Savanna-la-Mar Hospital crisis: how many more will we lose?
On March 5, 2016, at approximately 6:52 a.m., the call came from Cornwall Regional Hospital. Being a registered nurse for more than 15 years, I knew exactly what that call meant. My life, as I knew it, had changed dramatically because my mother and most trusted friend had died.
On February 28, my mother complained of loss of appetite and nausea. She subsequently started having vomiting and diarrhoea. She visited her private doctor on Monday, February 29 and was given oral antibiotics, anti-emetic (Gravol) and sent home to continue oral fluids.
I was most annoyed with this management, so I insisted that she return to the doctor and that she be given Gravol intramuscularly and at least 500 millilitres of intravenous infusion to help with her dehydrated state.
She was given the injection and sent home to have oral fluids. I spoke with her Tuesday night and when I called on Wednesday morning, March 2, she was unresponsive.
She was immediately rushed to Savanna-la-Mar Hospital, which seemed the best option at the time. Not living in Savanna-la-Mar, I kept in touch with relatives on my way down to ascertain what was happening. When I called, I was told that she had received eight bags of fluids (500ml) and she still was not talking. I asked how much urine she had passed, and the question was asked, 'Passed from where?' I asked in horror if she had a urinary catheter in place and was told no.
Her abdomen was now distended, which it wasn't prior to coming to the hospital, and there were signs of fluid retention in her face and hands. I immediately instructed my relative to ask the nurse or doctor why she did not have a urinary catheter. I was told that was passed about a half an hour later. She received at least 12 bags of fluid while in the Accident and Emergency Department.
When I got to the hospital, her blood pressure (BP) was very low. Her oxygen saturation was fluctuating between 70s and 80s. However, she started talking after I got there. She was reviewed by the medical and surgery team in A&E, who were quite cagey about their diagnosis and management. She was admitted to the female medical floor on Bed 24 later that evening and, for the duration of her stay, this is how she was referred to - as Bed 24.
I have heard stories about the medical care meted out to patients at this hospital but I never imagined, in my wildest dreams, that it was this bad. My mother came to the ward with a systolic BP in the 70s and a diastolic BP in the 40s. She was being given oxygen, she was NPO (receiving nothing by mouth), she had a urinary catheter and IV fluids. Her face, arms and legs showed signs of fluid retention.
She was placed some distance away from the nurse's station, not before the nurse's station where critically ill patients are supposed to be nursed, and to make matters worse, she was assigned to an enrolled nurse. I did not sleep the entire night because my fear was that her BP was so low and there would be no vigilance in monitoring it.
On Thursday, March 3, when I returned to the ward, my mother's IV fluids had run out, with the fluid moving down in the IV line, and she was being given antibiotics that she was not getting because the IV site was leaking. She was receiving dry oxygen as the distilled water was almost finished in the humidifier. I went to one of the nurses to find out who was assigned to my mother so as to ascertain her BP readings and to inform her of my findings. She informed me that all the nurses were assigned to her and the nurse who did her BP had already left, but she would check and let me know. She left without doing so.
What she did do, however, was to alert the doctor that the IV access for the antibiotic needed resiting. It took 45 minutes for the IV to be resited on the critically ill patient who needed the antibiotic and, in the end, it was done by staff visiting from another area.
It got even worse when my mother, who was NPO, was being offered a meal, and when I asked the nurse who was assigned to her whether or not she was NPO, she said she would have to check. There is no sign that said NPO and no obvious fluid balance charting.
A medical intern on the ward came to remove an IV access. After removing it, she left to wash her hands. When I looked, my mother's hand was bleeding because she did not pressure-bandage the area. After raising an alarm, a nurse came and did what should have been done.
I left the ward that night upset but was heartened by the fact that my mother was talking and appeared to be doing better.
I got back to the ward on March 4 at approximately 6 a.m. When I got there, my mother was gasping for breath and she appeared even more swollen than before. I called to the nurse and said my mother needed oxygen. She said to me, "I soon come," and continued writing. I found the oxygen mask hanging from the oxygen cylinder and touching the floor, so I grabbed my mother's wipes, cleaned the mask, put it on and started to give her oxygen. I started counting her respiration and the nurse passed and saw me looking at my watch and said, "Tell me what yuh get when yuh finish." I was crazy angry at this point.
At approximately 1 p.m., the consultant told me my mom was to be transferred to Cornwall Regional Hospital (CRH) to be dialysed. She stated that all contacts have been made and CRH was prepared for her. She went on to say that my mother's blood glucose level is so low right now, she could die.
When my mother got there, she responded to her name but could not speak. I later learnt that not only did the CRH doctors not know to expect this critically ill patient, but no documents, except the referral, accompanied her; no X-rays, no blood results, nothing. So I watched the doctors use the precious time to do X-rays, ultrasound and blood tests just to help them understand what was going on.
But with all their efforts it was too late. I stayed and watched her until almost 2 o'clock in the morning. I left and went back to Savanna- la-Mar. Then, at 6:52 a.m., the call came.
But the story does not end there, because now the cause of death was uncertain. So, a post-mortem had to be conducted. This, I hoped, would lay all my unanswered questions to rest. But did it? The cause of death, according to the pathologist, was aspiration pneumonia, episodes of vomiting, and acute gastroenteritis. Huh! According to the pathologist, the only abnormality found was vomitus in her right lung. Really? All the fluid retention had seemingly disappeared. There was no report of fluid retention anywhere. What had happened to all that fluid in her lungs?
Then the funeral parlour reported that during, and even after, embalming her they had a fluid issue. Her body felt like sponge. Every time they tried to handle her, fluids ran out. Wow!
Is this new? Absolutely not. Are there many stories like mine? Yes, there are. What is the Ministry of Health doing about Sav Hospital? Is it health care for all or only those with connections?
There must be greater accountability on the part of the persons entrusted with our care. Dr Christopher Tufton, minister of health, and Dr Lundie Richards, who has direct responsibility for hospitals and clinics, must move assiduously to cauterise this problem. There must be persons at the local level to bring pressure to bear on the first-line management.
My mom's death must not be in vain.
Jennifer Savariau Morris