I almost killed an old lady the other day. I have been volunteering at a nursing home for two years to visit with Suzanne, a 96-year-old woman who, despite being blind and crippled, was one of the most lucid, cultured and intelligent people on her unit, staff included. (See "Suzanne Takes You Down...") Until she fell out of bed a few months ago, trying to get into her wheelchair without assistance—since there was none to be had—and thus began a downhill slide to the state I found her in last week: she appeared to be in constant, agonizing pain and discomfort, screamed a lot, and had also become disoriented and was moving in and out of delusional states. Between yelling for someone to put her into the bed that she was already in, she would suddenly emerge for a moment and, for example, ask me how my audition for Fiddler on the Roof had gone. (I remain a Tevye wannabe.) (So does my wife.)
Although there were none of the obvious external signs of hospice care, I was informed that Suzanne was indeed officially under the umbrella of hospice. Having been a hospice volunteer for a short time several years ago, I knew that it is about keeping the patient comfortable. As far as I could tell, Suzanne was perhaps the least comfortable person I had ever met. So I innocently asked an underpaid overworked aide who happened by if surely there wasn't a more effective pain medication available that would offer Suzanne some relief. She said, "You have to ask the nurse," and took me down the hall to meet the head of nursing.
In chatting with the nurse, I threw in the words "palliative care" to sound like I knew what I was talking about, and posed the same question about meds. She said I'd have to speak to the doctor, and took me in an elevator, down a corridor, and into a small office where I met a young female physician and again asked my question. She looked at the chart and told me that they have Suzanne on "morphine as needed," but that perhaps they could change the order to twice daily. I said I thought that would be good. She said, "But you have to understand that she will be more sedated." I replied, "There isn't a single moment of being conscious that she enjoys." She said, "Let me call the nurse."
As I stood there listening to their phone conversation, the doctor told the nurse that "I have the P.O.A. here, and he would like to increase Ms. D's morphine order to twice daily." I started playing the acronym game in my head, trying to figure out who she thought I was. The best I could come up with was "Patient Something Advocate." I couldn't get the "O." I thanked her and left, and when I later related the story to my Dad, he let me know that P.O.A. stands for "Power Of Attorney." 
Yes, what I am saying is that a mere random volunteer, a stranger with absolutely no authority or rights, had somehow influenced a physician to dramatically increase Suzanne's morphine intake. As I drove home, I thought back to my days as a hospital chaplain, recalling all the patients I had witnessed in their last hours, and how often it was in fact the morphine that would gradually relax them into the arms of death. It suddenly dawned on me that if Suzanne was sedated, she would quite possibly stop eating, in which case it could be argued that I had in effect all but had her euthanized.
Suzanne was always telling me she wanted to die, so I suspected she would thank me for it. Only one week earlier she had requested that I call her nephew. "What do you want me to tell him?" I asked. "That I'm checking out!" she snapped, as if it was a stupid question.
The good news—I guess it's good news—is that Suzanne is still alive, and seemed a whole lot more comfortable the next time I visited. The bad news is, none of us have ANY idea what could happen to our loved ones when we leave them unprotected in hospitals or nursing homes. Since I wrote my previous post here, "Mom Flies Over The Cuckoo's Nest," about my own family's ordeal of seeing my mother through a two-week stay in a psychiatric unit, I received many emails from people telling me bad hospital stories. Here's one:
"When my mom was in the hospital with her stroke it was only for five days, but if I or my sister hadn't been there all day every day they would have killed her. Seriously. We intercepted potentially lethal medication mistakes, and had to tear the place up when they put her in restraints because she freaked out when they gave her the wrong psychotropic medication and then stuck her in an MRI casket. It was a frightening look at the system. And I truly believe now that hospitals can kill you. And like you, I found most of the individuals to be good people, but the system is so screwed up that good people get the wrong information and walk in cheerfully with a syringe of life-threatening drugs...."
When I myself was seven years old, I was scheduled to have a tumor surgically removed from my left shoulder. The operation was to be on a Friday morning, and my parents had assured me they would be there when the time came. Early Thursday morning, however, several aides came in, lifted me onto a transport cart and began wheeling me away to the O.R. I started kicking and screaming hysterically, "YOU TRICKED ME!" and they finally stabbed a needle into me to quiet me down. I was rolled into the O.R., still awake but pretty groggy, and remember staring up at about six masked faces. 
One of them reached under the sheet and pulled my pajama bottoms off, and I thought to myself, "Why do they need to take my pants off to operate on my arm?" but figured it was some sort of protocol, though I didn't use that word as a seven-year-old. Then, as I drifted off to sleep, I heard the surgeon ask his colleagues, "Which leg is it?" and reaching deep within myself, with great effort I dragged my brain back into consciousness and managed to squeak out, "It's my arm!" And what do you think the surgeon's response was to that little news flash?
"Oops," he said, "Wrong patient."
I just came across the following story, which I didn't find at all encouraging: The Rhode Island Hospital, a teaching hospital associated with Brown University's medical school, is being fined $150,000 for the recurrence of "wrong-site" surgeries. They were also ordered to install video cameras in the operating rooms in order to monitor "if surgeons are taking time to determine if the correct body part has been located for surgery."
Yes, that seems like a positive move. Going in the right direction. Plan ahead, fellas!
The hospital was previously fined $50,000 in 2007 after performing three wrong-site brain surgeries. They operated on the wrong part of the brain! Try to imagine, if you will, that you have been diagnosed with a brain tumor for which surgery is your only option, and you and your family emotionally prepare and gear up for it, endure the anxiety and fear during the lengthy procedure...only to hear this afterward: "Oops, that damn cerebellum looked just like the medulla oblongata from where I was standing. Sorry." 
To give equal time, an old friend of mine from college, an OB/GYN, wrote me about "wrong-site" surgeries from the physicians and hospitals' point of view:
"Here's a look from the other side. In an effort to eliminate wrong site surgeries, which none of us have actually ever seen at our hospital, the administration instituted what they call the "Timeout" which means before you do anything in the operating room, the nurse who is voted the biggest pain in the ass has to go through a checklist much like airplane pilots do to make sure no oversites have occurred. But whereas this discussion between the pilot and co-pilot occurs privately so that no passenger has to think to himself, "are these guys stupid or what?", we have to stand there while the nurse asks the patient to identify herself and to state what operation she is supposed to be having.
