It all started when my 88-year-old father’s home care nurse came to visit and noticed that his left foot looked infected. He has diabetes—meaning an infection in an extremeity could be serious—so she got some kind of medi-car service to take him to the emergency room at the local V.A. hospital. The ER there operates as a walk-in clinic during the day.
The doctor took a look at his foot, did some tests, and declared it infected. He wanted to admit my father to the hospital for a few days, but after my father’s experience last time, he didn’t like the idea. The doctor agreed instead to send him home with a huge dose of antibiotics—the V.A. pharmacist told me he’d never seen a dose that large before—provided we promised to come back on Wednesday for a followup.
Everything was fine when I took my dad for the followup visit, but I noticed that he was more worn out by the trip than usual.
The next day, Thursday, my father fell down in his room, slamming his back against the bedframe. He said he had gotten light-headed. My mother called for paramedics, and they decided to take him to the emergency room. Since he’s already a patient at the V.A. hospital, they agreed to take him there.
The ER did X-rays, and all kinds of tests. His back was fine, other than a nasty bruise (he’s on blood thinners, so all bruises are nasty) but they decided to admit him for observation, and maybe also to complete the course of antibiotics.
While he was there, they also discovered a problem with his lungs which they have been treating. His bedroom will get a new piece of medical equipment when he goes home.
If he ever goes home.
The title of this post, “nosocomial,” means “hospital caused,” as in “hospital caused disease.” This is a concept that has become an important part of my dad’s life, and therefore of my life.
My father is old and has arthritic knees, so walking has been difficult. With support, such as a walker, he manages to get up and around the apartment, going to the bathroom, adjusting the fan in his room, and coming into the living room to watch television with my mother.
During the first two weeks of my father’s stay in the hospital, they kept him resting in bed, with no physical activity at all. I don’t know much about medical care, so maybe a full bed rest was necessary, but the cost has been high: With so little activity, my father’s legs lost whatever conditioning they had, and he was unable to walk, even with assistance or a walker.
The hospital’s next step was to move him to a rehab ward and give him physical therapy every day. I’m sure that was the right thing to do, but it wouldn’t have been necessary if they had given him some exercise earlier in the process.
Rehab took about a month to get him back to where he was when he was first admitted. However, trapped in a dull, boring, and poorly-lit hospital room for days on end, my father began to show signs of delerium. His short-term memory went bad, he had a hard time expressing himself, he became obsessed with features of his environment, and he lost the ability to think about and explain his needs to the staff or to me. I know my father’s 88 years old, and his mind hasn’t been at its sharpest for a while now, but this was a sudden, steep, and frightening decline in his mental state.
His doctors assured me that they had checked for every possible physiological malady that could cause such an acute change in his behavior, and there was nothing. By process of elimination, it had to be caused by the environment of the hospital. They say that part of the problem is the unfamiliar environment, so I’ve been making the drive to see him every day for several weeks to try to help him improve. It may be working, because he’s returning slowly to his old self.
Late last week, the doctors started telling me they were planning to discharge him on Sunday, so my family started gearing up for it: Buying supplies, fixing up his room, putting his portable oxygen tank in the car.
Then on Saturday, they told us his white blood cell count was a little high. They thought it could be a reaction to some of his medication, but they were taking blood and urine samples anyway.
Sunday morning, his doctor told us he turned out to have a urinary tract infection, so they wanted to keep him in the hospital while they fought it.
On Monday, they apparently identified the infection as some sort of multi-drug resistant organism, so they isolated my father in a private room. I have to wear gloves and a gown whenever I see him, and I wash my hands thoroughly afterwards.
Again, I’m no doctor, but I do know a little about science. Organisms don’t appear spontaneously. Bacteria can only come from other bacteria of the same type. Since my dad didn’t have this infection when he moved to the rehab ward, he must have acquired it when he got there. Since even now he can’t walk without effort, I don’t think he was wandering around and visiting other patients.
No, someone gave him this infection. Either they were carrying it themselves, or they transfered it from another patient. Either way, it’s a breakdown in infection control: Somebody didn’t wash their hands, or they didn’t wipe down an instrument between patients. Hospitals are notorious for this kind of problem. Even before this, his ward had ongoing outbreaks of MRSA and VRE.
To summarize, my father comes in with a foot infection, gets dizzy from antibiotics and falls, is hospitalized for that, loses his ability to walk during the bed rest, has to get therapy to walk again, then catches an infection, for which he needs intravenous antibiotics.
All of this may well be unavoidable given the current state of medical care, but at this rate they will spend more effort—and he will spend more time—dealing with the maladies caused by his hospital stay than with the medical problems he had when he came in.