My mother's medical treatment was pathetic!!

and I don't know---you tell me, perhaps malpractice...even though she was elderly??

My mother died on June 23rd, 2004.
She was 85 and lived in St. Petersburg Florida.
In August of last year she complained that she was spitting up blood
and her own primary care doctor just said she "looked fine" and showed
her the door!
My mother was mentally VERY sharp and she wrote this doctor a scathing
letter about how he had ignored her. (I have a copy of it) She then
went to another doctor who also didn't run any tests on her to find
out why she was spitting up blood, but at least he prescribed some
things for her and she was SLIGHTLY more satisfied with his response
to her concerns.

Two months ago she went into the ER and was hospitalized for breathing
trouble. They treated her with duiretics and sent her home. On June
6th she returned to a different hospital having trouble swallowing and
breathing. After some biopsies it was determined she had two cancers,
lung and esophegeal. When she was at the previous hospital only two
months before they hadn't found anything diagnostically.

I am aware that my mother was "elderly" (although really she had been
a "young" 85). But that she was elderly, does that make it excusable
for those doctors to ignore her the way they did? I understand that
she was too old for "treatment" but she obviously had cancer for quite
awhile while everyone was "missing it". Didn't she had a right to
some diagnostic tests prior to the "emergency" situation? Particularly
because she was specifically asking? She went to doctors for years
for her breathing, does a great big cancerous mass in the lung just
appear overnight? (seriously, does it? I don't know!)

My final question involves her death certificate that I recieved
today. The reason for her death is given as "multiple, due to advanced
aging" (??????) She had two cancers, could not swallow or keep
anything down. What is the story on a death certificate? Isn't it
supposed to list the reasons, instead of this vague nothing reason?
Anyone could have seen that she died from the cancer. I was there. She
died from cancer, (well actually she never recovered from the "feeding
tube" procedure). Why is the doctor apparently reluctant to indicate
conclusive reasons on the death certificate?

Thank you very much for reading my post and offering your views. I apologize for it's length. At the very least I may want to complain about her treatment to someone.
(The hospital? The first doctor? the State of Florida?) But I would
like to hear your views first, however. Thanks again.

clueless,

I am so very sorry about your mother's death. I too have lost a parent and know all too well the sorrow, lonliness, and anger that can be left with us in this situation. I am a nurse and I am 'used' to dealing with the loss of my patients and their families. I hate to have to say this, but from reading your post, there is not enough information within to lead me to believe that anything improper with her care occurred. You have mentioned some things that are concerning rearding her care, but even this does not mean she was improperly cared for. I can answer only one question you posted with a definite answer: Large cancerous masses do not appear overnight. I answer that literally. However, in grief, descriptions such as 'overnight' may have a different meaning. What seems a relatively short period of time may not literally be 'overnight'. I do not mean to slight you, your grief, or your description of events. But, elderly patients often downplay symptoms and may be far advanced with disease processes prior to diagnosis. Again, I know this sounds hateful, yet I do not intend it as such. With only the information you post, I can best recommend that you deal with your anger, try to forgive those you are angry with, and lovingly remember your mother as best you can.

Not to add insult to injury, but I will agree that as you suspect, often the elderly are not cared for in the same manner as younger people. Perhaps I am idealizing my profession, but for the most part, I do not believe that is because the elderly are viewed as worthless. If and when that view develops, I believe it is because the rigors of many health care treatments--especially cancer treatments--are so very terrible within themselves. Health care professionals often feel that a more peaceful and less agressive course is correct. That feeling and view is born of experience. I will admit that I have often felt that an elderly person should be allowed to pass with dignity and grace rather than the ugliness and hardship of chemotherapy. My feelings and the feelings of most of the co-workers I know have come from compassion--perhaps wrong, even many times--but usually not from lack of caring or malice.

But, I digress. You and your family are the only ones at this point who can determine if your mother might have been treated negligently. There just is not enough information in your post to say for sure. I suggest that you review her medical records carefully and if you are still dissatisfied with her care, report it to the administration of the facility she was in and the AMA. However, I doubt that you have legal recourse. Being a nurse, the questions surrounding the death certificate are not ominous in my opinion. Cancer or not, she was 85 years of age. It is likely that her age did contribute to her death in addition to the cancer. All of these determinations would have required extensive and quite rigorous testing. Again, perhaps you need to read her records. Many advances in cancer treatment have been made. Yet even in this day in age, cancer of most types is an ominous diagnosis. For an 85 year old, it was almost certainly a fatal diagnosis. The treatments can often be more serious than the disease.

I truly feel for you because of your loss. Remembering your mother as she would want is the best healing you can have.

God Bless and take care,

lkc15507

Clueless, I am not a doctor or a nurse, nor am I an expert in anything, but I will say that from what you write, your mothers medical care seemed to be lacking a lot. The biggest clue that something was seriously wrong was her complaints of spitting up blood. People don't spit up blood for no reason, and it is usually an indication that something is very wrong.

lkc15507, if you can't see that medical care here was substandard, you may need to change your profession. If you are THAT "used to dealing with the loss of" your patients and their families, this might be an indication that the physician(s) you work for need to go back to medical school. If you do not see anything "improper with her care" when she indicates to her physician that she is coughing up blood and that physician does nothing, then maybe you can explain why this is not "improper?"

lkc15507, you say......

"Not to add insult to injury, but I will agree that as you suspect, often the elderly are not cared for in the same manner as younger people. Perhaps I am idealizing my profession, but for the most part, I do not believe that is because the elderly are viewed as worthless. If and when that view develops, I believe it is because the rigors of many health care treatments--especially cancer treatments--are so very terrible within themselves. Health care professionals often feel that a more peaceful and less agressive course is correct. That feeling and view is born of experience. I will admit that I have often felt that an elderly person should be allowed to pass with dignity and grace rather than the ugliness and hardship of chemotherapy. My feelings and the feelings of most of the co-workers I know have come from compassion--perhaps wrong, even many times--but usually not from lack of caring or malice."

My response to that is....first the patient has to actually BE diagnosed with cancer!! If you go back and read the post from clueless, this person says that her mother complained of coughing up blood in August 2003, which was ignored by her physician. Then in April, 2004, she went to the ER and was hospitalized with breathing problems, treated with diuretics (which indicates a diagnosis of fluid) and sent home. Then, on June 6, 2004, she returned to the hospital with trouble swallowing and breathing. Biopsies were done, which I am sure weren't done on June 6th, and only after the biopsies were done (sometime AFTER June 6th) was she diagnosed with TWO types of cancer. Then she DIED on June 23rd!! Do you think there was enough time between her diagnosis and her death for anyone to even consider a course of treatment and whether she should die with dignity? I truly don't think so.

Maybe if her original physician had put a scope down her throat when she first complained of spitting up blood, she could have been diagnosed much sooner and a course of treatment could be discussed along with a discussion on "dying with dignity."

As for the vague cause of death on the death certificate....maybe there were so many things wrong with her they couldn't all be listed. And maybe the same doctor that ignored her "spitting up blood," signed her death certificate.

Maybe you should read this lkc15507.......

Coughing Up Blood: Common Causes

Pulmonary infection (bacterial or viral infection in the lung or airway)
Bronchitis
Bronchiectasis
Laryngitis
Pneumonia
Lung cancer (see metastatic lung cancer)
Recent nosebleed
Irritation of the throat from violent coughing
Pulmonary embolus
Cystic fibrosis
Pulmonary aspiration (inhaling blood into the lungs)
From bleeding teeth, such as with gingivitis
Nosebleed (epistaxis)
Tonsillectomy
Diagnostic tests, such as bronchoscopy, upper airway biopsy, laryngoscopy, lung biopsy, mediastinoscopy, or spirometry
Tuberculosis (TB)
Pulmonary edema
Systemic lupus erythematosus (SLE)
Goodpasture's syndrome
Wegener's granulomatosis

We can rule out recent nosebleed, because she didn't complain of recent nosebleeds. We can also rule out tonsillectomy or the doctor would have said, "Don't worry that happens when you have your tonsils out at age 85," instead of "you look fine." And we can rule out bleeding caused by dianostic tests since her physician definitely wasn't doing any testing!!

GEESH!!!

clueless, I am very sorry for your loss. Unfortunately, there is probably not much you can do since most health care professionals (and I use the term loosely) stick together and would never even HINT that a colleague could have done a better job, as you can clearly see by lkc15507's response.

BennyDi
LOL-I can just imagine the rest of us old-timers on the forum rolling on the floor in laughter after your statement that those of us in the healthcare profession stick together. Right, lkc? hmmm...!

Anyway, I read the original post earlier and my initial thought was two words--Ronald Reagan.

There is no way this side of heaven or hell that if Ronald Reagan, at age 93, had gone to the ER because of spitting up blood that he would have been sent home without reasonable efforts to diagnose and treat.

Are we not all legally due the same quality of treatment regardless of age or ablity to pay?

Without a doubt this woman's scenario reeks of malpractice in its worst form--negligence, pure unadulterated negligence.

Is there a viable claim of malpractice? Probably not. The woman had a terminal condition with a very short prognosis. If it had been diagnosed, what would have been different? Quality of life, that's what--and, not for the better, either. Of course, I'm assuming she had a form of cancer that was not readily reduced in size by radiation or medication. In some ways, it was a blessing to her that she lived the majority of the remainder of her life without knowing; in other ways, it is a shame and disgrace that she was not allowed to have a single option regarding the cancer or her life. Because of the short life-expectancy and the lack of significant damages that would not have occurred otherwise, it is not financially feasible to pursue a medmal claim (in my opinion). I'm not an attorney and I encourage the original poster to talk with a medmal attorney in the area of the hospital or adjacent county.

For this to have occurred in a city with such a high percentage of citizens considered to be elderly, it simply is ludicrous.

If a medmal attorney will take this case for the purpose of bringing it to the attention of the public or bringing it to the attention of the hospitals in the area, I think it would be great.

Best wishes,
EC

Thank you!

When I first saw lkc's post I thought wow am I ever bad at describing things! This person thinks I have "displaced anger"--but then beenydi and ellencee wrote their replies, and I understand that it is not my poor reporting that illicited lkc's response. I agree that it seems lkc feels like my poor old mom was "toast" so what the heck, send her away when she is spitting blood. What difference does it make? Apathy and indifference at it's height.
Thank you bennydi and ellencee for what you wrote. My mother's struggle is over. She was a champion of truth, however, and she would have faced the truth (if only she had known it) with the same good sense she exhibited all her life. She really hated ageism. Thanks again for your help.
My mother, Bernice Bergin.

I am sorry for your loss. I lost my mother to emphysema a long lingering disease, she died at home with all her children and family at her side, I was the one to turn off the oxygen concentrator when it was clear she no longer needed it. Yes she was treated as are many terminally ill eldery, with morphine to make her "comfortable". The nurse would have told you that will do one of two things, shut down all systems, death usually occuring within a short time or they will get better. Usually they die, it is true that frail bodies seldom survive tests or treatment which in fact cut their possible time significantly and leave them in pain, the stress for the whole process from reporting trouble to the doctor and getting the diagnosis releases Cortisol into the system which in the short run may help but in the long run it is too late. Her writing letters to the doctor and doing something positive by going to another doctor possibly helped her.

Some forms of cancer are hard to diagnose and grow at a rapid pace and it is too late once they are found. Both of the forms of cancer are frequently linked to smoking or secondhand smoke. Esophegeal cancer is often diagnosed when it is too late and has a poor prognosis, also with two cancers, they may have even metastized from another location, was an autopsy performed? If not, then the cause of death is what the doctor puts down, also in this age of genetic discrimination, a diagnosis of cancer on a death certificate could keep you from getting insurance or raise your premiums, so don't be so quick to question that. I can't get life insurance because I am recessive for a genetic disease. If your mother didn't smoke there are several genetic causes that may have contributed to this. If she did smoke then living relatively healthy for 85 years exceedes the life expectancy.

I once had a client, about 40, he was robust, loved to eat, he even liked the food at the VA hospital! Quite litterally, overnight, he went from being able to down a huge steak meal, to not being able to swallow a pill! I told him to report it to his doctors at the VA where he was in a treatment program so he was seen the next day. They immediately xrayed him and said he had a hiatial hernia, but when I questioned him the next week, they didn't tell him anything about how to eat for this problem, so I sent him back, something was wrong, he did, this time they they diagnosed esophegeal cancer (he was exposed to agent orange and smoked) He was referred to the nearest VA hospital for surgery, so within 2 weeks of having trouble swallowing he had surgery and then other treatments, he never had the reconstruction surgery because he was never strong enough for it. He lost over 100 lbs in the 6 months he lived, and wished he never knew, he had enough time to make plans for the care of his young son and couldn't care for himself.

I told a colleague who is an onocologist about this and after I described that he couldn't swallow pills his question was, was it esophegeal cancer and how long did he live? The prognosis is very poor even in healthy younger patients and it is hard to diagnose early enough to treat. Some things that seem abnormal to those of us who are younger are commonly seen in elderly, so age makes a difference in how the doctor responds. Even though it seems unfair or uncaring, it is unlikely that the doctors did anything that would be seen as less than the standard of care which has some latitude, you would be complaining if they "put her down" with morphine as well. I am not an attorney but think it would be difficult to prove malpractice.

Your mother had hope, she had a death sentence but didn't know it, she lived twice as long as my healthy young client who sufferd for 6 months with no quality of life and fear of the end. Yes your mother had a right to know and it is possible that she didn't really report symptoms that caused alarm. There is nothing that will bring her back but you can be proud that she lived a long and productive life.

rmet, thanks for your views. I do appreciate them (sort of) --you are saying what has been said before--"well heck, she was EIGHTY FIVE!" (as if being eighty five in and of itself is some sort of disease.)

I am very aware that esophegeal cancer is practically a death sentence even in younger people. I read up on it. I know she could not have survived surgeries and so forth. That is not the point really. I know you and some others want me to look at the bright side (hooray! mother lived to 85 despite the fact she was shooed away like some kind of pesky hobo.)

You wrote:
"Yes your mother had a right to know and it is possible that she didn't really report symptoms that caused alarm. "

Wrongsville, rmet. My mother complained to doctors about spitting up blood for NINE MONTHS. You think it's nice that she didn't have the cold facts about her problems. Well, you did not know her. She LOVED the facts. She was apparently different than you in that way. She was very sharp and had all her wits, unlike many people her age. Despite this, she was "chalked up" and passed over. It would be different if she was the type who didn't want the truth. She wanted it, requested it and was dismissed. I KNOW she would have died with or without the truth. The point is, she asked for it. To be denied the tests to diagnose her disease because they already had her assigned to the glue factory seems reprehensible to me.

It is clear that this would be next to impossible to do anything about legally. Medical malpractice is ridiculously difficult to press even when one has an open and shut case--I am aware of that. I am still going to look into a formal complaint, particularily against Doctor #1. I just have to find out how to do it.

I hope if you reach my mother's age you won't be treated like your life is of little value. That is what happened here. I really doubt that it is standard medical treatment to ignore the symptom of hacking up BLOOD everyday.
She actually had medical reports (a chest xray) from the prior hospital two months earlier that stated: carcinoma ruled out.

I, like you, stayed at my mother's side for hours while she died. Dying, as you doubtless know, is hard work and it took many hours. I held her hand. nothing was unplugged and it seemed peaceful enough (despite the gurgling). She was allergic to morphine, so they had to give her something else (so now they care!). Lots of things about "our medical system" seem pretty incongruent.

But again, thanks for your input. Sorry about your friend and your Mother.
Patti

cluelesss
You have the right and the ability to close and lock your thread.
EC

Patti,
I think it is terrible how elderly and disabled people are treated, unless they have someone to advocate for them, which I have, BTW, they are often lost or fall through the cracks. Decisions are made without the consent of the patient or family, all the time. They make the dicision to "make them comfortable" when they decide their time is done, what ever their criteria for doing this, the family is informed after they are dosed, few object because they want their beloved family member to not suffer, they want them to be comfortable. Believe me, I have gotten up in front of professional organizations and protested this practice and done what I can do where I can, but I am not GOd and I cannot change the outcome. I wish I could, but I can't. We have to make the best of what we have and honor our relationships.

My Mother's thyroid medication was discontinued because they said she didn't need it, so she couldn't control her body temperature, she was not uncomfortable, she needed her Synthroid. She wanted to be in the hospital but you are only allowed so many days in the hospital and it really wreckes their moprtality statistics so people are sent home to die all the time, often being told they are going to recover and knowing they are not. Morphine which was PRN, ended her life, we thought it was to help her. She was on a coroner's list, the death certificate waiting for the call from the visiting nurse to confirm the date/time & cause. We were told none of this and had no input. She had already passed when I turned of the oxygen concentrator, I didn't turn it off so she couldn't breath, she didn't need it anymore because she was dead.

With my Mother-in-law, Who hated me before she even met me and was so cruel you would not believe it, I was the one who sat in the hospital every day to make sure they took care of her, to make sure she ate, when she couldn't eat that she got a feeding tube, so she wouldn't suffer, but she sang at night when I wasn't there, disturbing the whole facility, so they made her comfortable. In each case we were informed on the date of their death that death was expected, as this is the way of Morphine.

It doesn't matter your age, many symptoms can be normal or not. Your mother had a Xray R/O lung cancer 2 months before she complained of caughing up blood, that is possibly why they didn't do another one and also shows how fast it grew. I have caughed up blood, did they do anything because I was 45 and not 85? No they didn't do anything. I did have COPD caused by a genetic disorder, I went for 18 months before I figured out what it was and asked to have the test, oops, I have A1AD like my mother. Doctors don't like it when they don't know something and a patient makes the correct diagnosis, it dirves them crazy!

What do I know about bleeding? I have reported abnormal signs of bleeding for over 8 years. I have had my skin bleed with no trauma, or black bruises with no trauma, my fingers look like jumbo black olives. Did they do anything? Yes, at first they gave me a lot of tests that showed nothing and refered me to a psychiatrist saying it was all in my head or that I was hurting myself because I was reporting things that were odd but not out of the ordinary and insisting something was wrong. I am in the health care profession and this is how I get treated! 8 + years after caughing up blood and having blood oozing from my chin in a doctors office, I was diagnosed with vonWillebrand's disease a BLEEDING disorder, not on that list someone else provided earlier. I am going to write a lot of letters to people who have treated and ignored me in the past, I hope I can make it a learning experience for them, because they seldom learn what's happens because they don't see you again.

I couldn't answer you earlier because I was at the hematologist's office getting my first infussion treatment. I lost a baby last year because of this bleeding disorder not being diagnosed and therefore not able to get treatment. Actually I was in a large room of cancer patients getting their chemo therapy, so I know a bit more than you realize, first hand about facing these issues. I was tested for this in 2001, the test was negative, this June it came back positive, it is difficult to diagnose because it is an acute reactant so levels can be normal when there is trauma masking the disorder. That's how it goes, sometimes it takes years to diagnose a problem, when a patient is older, there are not years to do it. Yes I am greatful I know, because now I can do something about it and no one will accuse me of being crazy! I am greatful that there is a treatment and that it isn't fatal. I am glad that I have answers. Does this mean that I will live to 85? Maybe or maybe not, I could die tomorrow of a brain hemmorage or develope something else or die of an adverse drug reaction.

The question is, would I rather know I am going to die and not be able to do anything to stop it or kill myself treating it with no quality of life or not know and have hope and some quality of life. Reality is that often for one reason or another, we don't have all the choices we would like to have that doesn't mean that I am not an advocate against injustice, because I am but I am realistic. I do what I can do. I wish I could change it but I can't. Be greatful you had your Mother for the time you did.

rmet you wrote:

"Your mother had a Xray R/O lung cancer 2 months before she complained of caughing up blood, that is possibly why they didn't do another one and also shows how fast it grew."

No, you are mistaken--she did not complain beginning only two months ago, she complained of coughing up blood beginning in AUGUST of 2003, CONTINUED TO COMPLAIN until April of 2004, was put in the hospital where
SHE COMPLAINED AGAIN and was told her chest xray was "clear" and then
SHE DIED in a different hospital in June. (oh and yeah, she complained from April to June as well).

You have completely missed the important issue of how long this went on.
Maybe you were too busy comparing my mother's story to yours (intersting as it is, I don't see the relevance. Is the neglect my mother endured somehow assuaged by the neglect you endured?) If you want to say that it's commonplace to have doctors ignore complaints of spitting up blood from August 2003-June 04--then wow--YOU'RE in the health care profession?? No wonder she was ignored!

That we may all be struck down this afternoon by runaway buses also does little to enlighten me about whether or not my mother was entitled to the tests that she requested and was denied. I AM glad I "had" my mother (doh!) but whether or not I appreciate my time with her is not salient to my orginal query. It really helps if you just go ahead and stick to the question and the answers (if you know them, which you don't so thanks anyway.).