Cat writes:
First, I’m not a nurse. But I wonder what you think of this (and this is NOT a criticism of anyone–just an open question.) My Mom is on a Telemetry floor after passing through the ER and ICU. She went unconscious during the night. Her BP fell and she was found to have double pneumonia. She has had congestive heart failure and spinal stenosis for several years. She has very limited mobility (sits and sleeps in a recliner, can still use a bedside commode with assistance.)
Okay, so I’ve been wondering why she’s in so much pain. I’ve asked every nurse that has come on shift (not in a pushy or rude way, either). I have carefully explained that I have never seen my Mom in this much pain, and she is not a complainer–but she’s complaining non-stop. She whimpers, cries, pleads and begs for help. Well, this has been going on for over 10 days. Today, they noticed her leg was rotated out and took an X-ray of her hip. Yup, she has had a broken hip for probably the entire time she’s been in the hospital. How did this happen?? (Or rather, why have my questions been ignored?)
I even had one nurse sit with me for 45 minutes and, I have to say, very patronizingly “explain” to me that Mom’s pain, while real, was exacerbated by her anxiety and lack of trust. (Hmmm….wonder how trusting I would be of people who were torturing me–or so it probably seems to my poor, confused Mom.) Let me just say here, I don’t blame any of the nurses. In fact, I believe they are some of the best I’ve ever seen. So my question to you is, how does something like this happen? This is a state-of-the-art hospital which has received national recognition as one of the top hospitals in the country. Yes, I know that “things happen” and sometimes, that’s just the way it is. I guess I am frustrated and wonder what your opinion is (you, the nursing community)? Do you believe nurses don’t listen to family members? (The condescending nurse assured me that she could “see” that Mom was not in “that much pain.”)
I hope I don’t sound like I’m blaming the nurses. Is there anything I could do so that this doesn’t happen to someone else? I can’t imagine having an untreated broken hip and being shifted around continually, being given physical therapy, etc.? (Mom was on decent pain meds, but still…) Do you think elderly patients fall through the cracks?
Okay, I’m done. Thank you for any feedback. I genuinely want to know what you think, and I hope I haven’t offended anyone. Incidentally, my Mom was a Registered Nurse for many years. I feel sick at seeing her treated (even though unwittingly) like this.
————————————————-
I’m very sorry that you and your mom have been going through this. It has not been my personal experience that a broken hip would go undiagnosed for 10 days. I find it astonishing that absolutely no one noticed that your mom’s leg was rotated.
Of course we as nurses encounter family members who want to advocate for their loved ones. Sometimes they can be overbearing with concerns that are fairly unfounded. But when I hear stuff like, “She isn’t a complainer, I’ve never seen her in so much pain before,” it sets off warning bells in my mind that something is really wrong.
I do think that elderly patients fall through the cracks on minor issues, but I’m surprised about your particular issue. Can you imagine if she’d had no one advocating for her? No family around?
Thanks for the submission. I hope other nurses who read this will chime in with their thoughts.
I have been an Intensive Care nurse for 11 years. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!
Comments
Hi there..
First off, sorry to hear about your mum. I’m a nurse with about 10 years up my sleeve, most of it spent in emergency.
Pain is a really difficult, multi-faceted issue that has no clear answers for everybody. Being such a subjective thing, we normally have to take people’s words for it, when they tell us how much pain they’re in and score it out of 10.
Sometimes we become skeptical of patient’s scoring based on they’re appearance – for example, I’ve had people say “TEN!” (meaning, the worst pain they could ever imagine, ever) when describing their headache. In the waiting room I’ve watched them wander round, get a drink, read a book… that’s not ten. I feel like saying “ok, so how bout if I chop your arm off with a chainsaw – would that hurt more?”
But I digress – none of this helps your situation except to say that pain is subjective, but we also watch for signs the person is in pain – grimacing, uncomfortable, and systemic responses like tachycardia, paleness and the like.
The other problem with pain relief is that it causes problems. Long term opioid use leads to dependence and higher doses needed. Other medications reduce GI motility causing constipation. Others cause nausea, shaking, other side effects.
So it’s difficult to find a balance to get on top of someone’s pain without relying on it repeatedly hour after hour after hour. Eventually you have to wean and try other techniques like hot packs, pillow positions, moving around in bed.
Added into the mix is your mothers other complications – having congestive heart failure complicates choice of pain killers, and having spinal stenosis probably means she’s taken pain killers for years, also making the choice / doses difficult.
So my response is – the answer to pain, particularly long term pain, is not always hitting someone up with more pain killers. It can make it more difficult down the road when you take this route. I hope they work things out for your mum!
added by Ross on 01.14.09 11:53 pm | Permalink
As a former nurse aide, and then as long-time pharmacist, I’m inclined to believe that there’s another factor involved. I don’t know what to call it…but, I don’t think that it has to do directly with negligence, nor even a healthcare provider’s reactionary attitude in a personal way to the patient (or family member) complaint.
I’ve seen situations where there is some ambiguity about the situation and family members mention to patient’s nurse or doctor an idea, then doctor or nurse goes with the idea, and overlooks something else.
For example, there was this elderly patient who was put on corticosteroids for an inflammatory condition, which resulted in erratic blood sugar levels, for which she couldn’t be cared for at home.
She was admitted to a nursing home, and opacities showed on a chest x-ray, but the family member was sure it was cancer or some such, and changed her parent’s resuscitation status and this impacted the choice of an agressive antibiotic therapy. The elderly woman kept getting worse, having trouble breathing, worsening blood sugars, etc., which is normal indication of worsening lung infection, and was given sedatives for her anxiety that affected her breathing status. The complaints were interpreted as pain and she was administered higher and higher amounts of narcotics, which also affect respiratory status. By the time that the spots on her lungs were cultured to reveal empyema–a pus-pocket lung infection, she was in no shape to pull out of it. This was a case, I think of a family member’s contribution to an unclear diagnosis and outcome.
As for pain, it’s hard to tell what to do about the loved one’s complaint of pain. We are taught that pain is whatever the patient tells us that it is. If there had been a way to locate the pain, and follow up that with a specific investigation requiring diagnostic X-ray or other tests to rule out different causes, this may have been the tipping point in expediting the diagnosis of a broken leg.
An elderly patient moaning about the matters for which she was initially being treated is not all that common, but moaning in general is rather common, I think. Also, it is unfortunately not all that common to make the distinction that low blood pressure resulted in a fall which went on to result in an undetected broken leg. On the other hand, one would think that if someone fell, that the person would be checked for broken bones–what if the woman had a brain hemorrhage as the result of the fall–I’m sure though she was evaluated for that.
However as mentioned by the nurse above, a statement such as ’she’s never complained about pain before, and I can’t understand why she should be moaning, whimpering, etc. without a reason’ should’ve rung warning bells to the patient’s nurse–and, in this situation, she would’ve been the one that the aide mentioned the matter, as well as the nurse would’ve been the one to relay the message to the physician.
It sounds as if the family member did her best to get to the bottom of it. Someone fobbing off an answer in a manner interpreted as patronizing should not be tolerated, as well as the interaction without addressing the main concern is problematic. If the family member had ’seemed’ to sound angry and ‘threatened’ ramifications if the answer was not clear, maybe that would’ve been helpful. Who knows?
As a healthcare provider, if I had a family member that I was sure was involved in an undetected health issue, I think by what I know now, I would ask the nurse to either document in the chart my question for the doctor, or ask the nurse to leave a note for the doctor to get ahold of me, so I could ask him myself. It’s hard to be objective, though, when a beloved family member is involved in a situation for which the communication factor is not entirely there.
As in most matters, one has to ‘go with the gut’ about these feelings. Perhaps, we expect adult patients to be able to explain what’s wrong, but even an elderly patient in excrutiating pain might not be able to coherently describe why it hurts so much.
added by Cathy Lane RPh on 01.15.09 6:08 pm | Permalink
I’m sorry your Mom had to go through all that pain. And I’m sorry you weren’t listened to when you said she wasn’t usually a complainer. That statement is a dead giveaway that something else is wrong. Sometimes, when something critical, like CHF or pneumonia is going on, the health care team misses the forest for the trees. Your Mom was lucky to have you to advocate for her. I just wish it hadn’t taken so long for the team to find the problem.
added by Nurse Stella on 01.17.09 7:30 pm | Permalink
It’s not as uncommon as you might think, my father re-broke his hip while in rehab for hip replacement. The physical therapist and nurses kept telling him to stop whining, get to work, etc… Eventually, he was x-rayed and sent back to the hospital, where they discovered MRSA. He never left the hospital.
added by Amanda on 01.19.09 1:44 pm | Permalink
I’m sorry your mom was in pain and her (and your) attempts to get help went unheard. I brought mom to an emergency room when she was in her last illness for unexplained fainting. Mom was a diabetic with high blood pressure. I stayed with her for about 12 hours until they said she was definitely getting a room. She and I both told them she had diabetes and *if she doesn’t eat, it will rise alarmingly*. I went back the next day to find her in the ER and with no food for over 24 hours. She also had a whopping high sugar reading. My husband came in and complained vociferously about her treatment. She got foosome food and then went to a room where she had a meal. One ER nurse said she didn’t get any food because of the high reading, but another one said, quietly, that she was very sorry about the mixup, but ER was very crowded during that time. The corridor was lined with beds and wheelchairs with patients waiting. My quiet Mom just got overlooked until my loud husband came in.
added by maria k on 01.19.09 9:48 pm | Permalink
I appreciate the insightful and compassionate responses. And I do understand the need for caution and balance when treating pain–as too much might supress breathing, etc. I finally obtained a consult with the pain service at the hospital. The pain doctor thought most MDs don’t get a lot of training in pain management, learn it on the job, and then get stuck in a certain prescribing habit so that individual situations are sometimes not taken into account. The pain issue has been very stressful. But worse has been knowing that Mom had a horrible hip fracture that wasn’t caught. I’m wondering how this could prevented in the future? I do wonder if older people “fall through the cracks” sometimes. After the pain service consult, the doctors have put Mom on a Phentenol patch and are titrating it up every couple of days. She is finally able to be somewhat comfortable, unless they are moving her around. Still, it gives us hope that she will be able to tolerate physical therapy to see if she can regain some mobility.
Bless you all for the work you do, for your compassion and care. Thank you for your thoughtful answers and for taking the time to help. Wish I could give each one of you a rose. (Or better yet, a big, fat pay raise–I’m sure you deserve it!) Love, Cat
added by Cat on 01.20.09 9:28 pm | Permalink
I am 52 and fell at work. they took an X-ray and said all was fine. the next day they said (ER) I needed an MRI and found out I broke my hip. (I work in a hospital)…
I was called to be admitted in hospital and told they can’t fix my hip the way I broke it. So back at home in so much pain, it’s horrible. I’m waiting for workmen’s comp to send paperswork to orthopedic surgeon..who won’t see me until they get the paperwork. I’m sitting here today and sneezed and heard my hip crack. I should be in the hospital, not sitting at home waiting.. unreal.
added by pat on 01.22.09 4:19 pm | Permalink
I think it is a shame that she went through so much pain before the etiology was found. And yes thing do happen! She had classic rotation of her leg,however and where I think it fell through was with the PT! I cant believe they did not notice this! And yes the elderly fall through the cracks too many times in my humble opinion!
added by Laura on 01.23.09 10:52 am | Permalink
Yes I have seen this before! It is awful! I am so sorry to hear about this situation. There was an elderly female patient on our floor with an undiagnosed broken right arm for a week. Apparently the nurses were taking left arm blood pressures and the patient never complained of pain until someone tried to take a pressure on the right arm and she screamed in pain.
Another time a patient had a broken leg that was detected by the nurses aides while they were cleaning the patient they noticed it was externally rotated and notified the nurse.
I am sorry about your experience.
added by Jane on 01.26.09 8:18 pm | Permalink
It is so sad to hear of these experiences. Pat, I hope by the time I write this, you have been treated and are on the way to recovering. My jaw dropped when I read what happened to you. I am praying for you.
It is shocking how much this kind of thing happens. There are so many stories here; just imagine how many more are “out there.”
I don’t have the answers. I wonder if the economic pressure and the fear of litigation causes (and, sadly in some cases, perhaps ignoring people who are not socially powerful) have contributed to this neglect.
Another thing I’ve been wondering about: In my Mom’s hospital, there are many shift changes and seldom is there any continuity in care; that is, she has so many different nurses and doctors over the course of a week. I can tell when discussing particulars with them, that some are not even aware of Mom’s hip surgery (although she’s got staples from her hip half-way down her thigh). I’ve observed these professionals are harried, rushed, and undoubtedly victims of cost-cutting measures by the hospital. I know everyone is stretched thin these days. Do any of you think this is a contributing factor to these sad situations (lack of continuity in care?)
Again, bless all of you. I appreciate the support more than I can express.
added by Cat on 01.29.09 4:31 pm | Permalink
It’s just awful to hear to stories like this, I cannot imagine how life would have been. This is happening all too often and the majority of the medical profession really don’t have patiences interests at heart, they simple don’t listen.
added by Undiagnosed on 02.10.09 1:54 am | Permalink
My elderly mom was taken to the ER after a fall. After a few hours and a hip/leg xray they were going to send her home. She was in tremendous pain . Before the discharge was in place I asked the aide to help my mom go to the toilet. My mother couldn’t even STAND without extreme pain. They did some more imaging and discovered a hip fracture. She was admitted and … but that is a story for another day.
added by airedalelover on 02.12.09 10:17 am | Permalink
that is really sad to of happened to your mom. a good physical assessment by any oncoming nurse would have picked up any number of symptoms, little of all the pain. Mainly the rotation, possibly the decreased sensation and pulse in that leg. A broken hip can be very dangerous and she is very lucky. I have only been a nurse for 3 years and have always been taught and practice pull down the covers and take a look, no matter what they come in for.
added by kristal on 02.13.09 12:44 am | Permalink
I want to know what happened to those nurses evaluating the pain she complained about? In the hospitals I have worked as a RN for many years, we always do a pain assessment when the patient complains of pain, asking for it on the scale of 0-10, what makes it worse, what makes it better, where does it hurt, type of pain, etc. This would have led to a more detailed look at what had happened and it should have been discovered during a bath if nothing else. In additon, after intervening, with backrub, heat, ice, meds, whatever, I return in about 20-30 minutes and re evaluate to make sure that my intervention had helped, if not I re intervene, and/ or contact the physcian with the complaint, and what did not help. So sorry, I believe care in hospitals is failing, and that there are more excuses for the bad care, than correcting it.
added by Teresa on 04.06.09 1:01 am | Permalink
My brother was 17 when he was in a serious car accident. He had a multitude of serious issues wrong with him… internal bleeding (he lost his spleen), collapsed lung, cracked ribs, potentially life altering brain damage (thankfully not), etc etc etc. Some of the care he received in the PICU was absolutely fantastic. Some of it less so. Despite my family’s general appreciation at the care he received, we were blown away to find that when he was finally sent home, it was with an untreated broken jaw. He had complained about jaw/face pain during his stay but he had been intubated, had an NG tube, and several facial lacerations so I guess his pain was chalked up to that.
His jaw was probably the least of his problems (although has proved to be one of the most bothersome long-term)… so we were never that bothered because there was much more serious things to pay attention to. At the same time, it still amazes me that with all of the xrays, scans, and evaluations he received.. no one ever caught it.
added by Kay on 04.14.09 9:30 pm | Permalink
Line and paragraph breaks automatic, e-mail address never displayed, HTML allowed:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>