Sunday, July 13, 2025Tonight's picture was taken in July of 2007. Mattie was five years old and doing one of his favorite activities... bath time. When Mattie was a toddler, he hated water, and bathing him was painful. But by the time he was a preschooler, there was a transformation. I am not sure he loved bath time per se, but what he loved was playing with his cars and toys in the tub. His creativity would unfold in the water! This photo was classic Santa Mattie. He would give himself a Santa beard out of bubbles!
Quote of the day: Words are tears that have been written down. Tears are words that need to be shed. Without them, joy loses all its brilliance and sadness has no end. ~ Paulo Coelho
I could not get out of bed this morning. I think I finally got myself up at 8:45am! Unheard of in my house! Even Indie did not wake me up. Of course my mom got up early for some reason and was waiting for breakfast to be made. During my morning routine, I got a phone call from a nurse practitioner at the hospital. She basically said my dad was ready for discharge! Seriously this woman had no idea what she unleashed. I basically told her that unless my dad gets out of bed and we assess if he can stand and walk, I am NOT taking him home! There are no physical therapy evaluations over the weekend, so she was stuck waiting until Monday. But I told her, I would see her at the hospital when I got there and we would discuss this more! I did meet with her and she turned out to be a lovely woman. I explained to her that my anger was not really directed at her but to the system. A system which can't wait to push out patients, whether they are ready to go home or not! She understood. So tomorrow I await a visit from the physical therapist and my dad's rehab doctor. But I am prepared for my dad to be discharged and as always I am going to have to figure this out alone.
I told the nurse practitioner that I watch my dad throughout the day, but at night, I am not in my parent's bedroom. So in order to keep my dad safe and in bed, I have purchased a full side bed rail. This rail will prevent him from getting out of bed, until I am there and can safely monitor him. He won't like this change, but safety has to come first and I can't rely on my mom to oversee his evening care.
When I first arrived and went to my dad's room today, his nurse greeted me and handed me and my mom gowns and masks, because they have put my dad on contact isolation. My dad has a virus. He has had a virus since admitted to the hospital, but just today, they decided to classify him as having contact isolation. When Mattie had cancer, there were many times, he had contact isolation. Therefore gowns and masks were required. I certainly understood why his healthcare team had to wear these things, as they were going in and out of patient rooms, and they did not want to spread whatever Mattie had to other patients. However, I never wore a mask and gown with Mattie. Our life was chaotic enough, Mattie felt very different already, he did not need to see his mom and dad in gowns and masks. Only to emphasize his illness! We never wore them! If I did not wear them with Mattie, you can rest assured I was not wearing them with my dad. I am not sure my dad's nurse ever had family members outright refuse her request, but I did it without batting an eyelash. Later in the day, this nurse came back into the room, and I could feel her level of respect for me, as she heard me dealing with the nurse practitioner and advocating for my dad! She also let me know how sweet and kind my dad is.... indeed! What is very clear about my dad is he was and always will be a family man!
Switching gears, for two days, I have been working on a formal letter of concern to send to the hospital's ER director. I finally finished it and sent it off tonight. It is below. Do note that I changed all the names of people and the hospital for this blog posting.................................................................................................
Dear XYZ,
Thank you for this opportunity to share my recent experiences in your emergency department. ABC is our medical home. We live outside the beltway, but we have purposefully chosen your hospital because of your high standards of care and your compassion for addressing patient and family concerns and needs.
Our recent ER visit was deeply concerning and has given me pause about returning in the future. On Wednesday, July 9, I took my 90-year-old father to your ER. My dad lives with me, and I am his primary caregiver. My dad has Alzheimer’s, and I brought him to the ER because he had a 101 fever, chest congestion, a bad cough, and he was so lethargic that I had trouble getting him up to walk a couple of feet. Given that these symptoms came on quickly this week, I consulted my dad’s primary care physician by phone. He said it was important that I take my dad to the ER to rule out pneumonia.
I have outlined below my concerns and timeline using bullet points. Overall, I believe my dad fell while at home on July 11 at 2am, because he was ill and he was discharged from the ER prematurely (July 10, at 4am) and against my wishes. If my dad had been admitted to the hospital on July 10, he would not have fallen at home, and his recovery would be more manageable. Now we are not only dealing with the symptoms he presented with on July 9, but we are also dealing with a fragile 90-year-old who has hurt his back (thankfully he did not break a bone), is in pain, and any movement causes him great discomfort. The fall was a major setback, and it was indeed preventable.
July 9-10
- My dad entered the ER on Wednesday, July 9 at 9pm.
- The ER was not busy, and we were brought back to Room 20 within 30 minutes of our arrival.
- Thankfully I have access to my dad’s patient portal, because I could easily follow along with tests being ordered and see results in real time. I am not sure what families do without portal access. I say this because it was hours before we met Dr. WOW, the ER physician. Note that we only met with her because I asked for her to come to our room as I wanted to hear from her about my dad’s condition. In previous ER visits, we were always introduced to the physician almost immediately. Since the ER was not busy that night, there was no reason Dr. WOW was not able to visit with us sooner.
- Families come to the ER scared and concerned and with a 90-year-old even something minor can be a major health issue. In addition, it would be my hope that primary caregivers are considered valuable members of the healthcare team and therefore our observations are valued and taken into consideration. Not only did I not feel heard by Dr. WOW, but I also felt she had a condescending attitude, as she implied that having my dad admitted to the hospital would be committing insurance fraud. Who says this to a primary caregiver? Believe me, if my dad did not have to be in the hospital, I would not be at ABC. I took my dad to the hospital because he needed medical attention. Dr. WOW is all about the data, sticking to rigid admission criteria, and has therefore forgotten that patients are greater than their test results. The whole patient must be evaluated and considered when making sound medical decisions.
- On July 10, at 4am, my dad was discharged from the ER because Dr. WOW felt my dad did not meet the criteria necessary for hospital admission. She had no regard for the fact that I did not feel able to care for my dad at home in his current depleted state. I was left to figure it out and I told her I had a feeling discharging him was a mistake and we would probably be right back in the ER. Our family and friends asked me…. Who would discharge a fragile 90-year-old at 4am? They are not medical professionals, but even they immediately saw the problem with such a decision.
- Once we returned home, I monitored my dad’s vitals every four hours and shared this information with my dad’s primary care physician.
- On Thursday, July 10, I had the opportunity to talk with my dad’s primary care physician. He gained access to all the ER assessments, reviewed them, and shared my concern about being prematurely discharged. He felt that there was enough evidence to merit a hospital admission. But then again, this physician evaluates the WHOLE patient, not just the data.
July 11
- At 2am, my dad fell trying to get out of bed to go to the bathroom.
- After calling 911, six paramedics arrived and helped me get my dad off the floor, down the stairs, and into an ambulance. They wanted to take my dad to another hospital system. However, I refused that option. I wanted my dad back at ABC for two reasons. First, my dad endured extensive testing on July 9 and 10 at ABC and I did not want him to have to go through this again at another health system. Second, I believe it was important for your ER to see firsthand that it was the wrong decision to discharge my dad on July 10. My dad was clearly physically depleted, weak, and unable to function. His symptoms came on acutely, he was not acting like himself, and they significantly impacted his physical abilities.
- When we arrived at the hospital at 3am, I explained what had happened to the ER nurse, and I also told him that this time, we were not leaving your hospital until my dad was admitted.
- We waited from 3am to 7:30am, when a change of shift occurred. The change of shift made all the difference in the world. We went from the D team to the A team. The health care team was listening to our concerns, and Jay (our nurse) could hear how distraught we were, so he sent in Jasmin and then Chrissy to talk with me about my experiences. Chrissy promised that an investigation would be carried out, but I wanted to put these issues in writing.
- My dad was admitted to Room 505 on Friday at 3pm and remained in the hospital over the weekend.
In addition, I wanted to share my observations of listening to and enduring another patient’s issues while in ER room 20. On July 9, there was a young adult who was in a hallway bed right outside my dad’s room. She was clearly going through withdrawal from drugs. She was agitated, crying, hysterical, demanding drugs, and wandering around. I found this so upsetting as I did not know who to focus on first, my dad or what was going on in the hallway. I have no doubt other patients and families were facing vicarious trauma from listening to this for hours. Naturally patients addicted to substances need compassionate care, but this care needs to be in a different location within the ER, where other patients do not feel threatened by what is happening outside their ER room. I experienced this same issue during our April 2025 ER visit, but this time the issue seemed ten times worse.
In closing, I would like to hear how this information will be relayed to Dr. WOW and all your ER physicians. Patients and families come to you for help. No one knows their loved one better than their family, and the insights and concerns of family caregivers must be considered when making healthcare decisions. Older adults are the foundation of our society, and I expect the healthcare institution that I choose to care for my parents to value this greater generation and partner with me to ensure not only their medical health but their overall quality of life.
The medical data may indicate one thing, but even a minor virus can be deadly for an older adult and their well-being and safety to return to the community should be part of any ER assessment. There was no regard for my dad’s safety or my own when he was discharged on July 10 at 4am. Many thanks for your time and attention to my letter. I look forward to hearing from you about my concerns.
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