-quality medical care. It’s easy to reconsider your own experience; as much of what is significant in medicine is concealed, technical, and difficult to access. Without the specialized language of the hospital, even the most capable individuals can feel powerless, lost in a system void of clear regulations or guidance.
You are at the mercy of the system and the overworked staff within it. Trust is essential. And hope that everything turns out well.
On our better days in medicine, we earn that trust, and many outcomes do turn out positively. We exert considerable discretionary effort. We prioritize patient safety. We communicate with clarity and respect. We arrive with interest, compassion, and we prioritize dignity. Coaching for clinicians is vital here; it keeps us sharper, steadier, more resilient, and better set up for good days.
Yet, the bad days do arise. The days when a single hospitalist is stretched across more than twenty complex patients, managing discharges, admissions, and emergencies, with no capacity left for nuance or additional calls.
If you find yourself in this scenario, know you are not alone.
A 2023 Harris Poll revealed that over seventy percent of U.S. adults believe the healthcare system fails to address their needs; this reflects alarming communication and navigation challenges throughout all areas.