Eight Is Enough

We came home from the hospital Saturday night. It was eight days and seven nights at Howard County General.  The experience was not an exercise in the best that our health care system can deliver. There were unnecessary medications prescribed, unnecessary tests called for, some mistimed administration of medicines, and, with more diligent administration, could have easily been two or three days fewer. There was virtually no continuity of care with a rotation of four different physicians and physicians assistants supervising Faina's care.



Thoracentesis

 It took until Friday for it to occur to someone that some of Faina's discomfort could be relieved through a paracentesis and a thoracentisis. It was a good decision with more than a liter of peritoneal fluid being drained off and almost a liter of pleural fluid ending up in a bottle. This added a day to her stay and was a call that could have been made earlier.

Nurses shifts are 12 hours. With 15 shifts in our stay we only saw the same nurse twice, although Monday's day nurse stopped in twice to say hi and check on Faina, in a time she was assigned to other patients. The worst nurse was very good. The rest were excellent.

Most impressive, other than the newly renovated facilities, was that the hospital had a state-of-the-art tracking system for prescriptions. There was a computer file on each patient and laptops on mobile carts in which data was entered every few hours, vital signs, pain level on a 0-10 scale, and medications administered.  This technology, no doubt, will serve to prevent drug interactions, which in Faina's case, with at least eight different prescriptions, has increased potential or mismatching medication to patient. Before a medication was given, the nurse would scan Faina's bracelet and a bar code on the drug. Not that it ever did, but supposedly, an alarm would go off if there was a problem.

Faina came home by ambulance. The discharging physician insisted.

Faina did not sleep at all well on her first night home in over a week. The line that is feeding an analgesic into her system was slightly clogged, so the medication was slowly reaching her. She still received the full dose, it was just inelegantly done with way too many beeps from the pump than necessary. The dosage was also way too low, a problem that was rectified with a phone call. Her dosage was raised significantly. The pain management is still less than adequate, in part because Faina represents a moving target. The pain level increases, the drug resistance also rises, and the dosage levels are challenged to keep pace.

Late last week, Dr. K. told us that resuming chemotherapy is not an option. The name of the game, for now, is holding the pain at bay and keeping comfortable. We can bring this about best, surrounded by family and friends, here, at home in Fulton.