Wednesday, April 4, 2012

The Other Shoe

Mom and Dad had been getting settled in to their new place. Dad had been futzing around, finding the bank and checking out the wine department at the grocery store across the street. They were enjoying meals cooked by someone else, hanging pictures and generally relaxing. My girls made themselves at home there, even meeting some of the other residents over the puzzle table in the library. Me? I enjoyed driving 3 miles each way to see them, instead of 98!

Dad's leg had been bothering him for the past few weeks. He had picked up a knee brace, but it didn't seem to help much. It wasn't bad enough to keep him and Mom from enjoying a concert, happy hour or a little drama production, but enough that he resorted to using a cane. He mentioned it to his new doctor on his first visit, about a week after they had moved. She looked it over and prescribed total rest, alternating ice and heat and some Tylenol. If it didn't improve quickly, he was to call her back. It got bad enough over the next couple of days that he made another appointment for the upcoming Saturday morning, February 11. She planned to do an x-ray and maybe an ultrasound.

Like many men of his generation (my Dad's a WWII vet), Dad is pretty tough. He doesn't complain much and even when he does, it is tempered by his glass-half-full outlook on life. He was so happy to be done with his cancer treatment. He was proud of the glowing reports from his doctors about how well he had done. The next PET scan was scheduled for April. He wanted to get his leg fixed up so he could get back to the cardiac rehab/workout routine he had done so faithfully since his triple by-pass in 2000. Once he could do that again, life would be back to normal. Or at least his "new" normal.

At 5:19 a.m. that Saturday, I got the call.

"Hello? Ms. Pauken? This is Nancy at The Weils. I'm calling about your father. He's had a fall. It looks like he may have broken something."

"We have called the ambulance to take him to the hospital. They should be here in a few minutes."

"Okay", I mumbled, "thanks for calling. Which hospital?"

I jumped out of bed, brushed my teeth and as I was brushing, the phone rang again.

"This is Nancy again. Your mother wants to go in the ambulance with your dad, but she can't because of her walker."

Of course. The medics need to be taking care of him, not her.

"Okay, we'll get someone over to stay with her. Please tell her to sit tight."

I called my brother,who's about 45 minutes away. I filled him in and since I was already up and dressed, I told him I'd head to the hospital. Would he please go to the apartment and stay with Mom until we knew what Dad's status was?

"Of course."

In the meantime, my sweet Hombre got up, dressed and headed out shortly after I did, to stay with Mom until my brother got there. The girls were still sleeping. There was leftover coffee in the pot that I microwaved and poured into a travel mug. I grabbed a banana and a granola bar and hit the road. It was snowing; big, feathery flakes.

The emergency room was deserted when I arrived. There were two young nurses behind the reception window, chatting, and a lone hooded woman slumped in a chair.

"No, he hasn't arrived yet.Once he is in and settled, we'll let you go back and be with him."

They went back to their magazine or whatever it was they were poring over together, without a second glance at me.

I walked to the outside window, watching for the ambulance. Something that looked like dried vomit crusted the floor near a row of chairs. It was at odds with the new-ish, sleek room.  The slumped woman looked miserable. She was called back. While I waited, I called my other siblings and told them (or their answering machines) what had happened and where I was. I paced, watching out the window for the flashing lights of an arriving squad. All I could think of was the pain my father must be in and my mother's confusion.

Another woman arrived. She looked to be in her late twenties. Heavy-set with badly dyed hair, she took an aggressive stance at the window before the two cute young nurses.

"I have a scratched cornea. I got in a fight with my mother last night."

Of course she sat down right near where I stood. I didn't want to talk to a stranger. I was in no mood for small talk, yet she began to babble about the weather: too energetically, too enthusiastically. I wondered what she was on. Red flashing lights caught my eye. An ambulance pulled up outside. Through the frosted glass, I could not see who was brought out of it, yet I knew it was my Dad.

I turned back to the intake window. A man was there, telling his tale of woe. When he stepped away, I told the now lone nurse that I thought my Dad was here. Could I go back?

"We'll get you when you can come back," she said.

"He's really hard of hearing. I'm sure he probably doesn't have his hearing aids in."

"We'll let you know when you can go back."

I retreated back into the room, the rows of chairs empty except for the new man and Crazy Hair Woman. I paced. Another woman came in; in obvious discomfort. "UTI," I thought to myself, based upon how she walked and sat so gingerly.

The minutes dripped by. I paced. I tried again to catch the eye of the nurses at the window, who were decisively ignoring me, like Queen Bees at the "popular" table in a high school cafeteria. I considered going back into the examination area without permission but realized that my being escorted from the ER by the police would not help anyone. I hate feeling powerless more than just about anything.

A door opened and one of the nurses summoned me.

"He's in exam room number 10. You can go back."

I entered cautiously, not sure what to expect. My dad was lying there, in his shorty pajamas, on a bunched-up yellow towel,  gripping the side rails of the gurney tightly, his face pale, left leg bent and his right leg splayed at such an unnatural angle that it made my stomach tighten just to look at it.


"Hi, Dad. How are you doing?"

He grabbed my hand.

"I've never had pain like this. I don't mean to complain. I got up to use the restroom and my leg just buckled underneath me. I could tell right away it was broken. It hurt so bad when I was laying there, I prayed I could just pass out."

"Oh, Dad. Have they given you anything?"

"I don't know. I think so."

"Let me get a nurse and see if they can't give you something for pain."

He gripped my hand harder. "Don't leave me."

"I won't; let's find the call button."

Just then, he was seized by a spasm that caused him to lift up off the bed and cry out.  My stomach lurched again.

A voice came out of the handset, "This is the nurse, what do you need?"

"My Dad is in severe pain. Can you give him something for it?"

"I'll see if I can give him anything."

A few minutes later, a nurse came in with a syringe.

"I gave him half a dose of dilaudid when he got here; I'll give him the other half now."

She turned to Dad,

"Sir, are you in pain?"

"Yes. Terrible pain," he said.

"How would you rate it on a scale of one to ten, one being the least and ten being the worst?"

He grimaced. "Fifteen."

She depressed the plunger. I prayed silently, to whom I am not sure, for relief for him. I had never seen such agony.

His whole body remained clenched, waiting for the next muscle spasm to occur.

"Is anyone with Mom?" he asked.

"Got it covered, Dad. Kevin is there now and Pat is on his way over."

"I hate that I had to get you out of bed on a Saturday morning like this. Where are your girls?"

"In bed. They are fine. They know where we are."

"I hate doing this to you."

"You are not doing anything to me. This is what family is for. I'm glad I am able to be here. Don't worry about that, okay?"

"Well, I do worry about it."

"Well, don't," I smiled.

He gripped my hand, and then another of the muscle spasms took over.

We waited, together, through many of these episodes, wondering what was coming next and seeing almost no one. It was eerily quiet in the tiny room. He said they had drawn blood right after he got there, but that was all. He had not seen a doctor.

A frail looking woman came in and announced that she would be taking him for x-rays. Dad looked visibly concerned.

"I don't think I can move."

I cautioned her, "He is in a tremendous amount of pain. Please be careful with him, okay?"

She nodded, released the brakes on the gurney, grabbed onto the IV pole and wheeled him away.

"I'll be here waiting for you, Dad."

My younger sister called; she was on her way from Columbus. An older sister called. She and a brother were driving together from West Virginia. I got a cup of coffee from the nurses' station. I played Words With Friends. My brother called from Mom and Dad's apartment. She was okay, just worried and confused. They would stay there until Dad was moved to a room; the emergency room was no place for Mom.

I called my girls. Yesterday was Anna's birthday and we were supposed to go get her ears pierced today. It would have to wait, I explained.

"We will go, honey, just not today. I love you. Papa will be okay."

Finally, Dad was back, looking ashen.

"Dad, are you hurting?"

He nodded, not able to speak.

I pressed the call button. A different nurse appeared.

"He is still in very bad pain. Is there anything you can give him?"

She returned with a syringe.

"This should help."

"I hope so, " I said. "Thank you. Do you have any idea when we might see a doctor or have some kind of plan?"

"The x-rays have to be read and then they will let you know."

She disappeared and we were left, again, to ourselves.

Dad gripped my hand. "I am so glad you are here with me."

"Me, too. This is not the kind of thing you want to have to go through alone, that's for sure."

Some time later, a man came in, dressed in scrubs.

"I'm Dr. S_____, the orthopedic surgeon. His leg is broken. It's a clean break, but we will need to put in a rod and hold it in place with pins. We have scheduled surgery for tomorrow morning, because he has to be cleared by medical."

He raised the sheet and took a very brief look. He removed a pen from his pocket and initialed Dad's leg, on the upper thigh, just above where the break looked to be. Dad winced as he did so.

"Any questions?"

Dad wanted to know where he went to medical school and how many of these types of surgeries he had done; I wanted to know what was involved in being "cleared by medical". He seemed to be annoyed that we asked anything at all.

He left and the nurse reappeared.

"You will be admitted as soon as a room is ready." It was about 10:30 a.m.

I texted the news to my family and sat back to wait. And wait. And wait. And wait.

Around 1:30, they moved him to a room. He was still in agonizing pain. I had to leave the room when they moved him from gurney to bed. My younger sister, a nurse, arrived. She spoke to the nurses about pain control, in their own language. The surgeon had ordered morphine, but it wasn't cutting it. They got the surgeon on the phone. Since I had already met him, I took the receiver. He was abrupt with me. Rude, even.

"I ordered morphine for him."

"Yes, I know, but it's not working. He is having these muscle spasms that are lifting him off the bed, they are so bad. He is miserable."

"Fractures are painful."

"Yes, but he's 84 years old and you aren't doing the surgery until morning; can't you give him something else?"

"I'll see what I can do, but I already ordered morphine."

I seethed. "I would appreciate it if you could try something else."

Hours went by and there was no contact by the "medical" that was supposed to clear him. My brother and sister from West Virginia arrived. My brother arrived with my Mom. We paced. We talked and ranted among ourselves as Dad continued to writhe in pain. The nurses made repeated calls to the "Hospitalist", the medical doctor who would manage his care. She kept saying she was on her way but she never arrived.

Two of us went to find an ombudsman.

"None on duty on the weekend," we were told.

(Must be because things run so smoothly then, huh?)

"I can put you through to the nursing supervisor," the information desk lady said.

"That would be helpful."

The nursing supervisor was familiar with the situation, she said. She had been in communication with the nurses and there was really nothing she could do. It was up to the medical doctor to evaluate him.

It was now close to 5 p.m. My mood had soured considerably and what little tact I possess was long since gone. We returned to the floor and asked the nurses to get the "hospitalist" on the phone. First my brother spoke to her, asking her to please come and evaluate our Dad. She was apparently pushing back, because he handed the phone to me in frustration.

A cadre of nurses gathered around as I raised my voice and said, "We have been at this god-forsaken hospital since 6 o'clock this morning and no doctor has examined him! He is in excruciating pain and if he weren't we would have been out of here hours ago! In the time you have been on the phone, you could have been up here already!"

Do you remember Terms of Endearment? When Aurora goes after the nurses to give her daughter, who is dying of leukemia, her pain medicine? That was me.

At 5:30, the doctor finally appeared, full of CYA prattle, which none of us wanted to hear.  She actually examined my Dad and took a history. We expressed our displeasure with Dr. S____, the orthopedic surgeon. She said we were entitled to a second opinion, if we wanted one. We did. She called in a favor from a friend, who said he would come down and talk with us. She got the pain management doc on the phone and he changed up the pain medications. At last, things seemed to be moving in the right direction, although Dad still lay upon the pajamas that had been cut off him and the wrinkled yellow towel that the medics had used to lift him from the floor at 5:30 that morning.

At 7:15, Dr. H____ came to the room for our second opinion. He spent some time talking to Dad, who was finally getting some relief from the pain. He fielded questions from all of us, although he couldn't tell us why the surgery had to wait until morning. No one could. He said Dr. S____ was a "technically excellent" surgeon, who got good results. If we switched surgeons at this time, Dad would be bumped from his time slot on the surgery schedule.

He offered to show us the x-rays and we eagerly crowded around the monitor. It was ugly. The femur was broken jaggedly, and had dislocated so that one section was alongside but at an angle to the other.

"It's clearly a pathological fracture, " he said.

"A what?"

"A pathological fracture. Cancer. His lung cancer metastasized to the bone and weakened it, which caused it to break. See? You can see it very clearly right here." He pointed to a shadowy area on the screen.

"It was probably broken before he fell. Didn't Dr. S____ share that with you?"

No; no, he had not.

At once, our loquacious group was silent.


  1. Your poor sweet dad.

    So sorry he was made to suffer like that. So glad you lost your shit on the hospitalist. He definitely had it coming. What do patients do who don't have an advocate like you?

  2. Meg:

    Your writing is extraordinary, and your Dad and family sound wonderful. Your experience/story is agonizing. Sickening. Mindboggling. Unacceptable.

    I would send this to Monte Ahuja and his daughters if this was at Ahuja. To Toby Cosgove if a CCF hospital. Then I would send it to Regina Brett...


    1. Good idea. It was Hillcrest. Our subsequent experiences at Ahuja have been very good.

  3. I just got to reading this, Meg. It was an incredibly difficult read, I can't even imagine how hard it was to live. Hugs to you and your dad.


  4. Hello--I have come to meet you from Jocelyn's place. I am amazed and impressed. We have a lot in common, from elderly parents and horrible hospital experiences with them to career choice. At least my mother didn't have to move as part of her medical condition until my children were grown. It has to be overwhelming to deal with all of it while raising your kids (who are darling, btw). Thanks for sharing all of it. You are doing a great job on every field.