10-9-08

06:00 Checked in to admissions

08:10 Went back for surgery

09:00 Came out of surgery.  The surgeon talked to us in a family room and said the surgery went well, that he got out 200-250cc’s of fluid that looked clear. (I wondered where the rest of the half a gallon was. I figured that we would see the doctor later on and would ask him then, or I thought that more might drain out from the chest tube) We were told we could go on up to his room. He moved himself over from the stretcher to the bed. He didn’t seem to have any problems doing it. His foley cath bag had some yellow urine in it with a red tinge to it that the nurse said seemed to be clearing up. (I figured that they might have done some trauma placing the foley and that’s why there was blood in the tube) The “Pleur-evac” only had about 300ml of blood and clear fluid in it. He said he felt nauseated and threw up in a basin I handed him. They gave him some medication for nausea and after a few minutes he felt better. Everywhere they had put tape on his face to hold the tube in place and where they had taped his eyelids shut was purple, like a bruise and was bleeding. One of the nurses said that an OR tech had ripped the tape off of one of his eyelids and it tore the skin and it was bleeding. He looked like he had been beaten up. After he started feeling less nauseated he ate some ice chips, then a popsicle, and then some jello and drank some water. He talked while he ate and seemed to be feeling good. After that he had laid down and went to sleep. During this whole hour they had him on a portable vital signs machine that they periodically came in to take his vitals. I don’t recall what they were initially, but they were stable enough that they took him off of it and turned off the machine, but left it in the room. 

Approx: 13:00 My grandma and I went to go get something to eat. My mom and aunt said that after we had walked out of the room, he began complaining of pain. The nurse came in and gave him some pain medication in his I.V. My grandma and I were gone for almost an hour and by the time we got back, which was 14:00 he was still complaining of pain. It worsened by the minute and he was trying to get up out of bed to sit up. My grandpa punched the call button and asked for the nurse to give him something for pain. The person answering the call button said she would tell the nurse. They told us a few minutes later that it was too soon for him to have anything because it had only been almost an house since the last time he had had anything. My grandpa tried to stand the pain, but it got worse and he began hollering and begging for something and still trying to get up. He said that it hurt in his chest and left shoulder. My mom and I went back out to the nurses station and asked the nurse if she could call the doctor and ask if he could have anything else or if she would at least come and look at him, that he was coming up off the bed. A few minutes went by and she came in and watched him for a minute and asked him where and how it hurt and then said she would call the doctor to see what he wanted to do. 

14:25 It was twenty to twenty-five minutes before she came in with 3mg of Morphine and gave that I.V. During this time my grandpa began hollering loudly in pain and began praying. He was hurting so bad. They had already hooked him back up to the vital sign machine (I don’t remember what the pressure was before I began dropping, but as soon as she gave the Morphine, it dropped into the 80’s/40’s and then into the 70’s/30’s and 40’s.) She put him in trendelenburg position and increased the rate on the I-med pump that his fluids were running in. She didn’t run them wide open, but just increased it. About thirty minutes later, Approximately 15:00, they hung Albumin. I noticed that his foley bag still didn’t have but 30-40cc’s of urine and it was dark. I thought it was odd since he had some fluids that it hadn’t increased. His pressure kept dropping or staying in the 70’s/30’s and 40’s. They increased the amount of fluids and albumin being ran in again. My aunt and I discussed the seriousness of it and I told her that I wasn’t worried and that if I was I would be standing on my head. I thought they should be able to get his pressure to come back up with the increased amount of fluids being ran it. I told her to just watch his breathing and make sure he was still breathing. He would drift in and out of sleep. It was approximately 15:40 when he started hurting really bad again and was trying to get up out of bed. The nurse had just walked out right before that and a nursing assistant was there and asked him if he needed anything and he told her that he was hurting and it was hard to breathe and he said he had to sit up. She went to ask the nurse if it was ok. When she came back she started taking the bed out of trendelenburg. I told her I didn’t think that was a good idea because of his pressure, but she wouldn’t listen and kept doing it anyway, and as soon as he sat up his pressure went to 60/29. I didn’t wait for anyone to come into the room, I started putting the bed back down flat apologizing to my grandpa and telling him that his blood pressure was too low to sit up. He was lying there flat half asleep as my aunt and I were talking. I told her just watch and make sure he kept breathing because I was afraid his heart would stop with a pressure that low. I had just said this to her and looked over at my grandpa and I didn’t see him breathing. I jumped up from my chair and got right next to him and said; “Pa!” He opened hi eyes and said; “Huh?” and I told him that I was just making sure he was okay because his blood pressure was so low. He said "okay".

Approximately 16:00 All of a sudden, as I was standing there, another nurse came in an started finishing putting the bed back in trendelenburg position. I moved out of her way and several other nurses came pouring in with more fluids, Dopamine, and a crash cart. They started more I.V.’s and ran the others in wide open. My family started crying and was scared. I looked at my aunt and told her that she could start worrying now because I was. The nurses explained what they were doing and told us that they were moving him to CCU and that we could go on down there and wait in the waiting area until they got him stabilized. They said someone would call us and let us know. (During the whole time that this was going on from 13:00 until the time they took him to CCU approximately 16:25 we never saw a doctor or anyone but nurses (his nurse was an LPN) and a charge nurse in the room. He never got an EKG, never had blood drawn to see if he was having a heart attack, and never had an x-ray to see why he was having trouble breathing) We were in the waiting area for an hour before we called to check on him because no one had called us or came to talk to us and they said they were still trying to get him stabilized. This was at approximately 17:30. We called back again at approximately 18:00 and they said that they still hadn’t gotten it stabilized and that they were calling the doctors in (We couldn’t see what was going on in CCU, but did they wait until 18:00 to call in his doctors? Why? There wasn’t anyone available from 13:00 until 18:00 after a person has had this type of procedure and complaining of chest pain and shortness of breath?!) Approximately sometime between 19:00 and 19:30 the cardiologist came out to talk to the family. He said that it didn’t look good. His pressure was still dropping and they had him on fluids and vasopressors to bring it up and that he had developed this purple rash all over his chest and shoulders and neck. We tried to explain to him the he bruised easily and anywhere you touched him he would turn purple like the tape they pulled off of his face and eyelids. He seemed to think it was worse than that and that he was literally leaking blood into his skin and he thought that he had an endotoxin. I disagreed stating that he had been fine before, during, and after the surgery and that I didn’t believe it was an endotoxin and also stated that he didn’t have any fever. He agreed with me that he didn’t have fever and thought the he should but that they just didn’t know why his pressure was dropping and that was the only thing they could think of and I asked if it were possible to have gotten the endotoxin (if that actually was what had occurred) from the fluid that came out from the pericardial fluid when they drained it. He didn’t seem to think that it would have since the fluid was clear. (Funny to me that he disagreed with me on this right there in the family room, but when I read his progress report he himself actually questioned if it were possible that the endotoxin might have came from there, but didn’t know until lab results came back. To me, they didn’t have a clue.) He also said that the bronchitis that he was just getting over might have all of a sudden relapsed. He was drawing blood and sending off samples for cultures and starting him on antibiotics and also said that his kidneys didn’t seem to be functioning. That he had only put out 30’40cc’s all day and that it was looking dark. He was going to send that off for a urinalysis and cultures as well and thought he might have a urinary tract infection. I told him that I had been with my grandparents for the last 19 days and that he had not had any urinary problems that I knew of the whole time I had been there and that he pee’d fine and frequently or hadn’t had any fever. He said that they would start him on a lasix drip to try and get his kidneys to start functioning again. I asked him if he could give me a 50/50 and he said that he wasn’t good at that sort of thing but that I was very bad. We went in to see him not long after that. He seemed puffy around the face and neck and he didn’t even sound like himself. His voice was deep and hoarse like he had a terrible cold. He was hollering in pain. We all hugged him and cried telling him how much we loved him. He told us how much he loved all of us and my dog. He said he should’ve just stayed home. He was having trouble breathing even though his O2 sats were good and they sat him up a little and he felt a little better. He was moaning in pain the whole time and nauseated. His pastor came in and prayed with him by his bedside as my grandpa raised his arm up in praise. The pastor later said that he felt “the peace” in the room and he knew, although he didn’t tell us, that my grandpa was going to die. I didn’t feel any peace, just fear. Confusion.

Approximately 22:00 they had gotten his pressure back up around 114 systolic. He had seven different bags of fluid hanging and an art line. My boyfriend and I went in to see him. He smiled and said hello to my boyfriend. He was lying on his right side and was cold, so we covered him up. I told him I was going to go out and let him rest.

Approximately 00:00 his pressure was in the 120’s systolic. My mom and I went in to check on him. He seemed to be resting more.

02:30 I went back in to check on him and he was asleep on his side with his arm hanging over the rail. I didn’t want to wake him so I talked to the nurses. They said that he did have a urinary tract infection and they were still waiting on all of the other cultures to come back. (Again, who am I to doubt that he did or didn’t have one, but he wasn’t complaining of any urinary problems the whole time I had seen him the last two weeks every day. He had even been on antibiotics for his cold (not sure if they would have prevented a uti) I don’t understand how his urine was clear and an adequate amount when he came in and turned into a dark bloody infection within two to four hours after surgery.)

I went back in the conference room that we were staying in down the hall and laid back down on the floor to try to rest. The next morning my grandma and aunt and mom went at different times to go in and see my grandpa. They would all come back crying. His blood pressure had dropped or he still hadn’t produced any urine. I had to make several phone calls and got several phone calls, had to make a breakfast run for.

It was approximately 11:00 when one of the other surgeons came in and talked to us and said that he was still very very sick and if he even made it through this that he would probably be on dialysis. They still weren’t sure what was causing his pressure to be so low but were waiting on some lab results. Because of all the fluids they had running in him all night and because he wasn’t producing any urine he had gained 14lbs over night. It was maybe 15 minutes or less after that surgeon has talked to us that the initial cardiothoracic surgeon who performed the surgery came in and said that he was still very sick, but that he thought that he was going to be fine. He said that he thought he would get a room in a day or two and go home in a few days. We were surprised to hear him say that and told him so after what the other surgeon who had just spoken to us said, but he still said he thought he would be fine and would start producing urine on his own after he go the lasix drip. (They were supposed to have started the lasix drip when the cardiologist mentioned it the night before. Why had he not had it all night? Maybe he would not have been over loaded with fluid if they had started it the night before. Why did they wait?) He asked us who put in the pacemaker and we told him that his previous cardiologist, the one before the one we he had now, had put it in.  He wanted to know why they had it set so low and we said that that was the way they wanted it and told us that they had it set so that his heart rate would never get below 50 ( the reason they had put it in is because his heart rate had gotten as low as 33 beats per minute) and that his heart would beat on its own but would kick in if it got below 50 and also had it set not to ever go higher than a certain number (I had forgotten what amount it shouldn’t exceed) because he had also had episodes of tachycardia that would last for about 15 minutes and the pacemaker would keep it from going too fast. He told us that the rate of the pacemaker was set too low and that one of the leads were not correlating with one of the other leads, and that was one reason why his blood pressure was low all the time and that they had turned his pacemaker off and his heartbeat picked up allowing his blood pressure to increase. Then they had set it to beat in the 90’s. I told him that he had just had his pacemaker checked over the phone a week or so ago and it checked out fine. He said that we would worry about the pacemaker later. (Why did the previous cardiologist have it set that low and if it was too low why didn’t the cardiologist he had now ever have it reset? Did this contribute to his kidney failure/function from lack of blood flow, or to his being weak all the time and short of breath on exertion? Why did they let this happen?) He also said that his kidney function was not so good, and told us that his creatnine level before he even had the procedure done was a 2 and it was supposed to be a 1 and this morning it was a 2.4. I reminded him that he had told us that day in his office that all of his lab work was fine. He said, “Well, yes, but normally this wouldn’t have any effect on a person having this type of procedure. It just wasn’t a concern.” I said, “so, since he was given pain meds, and it dropped his blood pressure, and his pacemaker wasn’t working properly enough to keep his blood pressure up anyway, then could that have shut his kidneys down?” He said something to the effect of “maybe” but they still weren’t sure because they didn’t know why his pressure continued to stay low even with all the fluid they were giving him. (This was before we got the autopsy results that the cause of death was a punctured lung) (If his creatnine was so bad for so long, shouldn’t they have been working on that? They knew he had blockages in one of the arteries to his kidneys, but didn’t want to do the surgery or put in a stent in 2004 because of his heart problems and it was a rough surgery, but was the creatnine level high because of this or something else? Why weren’t we informed? And if they didn’t think he could make it through that surgery way back then, what made them think he could make it through this one and was it warranted enough to have it?) I asked him, “So, since his creatnine was a 2 before the procedure and since you only got out 250cc’s, would you have done this surgery?” His answer was “No, I would not have.” I asked him where the rest of the half a gallon of fluid was and he said that he and the cardiologist were in a discrepancy over the amount. He also told us that the fluid they got out of his heart was a little cloudy and again I reminded him that when he first talked to us right after the surgery he had told us that it looked clear and he said; “Well, yeah, but it was a little cloudy.” He also told us that during all of this that my grandpa had had a heart attack because his troponin level was an 8, which he said was not very high, but that there was some damage to the heart muscle. (I know that from working in the ER a troponin of 8 would have been considered very high, so why did he say that?) He said that the heart itself was functioning fine and when he took the “sucker” and ran it around inside the pericardium he didn’t see any abnormalities. “So, I said; when he was hurting really bad in his room when they had to give him the pain medicine he was probably having a heart attack?” The surgeon said that it could have been then, but it was sometime. (When did they draw lab to check the troponin? How long was it after the first initial chest pain at 13:00? Not until he got to CCU hour later.) He also told us that his chest tube, they saw on x-ray that morning (the morning of the 10^th) was a little too high up and curled up and had probably drained all it was going to (which at that point was still only 300ccs in the pleur evac) that it could come out because he didn’t need it any more, so they were going to take it out sometime today. (When did they actually do the x-ray? Did they do it on the evening of the 9^th and not read it until the next morning? Did they do more x-rays throughout the night and the morning of the 10^th also? If they had done an x-ray after tube placement, then they would have known that the chest tube was in the wrong place and curled up in the OR and replaced it and it would have been draining properly. They could have corrected it then. If they did an x-ray the evening of the 9^th then they should have known that sooner and already had the chest tube corrected or taken out. When did they do and when did they actually read the x-rays?) They were going to start giving the lasix drip and start trying to wean him off of all the vasopressors and try to keep his pressure up. My mom had gone to see my grandpa before the surgeon came in and caught about half of the conversation. When he was finished she got me and told me that I needed to go see my grandpa because he was asking for me and told her that he just couldn’t take nay more. I didn’t think that he meant in the capacity of he just couldn’t live any longer, but that he just hadn’t seen me yet and he just wanted to really bad. I went in and they had him sitting straight up. His heart rate was 91 and he was breathing fast. He seemed to be breathing better than he was the night before but he was very pale. He was still very nauseated. He wanted to hold my hand. His hands were swollen from all of the fluid. I told him I thought he looked better and he said; “Oh, you don’t know how I’ve suffered.” I told him I loved him. He said that he had so much pressure. I told him that the surgeon said that he was going to take the chest tube out today and he asked me if it would relieve the pressure. I told him that I thought it should. (When he said “pressure” I didn’t realize that he might have meant pressure in his chest. I actually thought he meant pressure because of all the fluid build up and his skin being tight because I thought surely they have done x-rays and know whether he has bleeding in his chest or not) I went to the nurses station and got a piece of paper and wrote him a note explaining to him that I didn’t want to say it out loud so just to read it. I wrote that the surgeon had admitted that they were wrong about the amount of fluid, there wasn’t as much there as they thought there was. I told him that there was a lot more and that we would talk about it later. He read the note and just looked straight ahead. He never looked at me. His male nurse came in and asked who we were. We talked and told him that the surgeon had told us they were taking out the chest tube and he said that the surgeon hadn’t said anything to him about it and he couldn’t take it out without a Dr.’s order and we told him that we had just seen him and he said that he was taking it out. Just then the surgeon walked through the door and he asked him and he said, “Oh yeah, you can do that.” (Since when do nurses remove chest tubes? Especially with someone in this bad of a condition?) He looked down to see how much fluid was in the pleur evac. It was still only 350cc’s. The nurse gave my grandpa something for nausea and a pain pill. After a few minutes my grandpa dozed off sitting there. We didn’t want to wake him up so we left and told the nurse to let him know we would be back. We never got to see him alive again. 

12:55 A nurse came in the conference room where we were at and asked for the nearest member of the Hipp family and said that if we would like to pray it would be a good time to do it because they just took the chest tube out and his heart stopped. I wanted to scream and yell, “No!” but instead I bowed my head. I knew this was it. My heart rate was very fast. I said a prayer to God to accept my grandpa into heaven and to take care of him. I jumped out of chair and headed down the hallway. I wanted to be there with him. I had the strange idea that maybe his spirit was still hovering in the room and I wanted to make sure he could hear me and saw me there with him. Before I even got to the end of the hallway the nurse and the other surgeon was coming out the doors. I knew he was dead. They stopped me and asked me if I wanted to go in and let them talk to us all and I told them I just wanted to go. Again they asked me if I was sure I didn’t want to hear them and again I told them no, that I just wanted to go. They told me to go ahead. I pulled back t he curtain and the male nurse and another nurse were still cleaning him up when I came in and told them it was ok (in other words I wasn’t waiting until they got him cleaned up). I went over to his left side where the chest tube had been and could see that it was gone and a larger hole than the one used to make the chest tube hole was there with tissue hanging out. (Why was the hole larger? Did they cut him open to see where all of the bleeding was coming from?) I ignored it and went up to my grandpa’s head and put my arm around the top of his head and one across his chest and put my head on his and said; “Pa, I’m sorry” over and over. I don’t recall what or if I said anything else directly to him. I just stayed in that position for minutes and wept silently. One of the female nurses put her hand on my back to comfort me. Instead of being mad that he was dead, because I felt that it had happened unnecessarily, I just began to tell the nurses what he meant to me. I told them that he was my best friend. Not just my grandpa, but my best friend. I told them that he raised me and that we did everything together. We went fishing and hunting and that he was my whole life. That he had always been there for me. While I was telling them, the other surgeon came in and asked me if I wanted him to explain what happened and I said I did. He said; “I don’t know what happened. He had been complaining that he couldn’t breathe (Again, did they do an x-ray and find out why he was having trouble breathing?) and we pulled out the chest tube and a large amount of blood came out, I’m not sure from where, and his heart just stopped beating. We tried to get him back, but we couldn’t. I asked him if it was possible that they cut something during the surgery and he said it was, but that he didn’t know if that’s what it was or not. He told me that we were welcome to have an autopsy done and that they would do it there at the hospital. He said he would actually like to see what happened himself. I told him that I would like to but I would have to see what my family would want because he said it would have to be up to my grandma to make that decision and for me to talk to them. The nurses were still cleaning him up while we talked. I noticed that someone had covered up the hole in his chest. His legs were still spread out across the stretcher, one on one side and one on the other. Where they had had the arterial line and other lines in his neck was swollen and bulged out with blood and the skin had actually separated like it had been split open. His chest along the collarbone on the right side was the same. His eyes were shut and his mouth open with yellow vomit still clinging to his tongue. The nurse asked me if I would go back and talk with my family about whether we wanted the autopsy done or not while they still worked on cleaning him up so they could let the family see him. She told me that if the hospital requested the autopsy, as they were doing, that we wouldn’t be charged for it, the hospital would pay for it. My grandma agreed to have it done so we could know exactly what killed him. We knew that he didn’t just die. They were supposed to do it that evening and send the body to the funeral home later, but by the next day, he still hadn’t arrived and we were told that he had gone to the state crime lab (It turned out later that the person performing the autopsy in his own private facility from what we understood and is a Forensic Pathologist who also works for the state crime lab) (Why was he the one that did the autopsy? Did one of the other Dr.’s order it because he thought it was another Dr.’s fault? Not everyone who gets an autopsy gets one like this in this manner.)

Since we got the autopsy results and have had medical/legal counsel speak with the person who performed the autopsy who says the cause of death was due to a punctured lung that happened during the procedure. He had 1000cc’s of blood in his lungs upon autopsy. I and my family know that what happened should not have happened and there were several things that could have been done to prevent it and/or possibly correct it and none of them were done in a timely manner and as a result my grandpa suffered and died. 

Our family has not been the same since and blame ourselves every day for not being more aggressive in asking for better care than what was given during my grandpa’s entire stay. It is standard care to do an EKG, X-ray, and labs on a person with chest pain, especially after a surgical procedure and no reason why a physician shouldn’t have been available and present during the onset of his symptoms. I know that what happened was not that hard to have figured out if the proper steps had been done to do it. Surely the physicians who worked on my grandpa and have been in that field for years knew what was going on and if they didn’t then maybe they need to change careers. Our family would ask that you take a look at this and do anything you can to keep this from happening to anyone else. A simple, “I’m sorry…we made a mistake” would have made a difference in us reporting or not reporting this instead of placing the blame on one another or chalking it up to my grandpa was old, but that has never happened. My grandpa was old, but that wasn’t what killed him.

As many of you know, I did present this case to several different law offices, and a medical/legal nurse that I knew, all of which said that something definately did go wrong.  It took me a year and three days to find someone though that would take the case.  They had their own medical/legal staff that poured over his medical records agreeing that there were several things that didn't add up, mistakes that were made, documentation not done in a timely manner, tests not performed that could have reversed the outcome had they been done sooner, and questions unanswered.  They began trying to find an expert cardiologist that would speak against these surgeons and cardiologist, the medical staff and the facility itself, but not one cardiologist would speak against them, despite all they found.  The lawyer we had, said she tried her best to find someone but she couldn't get anywhere with it.  She told us that she knew herself that something went wrong and that we had a good case, but she was sorry that she couldn't devote any more time and money to it, but that we were welcome to try someone else and she would even reccommend someone, but our family didn't want to persue it.  We had tried our best and the system failed us.

So, in writing this, I urge everyone to know what is going on if you or your loved one ever has to have a surgery.  Even if it is a simple one.  Ask questions.  Know prior to the surgery what tests need to be done and find out about lab values or get in touch with a friend who is in the medical field and ask if you can call them if you have questions.  If you think something is not going right, question the doctors and the nurses.  Write down their names, the times that things occur and what tests if any are done and find out the results.  I was in a medical field and I knew enough to question, but I was afraid of being assertive when I thought that things weren't going right because I was afraid it would cause more problems.  I wish I had asserted myself and not cared if it made the medical staff mad or my family.  My grandpa is dead today and the thoughts that I could have at the very least demaded that he had gotten that EKG and lab draw when he started having chest pain makes me mad at myself. We could've gotten him transferred to another facility.  You don't know what hasn't been done until it's too late, like the chest x-ray and the autopsy that showed blood in the chest wall cavity from him bleeding out.  I was told by another physician that anyone who has just had any type of heart surgery, even as minor as my grandpa's was supposed to be, and having problems like their pressure dropping should've been sent right back to surgery because the thing it points to the most is blood loss.  So, know all you can about what surgery is being done and the complications that can arise from it. Make sure the proper people (yourself if you want to be able to know anything or make any decisions) are on that patient's HIPPA list and that it is okay for you to have access to their records or know anything.  Without your name on that list, you won't be told anything (unless someone else on the list tells you) or be able to do anything for that person unless the person on that list consents to it.  Know your stuff.  I hope anyone don't ever have to go through what we did.