December 21st, 2018
By Natan Schleider, M.D.
A few years ago, I met Rick B (name changed for privacy) at the Lenox Hill Hospital Emergency Room in New York City at around 3-4 am. Rick had severe arm pain and tenderness and I was concerned about necrotizing fasciitis, a deadly bacterial infection that can simply put eat through your skin and cause blood poisoning (septicemia). I had prescribed Rick Ketorolac (which is like super strength Advil–it is not addictive) but the hospital’s pharmacy was not delivering it and Rick was writhing and crying in pain. So I gave Rick his ketorolac, documented all this in the chart and told ER staff, and was pleased to see Rick feeling better.
Later that day, the chairman of the hospital, Jill Kalman, MD, called me. She was furious and short with me on the phone, stating I had put her hospital at risk by giving the patient a medicine that had not come from the hospital pharmacy. I apologized and Dr. Kalman’s response: have security follow me around all day (including into my patient’s rooms) to ensure I did not give patients any more medicines. Neither I nor the security guard (nor the patient) had experienced anything like this.
When Rick said he wanted to go home after the day’s testing confirmed nothing serious, I was happy to discharge him immediately.
The above true story is one of several that remind me why I try to keep patients out of the hospital at all cost. I no longer admit to Lenox Hill Hospital.
You don’t need to be a genius to realize if the hospital does not have the exact medicine you need in a timely manner, is it not reasonable to use your own? The US National Library of Medicine Patient Safety Guide suggests this is reasonable: https://medlineplus.gov/ency/patientinstructions/000501.htm
Prior to Rick’s admission, I admitted a pleasant 90 year old woman, BD, who had never been in the hospital before (except for childbirth) with pneumonia. BD had barely been in the emergency room for an hour before the hospital staff determined that BD should be immediately put on hospice and put out to pasture. BD’s daughter, her health proxy, greeted me with tears in the emergency room saying she felt quite bullied.
My personal experience tells me most patients over 90 with a serious health condition are likely to be pushed toward hospice or palliative care rather than normal care. I understand prognosis in the elderly is poor and many intensive care units are over filled with nonagenarians. That said, patients have a right to comprehensive medical care and if that means it will take a miracle to cure them, visit the local chapel or synagogue, find a good doctor, and provide your loved one with the best care indicated.
BD spent 3 days in the hospital and ultimately died of pneumonia but the family has no regrets, at least they tried.
Thanks for reading,
Dr. Natan Schleider, M.D.