Monday, March 20, 2017

The doctors were all fed up. They had her in multiple times. They were tired of doing their jobs. They didn't think she deserved any more chances. Game over. Doctors decide. But why? Why is it that doctors decide on death -because this is a decision of death. If you don't intubate a patient in respiratory failure while in carbon dioxide narcosis--you are deciding on that patient's death. At this particular admission there was no sort of quibbling that my sister had made the decision on no intubation. She had been intubated. What this ICU doctor decided was to refuse future care for my sister whether or not she wanted to live or not. He or she made the decision to unethically act to prevent the future provision of life saving measures. When the colleagues at the UAH were asked to remove the R3 status imposed by this doctor and her colleagues they all refused. Doctors never go against the decisions of the other doctors. The ethicist hired by the folks at AHS indicated to the UAH doctors that withdrawal of services was a tad unethical (thereby supporting a stay at home mummy in her stand that this junk was unethical, unreasonable and liable to get the doctors sued). As a result of the ethicist report, my sister -after many conversions of the GOC (goals of care document) where the UAH doctors struggled mightily over the problem--they finally put down the R1 GOC but also put down that this order would have to be revisited in the future at the Good Samaritan Extended care at Millwoods. Of course, there was chatter at the facility about it but we insisted on the R1 status. Then Rebecca got kicked out of the facility in 2015 and got dumped at the Grey Nuns Hospital in some horror movie which never ends. At the GNH of course they went through numerous GOC statements as if they too wished they could finalise the ending of my sister. But instead, they just evicted her with the Hospital Act in 2016. Now we have Rebecca at the Villa Marguerite which is a SL4 site and not a long term care site. I believe she is now R1 which is full resuscitation. But you never know. In the eyes of doctors, the patient is fair game for extinction.

#NotDeadYet--Even though my sister is not dead yet, there have been numerous attempts by the doctors at the Grey Nuns Hospital to prematurely terminate her starting in 2010. It starts off simply.
One doctor will say she is not a good candidate for intubation even though that is sometimes the only way to save her life in the crisis state of hypercapnic respiratory failure.
Yet another helpful doctor will simply write it out --DO NOT INTUBATE.
If this is not clear enough there will be further orders--Do not resuscitate (DNR) and no ICU.
The phone call to the family to see if they are lax enough to go for the DNR route. I got a call asking about the resuscitation from the GNH doctors.
What the heck? She has a personal directive indicating full resuscitation. There is no wiggle room. As her supportive decision making partner I have to support her personal directive instructions. I told the woman to resuscitate my sister.
Then there is the phone call from the nurse asking to speak to the Good Samaritan Extended Care doctor to provide him with the instructions that have been apparently agreed to by my family and Rebecca that there is to be no resuscitation and we are fine with this. Why then are we rushing about trying to save her life while we are at the same time simultaneously agreeing to premature termination? What the heck?
Finally the good folks at the UAH who won't change the R3 status when we ask them. Nope. Family just don't know what we are asking when we ask for life.
It has to be an ethicist who gets the doctors to listen.
Doctors don't listen to the patients or their families.
But they listen to the ethicist saying perhaps their legal team will have no success in taking over the care of this patient and getting the courts to believe that what we are asking for is perhaps impossible.
In other words, doctors listen to the legal advice of an ethicist but not of families.
This is patient centred care.
This is listening to the customers.
This is premature termination.


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I found out Rebecca had a fall today when I phoned her to find out if she is still in isolation.
Sue phoned about the fall after.
I will go and see her tomorrow. If she is not tippy I will bring her out and about.
I guess you can get reinfected with the bug she has so we have to be careful.
The lawsuit is as usual full of drama. I have reviewed the Royal Alexandra Hospital emergency trip of March 27, 2013 where they send her home after finding out her blood test.
Then I am doing the preliminary review of the before situation before the Grey Nuns Hospital ICU visit of August 18-21, 2013 where they take her in, intubate, put her in ICU and dump her out with antibiotics plus a Goals of Care plan so that dad has to run to the UAH on August 22, 2013 (yes, just after she was discharged she is sick enough to go to emergency again so why did the doctors at the GNH decant her from ICU? ). It's a farce of care at the GNH ICU with less than compassionate care offered so that my poor dad has to go to the facility--where they are going to send her off again to the GNH and search for another place to take her to try to find her care.
The UAH is full so Rebecca ends up at the Royal Alexandra Hospital on August 22, 2013 where she is sick enough to stay until September 12, 2013.
So again, if my sister was sick enough to have the problems she did after the GNH ICU dumped her out why was she dumped out of the GNH ICU in the first place? I go look at the ICU notes from the GNH.
The bland notes there say extubation within 24 hours, possible infection but hey I'm giving her antibiotics and now beat it-with the R3 goals of care established. What are the R3 goals of care? You guessed it -its that no intubation and no chest compressions business that the GNH doctors have been pushing from 2010 with no success with our family.
The reason for the R3 status is amiably explained by the darling ICU doctor--its that noncompliance business.
But have the doctors done their due diligence? Did they get the download from the facility to see the care and compliance or did they simply assume that a handicapped woman is responsible for her own lack of ability to follow a care program without a compliance program of some sort?
The doctor simply called the facility and did the progress note check. This apparently is good enough for the ICU doctor to establish non-compliance and then write off my sister. Dad was speaking even in 2013 of concerns and he was written off as soon as the progress notes were read.
Now usually there is congruence between nursing notes and the BiPAP down load. However in some cases, there are discrepancies as was discovered in the two abuse incidents in 2014 where staff failed to put on the BIPAP machine.
This is why it is important for doctors to do their due diligence and get the proof of non-compliance rather than machine problems or staff failure to put on the machine in the hard evidence of a data card download.
Instead of doing this, the nice ICU doctor did what the other doctors in the past did at the Grey Nuns Hospital which is assume that my sister was non-compliant because of intractable medical conditions that prevented her from being compliant. Even if this were the case, why the heck is it her fault? If you can't control the matter of your hands coming up in the night and taking off the mask this means that there is a problem not in the patient but in the medical / sleep problem. If there are problems maintaining therapeutic levels of drugs this means that compliance is also impacted.
But of course no one was interested in the matter of whether the patient could help being non-compliant.
The doctors were all fed up.
They had her in multiple times.
They were tired of doing their jobs.
They didn't think she deserved any more chances.
Game over.
Doctors decide.
But why?
Why is it that doctors decide on death -because this is a decision of death. If you don't intubate a patient in respiratory failure while in carbon dioxide narcosis--you are deciding on that patient's death.
At this particular admission there was no sort of quibbling that my sister had made the decision on no intubation. She had been intubated. What this ICU doctor decided was to refuse future care for my sister whether or not she wanted to live or not. He or she made the decision to unethically act to prevent the future provision of life saving measures.
When the colleagues at the UAH were asked to remove the R3 status imposed by this doctor and her colleagues they all refused.
Doctors never go against the decisions of the other doctors.
The ethicist hired by the folks at AHS indicated to the UAH doctors that withdrawal of services was a tad unethical (thereby supporting a stay at home mummy in her stand that this junk was unethical, unreasonable and liable to get the doctors sued).
As a result of the ethicist report, my sister -after many conversions of the GOC (goals of care document) where the UAH doctors struggled mightily over the problem--they finally put down the R1 GOC but also put down that this order would have to be revisited in the future at the Good Samaritan Extended care at Millwoods.
Of course, there was chatter at the facility about it but we insisted on the R1 status. Then Rebecca got kicked out of the facility in 2015 and got dumped at the Grey Nuns Hospital in some horror movie which never ends.
At the GNH of course they went through numerous GOC statements as if they too wished they could finalise the ending of my sister.
But instead, they just evicted her with the Hospital Act in 2016.
Now we have Rebecca at the Villa Marguerite which is a SL4 site and not a long term care site.
I believe she is now R1 which is full resuscitation.
But you never know.
In the eyes of doctors, the patient is fair game for extinction.
At least when she was dumped out of the GNH ICU the doctors at the Royal Alexandra Hospital did not do what the GNH ICU doctors did. Instead they simply kept her alive. How about that folks? They kept my sister alive and they gave her enough time to heal. Maybe this is what Covenant Health should be doing when it takes care of our family members? Maybe instead of focusing on premature termination the Covenant Health folks could focus on life?
I appreciate the work of the Royal Alexandra ICU folks who saved my sister's life in 2013. Without them, my sister would not be here today.

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