After a misdiagnosis and a host of mishaps, my 69-year-old mother lay on crisp, white sheets in an intensive care unit hospital bed with a tube in her trachea - the same tube that punctured her lung on the way in. She was plugged into countless blinking, beeping machines; her short, salt and pepper hair was tousled; but her beautiful smooth, translucent skin and grey-green eyes looked the same as they did the day before. I set up a CD with soft instrumental music as my brother and sister waited for me to join them for dinner. "Are you thinking a lot?" I asked, my way of seeing if she was afraid. She shook her head no. As I turned to leave her curtained cell, something pulled me back inside. I gently touched her arm and looked into her eyes. "Mom, Do you know that your four kids think you are the best mother in the whole world?" She nodded yes. I kissed her goodbye.
She waited until we were seated for dinner before she slipped into a coma.
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Her death certificate reads "cardiac arrest," but that is not the only truth.
In February 2005, mom was transported by ambulance to the hospital emergency room from a walk-in clinic, where the look in the doctor's eyes told me how serious it was. In fact, I could tell he wanted us out of his building quickly. In less than an hour, she was admitted to the hospital with a diagnosis of pneumonia.
Even though her primary concern was respiratory distress, she was placed in a corner room on the orthopedic floor out of sight of the medical staff, where, it seemed to me, she was largely forgotten about. When I asked a nurse about my mom's tender, swollen foot, my mom interrupted, "It's just my arthritis." The nurse took my mother's word for it. After several days, she was not getting any better as she struggled to breathe, and there did not seem to be any care administered other than the IV antibiotics and fluids she had been taking for a week. I approached a nurse, "If this were your mom, would you say this was the best floor for her?"
Within hours she was transferred to a floor better equipped to deal with her respiratory distress. In the middle of the night, she passed a blood clot to her lung (a pulmonary embolism) and lived to tell the story of her terrifying experience.
We were later told that our mom likely had an embolism when admitted (with a tender, swollen foot, and difficulty breathing), but it was not diagnosed until a week later when she passed the clot to her lung. Unfortunately, she received no prophylactic treatment upon admission, not even compression stockings on her legs.
After mom died, I learned she was high risk, but we were not asked the questions that could have saved her life. Among the many high-risk criteria that mom met were: her age, she was considered obese, she had arthritis, she had lung cancer surgery within six months, and she had just returned from a thirteen-hour car trip to and from Atlanta (she was sedentary for a long period of time.) Her medical history included a blood clot in her brain when she was twenty-seven years old that nearly killed her. As a current patient, she was bedridden with a swollen and tender extremity and was in respiratory distress. The DVT (Deep Vein Thrombosis) Risk Assessment tool I found online after her death indicated that a high-risk patient would score three or more points. My mom had at least eleven points. No matter what scoring tool I used, she was high risk. Since my mother's death, another family member has tested positive for the Factor V Leiden gene, a genetic disorder that makes it more likely for one to develop blood clots. It's expected that mom had this disorder, given her history.
Mistakes happen all the time to everyone, but we need to learn from them. I credit the many heroes in the medical profession, from technicians to surgeons - they have the power to change lives; they can make a difference every day. Yet, with rewards come risks. For those in medicine, a life hangs in the balance.
Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein. In 2005 it was and in 2022 still is a leading cause of preventable hospital death in the United States. According to the Center for Disease Control, as many as 70% of hospital-acquired blood clots are preventable through measures such as using blood thinning medications to help prevent blood from clotting or by using compression stockings. Fewer than half of hospital patients receive these measures.
Most hospitalized patients have at least one risk factor for DVT, including immobility, cancer, infection, or surgery. Patients with certain pre-existing diagnoses (such as AIDS, anemia, arthritis, or congestive heart failure) are almost three times more likely to be diagnosed with an embolism than hospitalized adults without these conditions. Fifty percent of adults over the age of 65 are diagnosed with arthritis.
Almost twenty years after mom's death, there is much we can do as patients or loved ones to be proactive in our own care. Hospitals should be required to post a checklist for blood clot risk factors and symptoms using layperson terminology in a visible spot in the patients' rooms, like a bulletin board. Had anyone posted a checklist of symptoms to be aware of, my mother would have quickly been categorized as high risk, and her symptoms would not have been missed. We could all have been partners in her health care, and she might still be alive.
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