So, you think that if you go to a good hospital, with sufficient insurance, you can assume that the care provided is sufficient to cover the illnesses that you have. You would be mistaken.

Yesterday, we had a call for an eighty year old female who was going home, back to her nursing home, after being admitted to Rush University Medical Center since Thursday. Initially, she was sent to said hospital due to bleeding, but when she arrived, they specifically noted in her chart that she had was hypoxic. Hypoxia means, essentially, that one does not have enough oxygen in their blood, and therefore the blood is not transporting suffient oxygen to the body's other tissues. There is a simple fix for this condition: put the patient on supplemental oxygen until he or she has a higher (between 95 and 99%) oxygen saturation. That may seem to be a temporary fix, and it is. Usually there is an underlying condition which is causing the hypoxia, such as any of the myriad respiratory conditions that are caused by smoking for a lifetime. In this particular patient's case, she admitted to having been a smoker for greater than twenty years, and was diagnosed with several of the previously mentioned respiratory conditions, the most serious her conditions was congestive heart failure. This means that her heart is not pumping forcefully enough and so fluid is backing up into the patient's lungs, making breathing difficult.

When we finally had all of our paperwork complete to transfer the patient, the nurse came in and asked if we could stay for a few minutes so that she could take vitals on the patient. The nursing shift had just changed and she had to take a final set of vitals prior to the patient's discharge. We agreed, it would not hurt to stay another minute or two while the patient's blood pressure was taken. The results of the vitals were suprising, to say the least. The nurse checked her oxygen saturation, the relative percentage of oxygen dissolved in her blood, and got 87%. That is a bad thing. Any value below 90% is hypoxia and if the patient is still hypoxic, she is in no condition to be transferred, ambulances are only, with rare exception, supposed to transfer stable patients to or from a hospital. The hospital is the one place that the patient can receive definitive care for their illnesses or injuries, so why take them away if they have not received such care? The nurse announced that the patient's saturation seemed a little bit low. My partner and I began questioning the patient's daughter who had overtseen much of her mother's care. The daughter stated that the hospital never put the patient on supplemental oxygen, in fact the daughter had no idea what oxygen saturation was. That means that the patient was admitted to the hospital for a condition that the person who had control over medical decisions for was never told about. The patient was not receiving the definitive care that she was paying for. Occasionally, the pulse oximeter, the device that measures oxygen saturation, can come up with incorrect values due to irregularities in one's finger, because there is just a probe that attaches to the finger to measure the saturation. So, the nurse moved the probe to another finger. The second finger: 90%. Not officially hypoxia, but her saturation was still too low. The nurse moved to a third finger: 91%. Announcing the hypoxia was a stable, resolved, condition, the nurse did not see reason for us to put the patient on oxygen. I am by no means a doctor, and even these lowly nurses have more official training than I do, but a patient who is satting low is still in need of supplemental oxygen, even if her saturation is above the official value defining hypoxia.

We transported the patient without incident, and without supplying oxygen, on the orders of the nurse in charge. As I monitored the patient during our short transport, she did not seem especially short of breath, considering the congestive heart failure and other respiratory conditions she was diagnosed with, so oxygen might have helped but was not essential to her survival. What disturbed me most about this case is that the patient was at what is considered to be an excellent hospital, one which purports to be one of the best in the nation for geriatrics, and none of the physicians or nurses who treated this patient over the three days she was in the hospital had the foresight to think that this patient may be helped by being provided supplemental oxygen. It would have taken about 30 seconds out of their day to put a nasal cannula on this patient and it might have made her day just a little bit better. After talking to the daughter, who appeared to spend most of her day with mother, had one of the healthcare providers suggested that the patient might need supplemental oxygen, the daughter would have agreed instantly.