I learned Tuesday that the hell we went through with 911 in December had some value. Our local Fire and Medical did a quality management review and made some changes that will perhaps prevent some of the delay that led to Mom arriving at the hospital at 7:35 instead of 6:15, as she would with the new provisions in place. That's good, but it was still difficult to learn that the problem began with the nursing home and specifically with a nurse who apparently couldn't distinguish between symptom and diagnosis.
NOTE: Normally I blog mainly for myself, but I hope this entry gets passed on to healthcare and communication educators, who can perhaps help their students understand that language matters.
I last had a conversation with Mom the night of December 9, 2007. We said "goodnight" on the phone at 7:30 as she was getting ready for bed. Sometime before 5:45 that next morning Mom had a massive stroke. Mom is dead, and I'm fully aware that a timely arrival at the hospital would have not made a difference for her ultimate fate. Her stroke was hemorrhagic; the bomb in her head had already gone off, and the damage was irrevocable. But there was other damage done by the delay, and a healthcare professional with stronger communication skills could have made a difference.
When the nurse found her, Mom's face was sagging; her speech was slurred; she seemed paralyzed on one side; her tongue was swollen; and she had difficulty swallowing. Those were her symptoms. I know these because the RN listed them when she called me at 5:50 immediately after she called 911. Unfortunately, according to the documentation, that nurse hadn't shared those symptoms with 911. Instead she gave a diagnosis: "possible stroke."
Zeroing in on "possible" and the nurse's statement that Mom was still conscious, the dispatcher assigned the case to the lowest priority of transfer. A stroke victim would be transferred to the hospital as convenient.
How could a stroke victim be relegated into a non-emergency status? Because the nurse did not communicate the pertinent information. This is a woman who no doubt spoke with a professional voice but with an tone inappropriate for the urgency of the situation. I haven't had the emotional stamina to listen to the 911 tape; however, I know this nurse to be a caring young woman, but one who is very quiet and introverted. As a newly graduated RN, I can well imagine her being careful to sound objective and professional--to a fault. As an employee of that particular institution, where avoiding legal encounters is top priority, I can also imagine that she had been cautioned to qualify statements with words like "possible," since she had no legal right to give a diagnosis.
Combining her naturally quiet nature and the fact that she was nearing the end of a long shift, I doubt that she used a tone that conveyed urgency. At least she wasn't emotive the afternoon after Mom finally got to the hospital. When I returned to the facility to check Mom's room, she was back on duty. "How's 'Miss Millie'?" she asked with clear concern but also in a very matter of fact fashion. When I made an evasive comment about her not being well (I had been cautioned to not yet disclose her condition lest we lose her room), the nurse quietly commented, almost as an aside to herself, "Hmm, I was a little worried about her." That was all--no emotion.
To add to the unfortunate turn of events, at that time non-emergency transfers were emailed to a battalion chief for assignment to an available crew. For some reason, that transmission failed, and the 911 dispatcher did not confirm the communication. Consequently, no ambulance was dispatched until after a second 911 call. When the new shift nurse made the second call, the 911 dispatcher asked if there had been a change of status. Instead of taking the opportunity to state the symptoms or even reiterate the diagnosis, the new nurse simply said, "No, but her daughter is waiting for her at the ER." This nurse clearly didn't understand what would generate a response from 911.
In the meantime, I have no doubt that the nurses did with Mom as I've seen them do with others--deny them privacy and dignity by rolling them to the nurses' station with lights glaring and people passing while they waited for the ambulance to arrive. Mom so wanted to die quietly in her sleep that I am troubled by the fact that she was no doubt very embarrassed and scared and confused by this public exposure. And I fear that she felt abandoned waiting there alone. The nursing director later told me that, at that point, she could still say my name. But I wasn't there to answer; I was at the ER trying to learn the cause of the delay.
The failed transmission did what the nurses could not. Mom's case became "a hot one," and she was delivered to the hospital at 7:35. When she finally arrived at the hospital she could no longer say my name.
