The House of God

I just finished reading the classic novel of life and death in a American Hospital: The House of God, by Dr. Samuel Shem.  With over two million copies sold, The House of God, has been said to be the most important medical novels of the twentieth century. It was published in 1978.

It was written before DNRs and when doctors did everything to keep patients alive.  The most important reason for reading the book was I was looking for swear words used 40 years ago and they were all there.  These words are still being used now so they are not swear words; they are part of our everyday language.

The mindset of Vancouver Coastal Health is still in the 1950s.  All one has to do is go to an emergency room at VGH and listen to what patients and doctors are speaking.  So called swear words are used in everyday speak; they are nothing more than an expression in shorthand of fears/feelings/conclusions of patients.

SLURPERS: Doctors striving to lick their way up the academic medical cone towards the top.  (from House of God).  The reason why health professionals refuse to say anything negative publicly about their colleagues.

On Sunday July 13 2014 will be Randy's third month since he died at VGH.  I gave him a green burial.  It was a perfect funeral with good memories.  I laid bunches of carnations on his grave.  Carnations have a long life span (three weeks).  When I get some extra money, I will purchase the space next to him.  It is wonderful and peaceful under the trees among nature.    .

Randy's Stuff

I haven't been able to unpack Randy's belonging yet.  I just couldn't.  I was afraid that if any of his belongings were missing and I would become upset and I am tired of being upset.  GPC won't even let me on site to pick up his stuff.  A friend of my went there and she said that Randy's stuff was in garbage bags in a common area that anyone could rifle though.  I asked for an inventory but GPC refused to do one.  I know his memory foam pillow which I purchased for him went missing in December 2013 and his stand for his television was thrown out without notifying me.

I want to know why Karen Marshall, a security guard, put a choke hold on me when I was attempting to remove Randy lawfully from GPC: October 2013.  Paladin Security isn't suppose to touch anyone so why did she do this to me.  Practising her martial arts on an old lady.  I told the police I wanted her charged and the police did nothing. And there was Brad who stood at the entrance to the visitior's room when I was inside in a boxing stance with his fists up threatening to punch me if I attempted to leave the room.  Once you get labeled by VCH you are open season for abuse. Where do these people come from that encourage violence.




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I am so sorry, Randy.

I am so so very sorry Randy that I did not fight hard enough to keep you safe.  How could they do this to us in our counrty at the hands of our most educated physicians in the world. Every single time you were at VCH or St. Pauls I begged them not to send you back to GPC as it was not safe, and they did it anyways.They won't even investigate  GPC was not his home; it was purgatory from where there was no escape. How could they have allowed this to happen. He was suppose to have gone to GF Strong but at the last minutes they decided that he was never going to be a productive member of society so he was sent to GPC. Them deferring to a head nurse.  This is what this terrible terrible injustice came down to Tanu and her control freak management.  She even scared staff so that they would report things the way they knew that Tanu wanted.. She even scared off visitors that came to see Randy..  And management also would collude and back her up as well.  Her bullying forced every manager of GPC to quit but like all successful bullies she is still there dictating that she was able to ban me one hundred percent from GPC from my Randy in life as well as death and she can continue and no one can stop her..I am still angry over the fact that I was not notified of Randy's memorial service at GPC.  I wonder who went,  You would never think that a health facility would treat people like they do but they do. 

I am sorry Randy.  I am so sorry.
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Forgive but Do Not Forget

Forgive But Do Not Forget.  I do not know what this means.  I was told to do this but I do not understand it.  How can you forgive a bunch of professional health care providers that put Randy and me through hell for four years with their over cautiousness as if I would harm someone.  What about them, them that are guilty of culpable homicides like the Timer "accidental' death.  Them putting on Randy two Do No Transfer Orders when he was in need of acute care so that he would die if he needed care more than what George Pearson Centre could offer.  What legal right have doctors to do this.

On two occasions I found Randy needing acute care and him having a do not transfer order on him and then what happens I get banned from seeing Randy for ninety days with management saying it will be extended forever..  They wanted Randy to die without me being with him as I might call 911 again.  Ro Ang the manager of George Pearson Centre said that all patients have a DNT on them.  I was shocked and still am as on November 18 and December 26, 2013 staff refused to send Randy to VGH because of these orders.  I had to force a call to 911. If Randy didn't go to VGH, he would have died a not good death at GPC.

It has been nine months since I contacted the College of Physicians and Surgeons to do something.  I haven't heard anything from them.  If I am to follow the advice of forgive then the college must be assuming that I am forgiving Dr. Dunne for his culpability.

Because of what Dr. Dunne did and when previously we asked that Dr. Dunne be removed as Randy's physician: this never happened.  Something about policy.  Once you have a physician in residential care you can't have him removed. You are forced into a deadly alliance.  Randy knew Dr. Dunne wanted to kill him but he couldn't do anything about it and neither could I.

Read: LifeNews.com

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Nurse Jennifer Timer and the death of her mother

Yesterday in the Vancouver Sun (front page) is a report by Pamela Fayerman after her talking to the daughter of Rosemarie Timer. Rosemarie fell while in hospital and died from a head injury which Jennifer thought could have been prevented.

Deaths from falls in hospitals happen often but no one takes the deaths seriously, especially the media. I am sure there should be a criminal charge of endangerment or homocide for this careless behaviour on part of hospital staff but I suspect it is not in the public interest to arrest those that are responsible. It would be against the public interest for us to know that there were 456 preventable deaths (BC Coroner) from falls last year 2013. The public might demand criminal charges or worse yet patients would refuse to be admitted to hospitals in the first instance.

I am surprised that the report was even published. It must have fallen through the cracks of the editorial staff at the Sun. When Randy Michael Walker died I had to have a court order to access him at his death in the ICU and the media didn't comment on that, nor anyone else. I also had complaints about his care. (The media reads all Supreme Court Orders.)


Again, if anyone wants a full version of my blog let me know and I will have Blog2Print print the contents and mail it to you. The Blog2Print paper book edition (its cost) is $50.00.

23 June 2014

I was hoping my grieving would be getter lesser but it hasn't. I see Randy wherever I go or not go. I did not know he was going to die. He has had pneumonia many times and he always recovered.

Yesterday I went to the Oakridge Senior's Senior for breakfast and at 10:30 NIDUS was scheduled to give a talk about representation agreements. The young women made it sound like it was some sort of answer to some sort of problem. I told the group of my experience with Randy's representation agreements and the failure of Vancouver Coastal Health to honour them.

I got upset when the girl said that representation agreements could ONLY be registered online for $25.00. I asked her could they be filed manually. No. Only by computer. I said that most of her target audience (us oldies) are uncomfortable with computers. And on top of it if you want to register a representation agreement a person would have to have a credit card for the $25.00 fee. I do not understand why there is a fee when the United Way is funding the project and its staff of three.

When I got home I had to face Misey who had a serious eye infection, the size of a golf ball. So with difficulty I had to arrange for a ride to the vet. $32.00 it cost for the eye drops. I had a hard time gettng Misey to walk home as she walks three hundred steps then sits down for a rest. Finally and slowly we got home and now she refuses to leave the apartment. She is on strike. I think she is afraid of being abandoned. Just like me having to abandon Randy because VCH deemed that was best for Randy. GPC bans people because they do not want anyone to see bedsores on patients which Randy had one when he died at VCH. GPC tried to hide it. Maybe he died of blood poisoning rather than pneumonia. I do not know and I still haven't got the autopsy yet. I hope that the pathologist wasn't too busy to recognize a wound the size of a toonie.

GPC:Hospital for special care.? Quality of Life okay for most.

New York Times June 23 2014

NEW BRITAIN, CONN. — Propped up in a hospital bed, a 75-year-old man with amyotrophic lateral sclerosis, or Lou Gehrig’s disease, must make an agonizing decision. Should he keep struggling until the illness inevitably kills him, dependent on a ventilator, unable to walk or eat or move? Or should he choose a day and a time to have the ventilator disconnected, and die?

The man, who asked not to be identified to protect his privacy, was a patient at the Hospital for Special Care here, one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives.

These facilities often are tucked out of sight, and even many doctors do not know they exist. This one sits on the edge of a decaying industrial town.

“People don’t want to think about us,” said Dr. Paul Scalise, chief of medicine at the Hospital for Special Care. “I don’t want to think about us, either.”

But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.

There are two reasons, said Dr. Judith Nelson, a critical care specialist at Mount Sinai Hospital.

The population is aging, increasing the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may land patients in a hospital like this one. And doctors are getting better at keeping people alive when they are in intensive care. The result is an increase in the number of highly dependent patients who survive the intensive care unit but must remain on a respirator. They cannot go home or to a rehabilitation facility. Many are too sick even for a nursing home. Long-term acute care is “where you go when you survive but you don’t recover,” Dr. Nelson said.

And yet this Connecticut hospital is not a place of unrelieved misery. The campus is leafy and green, and the windows are wide and filled with sunlight. Paintings by residents and local artists decorate the walls. On nice days patients can visit a landscaped garden along a path of paving stones and lined with respirator hookups.

Dedicated doctors and staff tend cheerfully to patients who require nearly constant care, some of whom are managing to make lives for themselves. Recently two patients with muscular dystrophy, both in wheelchairs, married in the courtyard outside. The bride was given away by her weeping father.

“It’s remarkable,” said Dr. John Votto, the hospital’s chief executive. “You are on a ventilator, you can’t move, you can’t walk, you can’t breathe. You and I would say, ‘Oh my God, you must have this terrible quality of life.’ But they really don’t. Honestly, many are quite happy.”
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Tammy Bohmer, a nurse, assisting Murray Zack with telephone conversation with his son. The outlook for patients usually isn’t hopeful, but the hospital is not a place of unrelieved misery. Credit Richard Gershon for The New York Times

Often they arrive here because ordinary hospitals do not want to keep them. Reimbursement is tied to diagnosis and treatment, but most of these patients no longer need a diagnosis; they need treatment and care. Most start out being covered by Medicare, but when that benefit runs out — at 150 days — long-term-care hospitals either discharge the patients anyway or Medicaid usually takes over.

Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities. Medicare officials argue that perhaps these patients could stay in regular hospitals or nursing homes instead, and say it’s unclear whether care is better in long-term acute care hospitals.

But nobody knows what “better” means for these patients, and that makes it difficult to assess how well these facilities are operating.

“We don’t know how to measure quality,” said Dr. Jeremy Kahn, associate professor of critical care, medicine and health policy in the University of Pittsburgh School of Medicine. “The current Medicare quality measures are borrowed from I.C.U.s. Whether they apply in long-term acute care hospitals is unknown.”

The Hospital for Special Care is unusual because 70 percent of its patients are on Medicaid. Yet just 30 percent were on Medicaid when they were admitted, Dr. Votto said. Even with government support, many families are financially devastated when a relative lands in one of these hospitals.

The facility may be several hours from a family’s home, so relatives end up staying away from their jobs, living in hotels to be near a parent, child or spouse. Some deplete their life savings. “It’s a tragedy, a real tragedy,” said Dr. Christopher Cox, a critical care specialist at Duke University School of Medicine. “A heartbreaking situation.”

The road to a long-term acute care hospital often starts in an I.C.U. somewhere else when a doctor suggests placing a tube in a patient’s throat so he or she can be hooked up to a ventilator. “Once that happens, your future is not bright, unless you are quite young,” Dr. Nelson said.
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A ceiling tile above a patient’s bed at the hospital was replaced by a scenic image. Credit Richard Gershon for The New York Times

Deciding to have a tracheotomy should be a difficult decision for family members, she added. But, she said, “people misunderstand — they think it is a sign of hope.” Few doctors discuss the likely consequences or the alternatives.

“It could be that physicians are not confident in their prognosis and therefore don’t want to share it, or it could be that physicians do share it and families don’t want to hear it,” said Dr. Shannon Carson, a critical care specialist at the University of North Carolina School of Medicine, who has studied what families expect when a relative enters a long-term acute care hospital.

But the likeliest reason for the disconnect, he said, is that families are initially dealing with I.C.U. physicians who are focused simply on keeping the patient alive: “They are discussing how the patient is doing today, not how they will be doing in six months,” he said.
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The result is predictable, experts say.

“People are not prepared,” Dr. Nelson said. “There is one intervention after another. Ventilator, feeding tube, permanent feeding tube, permanent intravenous access. ‘Should we treat this infection?’”

The initial optimism soon vanishes after the patient arrives at the long-term acute care hospital. Some patients and their families eventually must confront an extraordinarily difficult question: When is it time to stop the interventions?

In one of their studies, Dr. Nelson and her colleagues telephoned people six months after they entered long-term acute care hospitals, intending to give them a brief set of questions to assess their mental functioning. But, they found, almost no one they called could respond to the telephone.
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Dr. Paul Scalise, left, of the Hospital for Special Care, with Joy Franklin, a patient, and staff members. “People don’t want to think about us,” he said. Credit Richard Gershon for The New York Times

Dr. Cox and his colleagues have found that about half of the patients who enter these facilities are dead within a year, and most of the rest are in custodial care. Just 10 percent to 15 percent return to an independent life.

At the Hospital for Special Care, 100 patients, including babies and children, are on ventilators. Seventy-five of them, Dr. Scalise said, “are on ventilators forever.” That’s why there are hookups in most of the hallways.

But while many of these patients may occupy a frightening middle ground between death and the lives they once knew, some do find happiness. The children, some abandoned by their parents, gurgle happily in the hands of volunteers careful not the disturb their respirator hoses. The couple who recently were married, Chris Plum, 38, and Margaret Lavigne, 43, share a room crowded with medical equipment, attended at all hours by determined aides. They kiss each other good night before being lifted into separate hospital beds.

“Everybody wants ‘the One,’ ” said Ms. Lavigne. “I did not expect to find him here, of all places.”

Other patients face tougher choices. The man with A.L.S. knows he will never eat again, that he will never walk again. He knows that the little muscle movement he has left will go. But it is not easy to pick a day and decide that is the day you will die.

Dr. Scalise visits the patient, who signs and mouths the words that he does not want to live like this any longer. But Dr. Scalise wants to be certain the man is sure. He asks a psychologist, a psychiatrist and another doctor to talk independently to the patient about what he wants to do.

Dr. Scalise, the nurse and the respiratory therapist are haunted by that first difficult conversation. “He does not want to live here, and he does not want to die,” Dr. Scalise said. “There is no training that deals with any of this.”

The man waits a week, speaking with the other doctors, thinking about how hard it would be to leave his family, including four children, two of whom were still in college. Then he asks the hospital staff to disconnect the ventilator.

On Wednesday, Feb. 27, at 8 p.m., the man’s nurses began giving him intravenous medications to deeply sedate him. The next morning, they turned off his ventilator. The man’s family was gathered at his bedside. Death followed in about 20 minutes.

“It was very hard to lose him,” his wife said. “I think it took a lot of courage.”

A version of this article appears in print on June 24, 2014, on page D1 of the New York edition with the headline: Where Recovery Is Rare.