I Think My father Probably Died from a Lack of IV Access

Damn you hindsight! Why aren’t answers as readily available when you need them as they are obvious with the aid of hindsight? Damn you!

I know stuff, I see stuff, so why didn’t I put on my big girl panties & demand that someone put a functional IV in my father when he was a patient at St. Joseph’s Hospital in Elmira, NY?

Ironically, I was working at the Hospital of the University of Pennsylvania for a biotech company when my sister called with a FYI”  letting me know “Dad’s in the ICU at St. Joe’s, he has bronchitis”….. hmmm, that doesn’t sound right…. I think to myself, so I give a call to the hospital. “Sorry we can’t talk to you right now, we are working on him”… OK that’s an alarm, this is definitely not right.

So, I decide to take a drive up there. Five hours later I am standing in the ICU. CHAOS, a disaster.  “ICU” implies INTENSIVE care being provided here to the most unstable patients in our facility.  Here you have nurses who can’t start their own IV’s…. in an INTENSIVE care unit!  IV access is everything.  The FIRST thing that is done in an emergency, critical, unstable, patient is to get a “line” in, usually a big one.  Here in an ICU bed lies my dad with a BP of 80/palp with a 22g IV that only works intermittently.  A 22g IV is tiny.  You can’t “hose down” a patient with fluid, you don’t take a patient to the OR, you can’t give a unit of blood, & you certainly aren’t prepared for an impending emergency.  Forget the bore of the needle, this one doesn’t even work.  That blood pressure is inadequate & his heart is going to crap-out any minute.  HELLO!?!

My dad had pulmonary edema which basically means that there was a large accumulation of fluid in the tissue of his lungs making it impossible for them to maintain the exchange of oxygen & CO2 necessary to sustain life…. it’s a big deal.  This situation is extremely taxing on your cardio-pulmonary system which is working over-time in an attempt to kept a minimally acceptable amount of oxygen flowing in the blood stream.  UH? What are we doing about this shit-ass IV I ask?  A call was in to the “IV team”, AKA as the only nurse in the building trained to start an intravenous line…. OK, so where the hell is she?  Every minute that the blood pressure assisting drugs & diuretics aren’t being infused into my dad the weaker his heart becomes.  He is a 59-year-old man dying from a first episode of CHF (congestive heart failure) which is a MANAGEABLE chronic illness.  This is bull shit.  I can start an IV on anyone.  Finding a vein to give another round of chemotherapy is my specialty.  Working as the manager of an in-patient oncology unit at Thomas Jefferson University Hospital I spent my on-call weekends helping staff start difficult IV’s for patients who had nothing left all day long.  I knew if that IV team nurse ever did show up, she wouldn’t be able to get a line in my dad, it was obvious.  I could have started an IV on my dad in 5 seconds, so why didn’t I do it? Why didn’t I demand that they call the anesthesiologist on-call up there to put in a major pipe, which is what was needed at this point? I have never had a problem advocating for my staff & patients in situations that were going south before, going above the heads of interns & residents, calling in “experts” PRN.  That was my job & I was very good at it.   HOLY SHIT this situation is going down the drain right before my eyes & I’m just standing there watching it happen  like a family member with a dying loved-one who is helpless to do anything about it.  Idiot.

By the time we get a doctor on the unit my dad is in severe respiratory distress.  They decide to transfer him to the “bigger” hospital in town, where they have real intensive care?  The ambulance drivers put him F-L-A-T on a gurney…. Uh, the man is gasping for breath, could we maybe put his head up?  At this point I fear that he will not survive the ambulance ride across town.  This is bad.  Miraculously Dad survives his ride with Tweedle-Duh & Tweedle-Dumb.  But, by this time his heart had suffered too much damage to recover.   What a relief  it was  to see a familiar & competent face in the surgeon who came to put in an AV (arterio-venous) line.  I knew him when he was a resident at the University of Rochester, same place I trained.  He successfully placed the huge pipes into my father’s chest so that he could receive the life-saving dialysis now needed because his untreated low blood pressure had choked the life out of his kidneys.   My dad’s situation had deteriorated from a moderate excess of fluid in the body, to a flooding of the lungs, to a failing of the heart, & now failed kidneys.  Multi-organ failure, kiss of death.

My father was a mountain of a man. Standing 6’2″ he was a giant to me as a child.  A football letter-man, professional firefighter, a big strong man, brave.  Now on a respirator, I knew he would never be rid of it. It’s sounds crazy, but he looked so much better after they intubated him.  Despite maximum dosing with Dopamine, attempts to raise his blood pressure enough to make dialysis possible failed.  Fluid is accumulating, flooding, drowning, a heart too weak to move it, lungs incapable of transferring oxygen to the diluted blood.  DOOM & DREAD.  I could have stopped this, now it was too late.  A day late & a dollar short.  Fail.

My dad never lost consciousness.  He endured one painful, futile, procedure after another in attempts to prolong what could have been prevented.  All of the tubes, lines, drugs & machines in the world could not aid his poor tired heart.  After three days of unimaginable suffering he “called it”  mouthing the words “no more”.  Sadly,  I was not there to say goodbye.  He died just minutes before I arrived that morning.  It was awful.