In the absence of PACS, emergency communications suffer

A Diagnostic Imaging staffer describes the personal costs of poor hospital communications

My work life and personal life collided a few months ago. While in the middle of editing an article for Diagnostic Imaging, I got a call from the director of the home where my mother lived, saying, "We're sending her to the hospital - she's still breathing."

I raced across town on my bike to the hospital where, only months before, she had been admitted with pneumonia complicated by CHF, a pelvic fracture, and unexplained blood loss. Dr. Lee, her geriatrician, had worked miracles, and Mom had gone back to the Alzheimer's home that provided friends and loving care.

No one was at the triage desk, so I poked around the familiar, rather quiet, ER, and finally collared a nurse. She looked on the board and found that no Merle Taylor had arrived. She indicated that I should go to the waiting room and chill.

Strange, I thought, bicycle beats ambulance. I waited a bit, then tried to call the home. The first pay phone didn't work, but finally I got through.

"They didn't tell you? She went to the nearest ER."

Back on the bike across town again, the way I had come.

Mom was being worked on by several staff in a much busier ER when I got there. She had revived and was combative, but I was given no information about what was wrong. The home had called my partner, an RN, and I felt reassured when she showed up.

"You speak hospital," I kept bugging her. "Find out what's going on."

The ER doc explained that Mom was going for a CT scan. "We're sending her for a very strong x-ray," he enunciated. I was tempted to whip out DI and say, "Do you know what I do for a living?"

All they saw on the scan was stool in her bowel, and they chalked up her stomach complaints to severe constipation. We tried to tell them about her earlier transfusion, possible ulcer, heart conditions. The doctor handed me a little box of her meds that the paramedics had brought, explaining the hospital would order its own.

I stayed for hours in the ER, wrestling Mom back as she tried every few minutes to climb off the gurney and pull out her IVs. Someone asked me if I was the sitter. When she finally got a bed about seven hours later, I asked the nurse if her meds were listed in the chart. No. My mother was on heavy-duty heart meds, and no one had written them down. I had to call home and get my RN to read the labels off the batch handed to me earlier so the floor nurse could enter them in the chart. She had no idea when they would actually be ordered, however.

Later, I learned that Dr. Lee had been calling all day, trying to contribute his considerable experience with Mom's history. He couldn't get through. He was like a moth beating against a window - they wouldn't talk to him.

What about PACS, wireless technology, all the wonders I read about every day while working on DI? In real life, hospitals don't even phone across town.

The next day, my mother died of septic shock due to peritonitis. She probably wouldn't have survived surgery anyway, and my sister and I had long agreed not to pursue heroic measures. We were relieved that her suffering was brief.

But I was appalled at the terrible communications that I encountered at every step during my mother's last day. I kept thinking, this sure isn't what I read about at work!