On Sept 7, 2011 Maria was admitted into ER at Cambridge Memorial Hospital in Cambridge, Ontario. She had been in the hospital in early May of that year with some electrolyte problems, and early symptoms of electrolyte imbalance had begun to resurface. She had felt weak, irritable and easily confused for a week or two. Her Family Physician called me at home on September 7thand told me that blood work had come back showing some lows in her sodium, magnesium and hemoglobin and she felt that having her checked at ER would be a good idea.
When I picked her up at 7 pm to take her over to ER, she was displaying some alarming symptoms. She was confused, speaking in garbled sentences and mixed up her consonants often in conversation. Scary stuff. I found myself very glad the Doctor had faxed ER to expect us given the new symptoms. Like most Family Doctors these days, Maria’s Family Physician did not have hospital privileges…hence the need for an ER assessment. We spent the usual several hours in the waiting room despite my description of the 7 pm episode of early stroke signs. I did get some attitude over the Family Physician having sent us to ER to recheck electrolytes.
Sometime around 11 pm we finally got to see a Doctor. He took a partial history, spent some serious time querying the Family Physician logic for requesting further exploration of electrolyte imbalances and recent changes in Maria’s behaviors and energy levels. It became very clear that the ER department had some definite issues over the request to have ER look into the problem. He barely acknowledged the episode of garbled speech and confusion earlier in the evening even though I told him she might have had a silent stroke a year earlier. He took some blood work and said he would return with the results.
The blood work didn’t show any worsening of the electrolyte problem and he allowed that perhaps the change in mood and behavior was of some concern and suggested keeping her overnight and having a geriatric psych/social work team assess her in the morning. Since she was not presenting any specific early signs of stroke while in ER, that patient/family concern was dismissed as not requiring further exploration. This was around midnight. Maria __Mom__ had been pretty quietly trusting that the Doctor would do a serious physical type check of her condition. When it became clear it wasn’t going to happen…. she stopped him in mid escape from the room and told him, “Something is very wrong with me.” The doctor offered an ambiguous platitude and left the room.
Needless to say Maria was feeling pretty discouraged after this consultation and resigned herself to spending an uncomfortable night in ER. She was uncomfortable having me spend an equally uncomfortable night in ER and begged me to go home. I stayed until about 1 in the morning, but it was clear that the stress of keeping me up all night was keeping her from falling asleep, so I said my good nights and promised to be back first thing in the morning.
I live in Guelph so I had barely gotten myself home and into bed when my both my phones started ringing … both went quickly to voice mail. On voicemail panicked voices trying to script-perfect calm seeking next of kin. I called ER right back and an anxious voice told me the nurse had gone into Maria’s cubicle at 3 a.m. to do a BP check and found her unresponsive. They needed me back immediately.
‘Immediately was not because Maria needed family near by…immediately was because they needed someone to speak to end of life choices for her. So much for the 2008 Stroke Prevention and Best Practices guidelines.
Did I mention Cambridge Memorial Hospital is actually an approved Stroke Center??