Did a Military Hospital Kill My Dad?

[Notice: this post was originally written for my political blog, 6/28/15.]

My folks were Massachusetts natives, but when it came time from my Dad to retire from the Air Force, they made a decision to retire in Texas. The San Antonio area has a cluster of military bases and medical facilities. (My Dad had some health issues related to his military service, notably a hearing disability for working years on the flight line as a jet mechanic.)

To some extent, bodies often break down as part of the aging process, although my Mom had attributed some of Dad's back problems due to the nature of his mechanical work. (My Dad himself never complained about his health issues with me; I knew he had knee issues the last few times I visited home because he had to stop and rest on our way from and to the parking space at a local base exchange.) I knew he had had some major back procedures several years back. In any event, I got an email from my Mom maybe 1 to 2 years back, complaining that Dad or she needed to have an operation, but as senior citizens, they were ineligible. (My Mom gets a lot of forwarded emails that involve urban legends; I've constantly sought to teach her how to use snopes.) I hadn't heard this bit of misinformation before and quickly Googled the topic, which confirmed that the rumor had no factual basis. (In light of what happened later, I sometimes wonder if I should have said anything...)

I hadn't been home in 5 years, since my maternal uncle's golden anniversary of his ordination. (He's now a retired priest in the Fall River diocese. He wanted a quiet, small, intimate celebration. Oddly enough, what I remember most about that weekend was that my MBA marketing service course professor, who later took a position at the University of Georgia, was on the run following the murder of his estranged wife and a man--and was later found having had committed suicide.) I had unsuccessfully sought several times since 2000 to return to Texas, in part to live closer to the folks. There were a variety of budgetary or scheduling reasons I hadn't visited them, including my 2013 birthday start date in a government contractor position in West Virginia (my birthday being during the holiday break).

I gradually become aware that Dad's back issues had recently returned, roughly around April-June 2013 (around the time I lived in WV); I had seen Dad on a number of occasions after his last back surgery (around 2006, although he had a related post-USAF workplace accident in 1983), and he never mentioned his back.  He did have some issues (perhaps the knee problems); I remember that he tried to park once in a handicapped spot, but Mom and I told him that we would not not leave the car until he parked in a regular spot. I had never seen him doing that sort of thing in decades of riding with him, so I suspected that he was in some discomfort walking; he grumbled about having to find another spot. The only reason I'm mentioning that is on my next trip, I noticed my Dad's vehicle had handicap plates.

My folks, devout Catholics, seemed to be constantly on what I call the sacrament/graduation/special events tour. (The folks have 6 younger children, 21 grandchildren and at least 14 great-grandchildren (and I think one on the way).)  I know that the folks had been to a niece's college graduation in Kansas in December 2013,  and one of their great-grandchildren was baptized in February. However I noticed that he wasn't in the pictures for my nephew's Master's in Accounting in early May. My Mom hadn't brought it up, but she confirmed that he was too ill to attend, and they would be skipping that month's other high school and college graduations for 2 other, out-of state grandsons. My baby brother lives in the same area, and I became aware of his helping my Mom deal with my Dad's emerging mobility problems. (It wasn't that my Dad had a weight problem; Mom is petite and had issues, say, helping get him in a car.) He had some spinal injections and had been given a go-ahead by doctors to attend a granddaughter's wedding in mid-July. I know at some stretches during this period he was using a wheelchair to get around, and my parents watched the events via a Skype connection.

I'm confused as to the insurance issue because my Mom at one point argued that she was asked as to whether Dad was covered under ObamaCare, but at some point during July my folks got in touch with the 2006 surgeon who had worked on his back, and a new procedure was scheduled around the beginning of August at a local military medical facility. Mom explained that without surgery, Dad faced spending the rest of his life in a wheelchair and/or in pain. The initial account was that the surgery (in a military facility) was a success, although my Mom implied that he was more listless and less motivated to do therapy, which frankly disturbed me. My baby sister was there to help the folks during this period.

Then came the evening of August 11, a date and a telephone call that I'll never forget. My Dad had been released to a rehabilitation facility less than 24 hours within easy distance from my parents' house. By all accounts, Dad had had a good first day of therapy. My Mom had stepped out to get a bite to eat, when all of a sudden the facility called her to return immediately. My Dad's blood pressure had crashed through the floor. They had called an ambulance, and it was all they could do to stabilize my Dad's blood pressure to get him to the medical center. I was watching some Monday evening entertainment program when I got a call from Mom. My Mom is a tough cookie, so this was totally out of character. She was saying, "We're losing him, your father, Ronald. Do you understand?" She was crying, and then became frantic as they apparently had her escorted from his bedside. "He's dying, Ronald; there's nothing more they can do." There is nothing you can do over the phone; you can't hold her and comfort  her." I was grasping for understanding; he had been released within 24 hours, presumably with a thorough health check; how could Dad be fighting for his life? Luckily, Dad seemed to stabilize while we were still on the phone, but Mom was insistent: Dad was dying, and if I wanted to say goodbye, I had to be there as soon as possible. I couldn't find a seat flying out of Pittsburgh, my nearest major airport, for Tuesday. It would take two days of driving to get to San Antonio.

One of my middle sisters called me early afternoon Tuesday and reaffirmed that I needed to get there ASAP. I did find a flight going out the next morning at 5AM with 2 connections, touching into San Antonio around noontime. It seems that they lowered medication enough for Dad to regain consciousness for a limited period of time. He needed breathing tubes and so Mom had to communicate with "yes/no" type questions. His organs were beginning to shut down, starting with his kidneys. My siblings, except my baby sister (who said that she had a feeling and make her peace with Dad), were there with their spouses. After my arrival, they once again lowered his drugs. He knew we all were there; I saw his eyes follow me from one side of the bed to the other. He couldn't talk. My memories were a blur during the last 15 minutes or so. They took the breathing tubes out of him; I was confused: why were they doing that? Is he strong enough to survive without the tubes? I can still hear my RN sister telling my Dad to focus on his breathing. My Dad was trying to talk but his throat was too raw. His breathing began to slow; I didn't understand why they weren't reinserting the breathing tubes. My Mom was sobbing inconsolably. He passed all too soon. The doctors were highly professional, but I never got a good answer what the hell happened? It was septic shock, most likely a urinary tract infection. (There was no sign of infection at the site of the surgery.) These sorts of things "happen all the time" Shit happens. How did he get such an infection less than 24 hours in a rehab facility? It didn't make sense. Mom, and the rest of the family including myself, waived an autopsy.

Before proceeding, let me quote from Wikipedia (my edits) :

Patients undergoing major surgery are often catheterized and may remain so for some time. The patient may require irrigation of the bladder with sterile saline injected through the catheter to flush out clots or other matter that does not drain. In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into a patient's bladder via the urethra....A clinician, often a nurse, usually performs the procedure. A Foley catheter (indwelling urinary catheter) is retained by means of a balloon at the tip that is inflated with sterile water. The balloons typically come in two different sizes: 5 cm3 and 30 cm3. They are commonly made in silicone rubber or natural rubber.
Everyday care of catheter and drainage bag is important to reduce the risk of infection. Such precautions include:
Cleansing the urethral area (area where catheter exits body) and the catheter itself.
Disconnecting drainage bag from catheter only with clean hands
Disconnecting drainage bag as seldom as possible.
Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically.
Use of a thin catheter where possible to reduce risk of harming the urethra during insertion.
Drinking sufficient liquid to produce at least two liters of urine daily.

My Mom recently mentioned that my brother-in-law, married to my RN sister, had ranted at the surgery facility. His issue was not the surgeon and his staff but the quality of the nursing staff (ironic, since my Dad has one RN daughter and two RN granddaughters). Let me excerpt one of his relevant responses to my query:

I asked the question about a hospital acquired  infection when I had heard Dad’s sepsis was caused by the infection at the site of the Foley Catheter. His surgical wound was clean and the only location of infection was the catheter. To me, it pointed to poor nursing care at the hospital he was at for the back surgery. I called XXXX and identified to their Risk management folk that Dad’s sepsis was due to improper care for his catheter at the hospital where he had his back surgery.. XXXX’s risk management folk referred me back to the initial hospital. I spoke with their Risk Management representative and she started to blow me off until I told her a patient that just had surgery at their hospital and been discharged to rehab had been sent as an emergency to XXXX and subsequently passed away due to a hospital acquired infection at the site of his catheter causing sepsis. Oh yeah and by the way, this patient was at the rehab facility for less than 24 hours. She suddenly became very engaged and took my information and Dad’s information. I never heard back from them and I asked mom if she wanted me to pursue this and her answer was no as it wouldn’t bring dad back.
I firmly believe it was poor nursing care at the original facility dad had his back surgery at. His catheter care was not done correctly as well as his change from post operative day 1 to a lethargic state prior to his discharge to the rehab center should have been keys as to something going on.
This was all my driving thoughts and why I wanted to identify a problem at the initial facility so it wouldn’t happen to anyone else.
The surgeon did a fine job. The wound looked great and showed no signs of infection. The only site of infection was the foley catheter site.

God bless my brother-in-law. I understand that hospitals get CYA syndrome; but there must be accountability and a due diligence standard for nursing. Our experience as a whole is a positive one for the military level of care, quality and professionalism; I'll always appreciate their efforts to give me a chance to say goodbye to Dad. It is important to remember not just to do the big things well, but the little things, too. In this case, we lost my Dad, done far too soon. I regret the lost opportunities to have conversations with my Dad. My Dad was not just another patient.

Father's Day: Not the Same

Until I went home last August, I hadn't been home since 2009 (when Mom hosted Uncle Roger's golden anniversary of his ordination to the priesthood). I had normally gone home to spend the holidays with the folks. There were a variety of issues (principally budget and scheduling issues) during this period; for example, I was due to start a new government contracting job in northern West Virginia on my birthday just after Christmas 2013. The new job had been contingent on an interim security clearance process initiated in late October.

I think it never really crossed my mind I was missing one of my last chances to see him: woulda, coulda, shoulda. He looked younger and healthier than many people his age; his oldest brother had lived well into his 80's, and I've had some relatives live almost to the century point. Calling was not much of an option; Dad's hearing disability (from his military service as an aircraft mechanic) meant hearing aids, and Dad seemed to have trouble finding good ones: inevitably if and when I called there were high-pitched squeals drowning out our conversation. But to be honest, Dad wasn't big on conversations, on expressing his emotions. I've noticed that my little brothers were more verbal in expressing love for their own children. As for Dad, maybe it was the way he was raised, his military discipline, or more of his own quieter personality (vs., say, my outgoing mom).  But his messages, verbal and nonverbal, were powerful and loving. For example, I remember I didn't go to see him off at the airport when he left on orders cut for Vietnam. (I think his orders were changed to Thailand once he got there.) I was 12 years old; I had 6 younger brothers and sisters, the baby still in diapers. I heard the weekly casualty lists on TV. I know families had dads, brothers, and sons dying there. My Dad wouldn't be on the front lines, but he would be working in a war zone. The idea of saying goodbye for the last time to my Dad was unbearable. In my trunk somewhere I still have a Christmas postcard. where my Dad wrote that he was counting on me being the man of the house until his return.

It's strange how little memories come flooding back. I remember Mom ironing Dad's shirts while watching soap operas, my siblings and I rushing to the door to welcome Dad home. I remember one of the one-on-one experiences;  maybe this was a time when one of my middle sisters was born, but I remember accompanying him to a diner, being served a powdered doughnut and a glass of milk. I was at the top of the world, being there with my Dad.

There were times I treasured over the last several years; he came up to be with me when I had an outpatient procedure. One of our rituals every visit was that he would get on my case to get my hair cut. He would inevitably bring me down to the American Legion or VFW for a beer and to introduce me to his friends.

Normally this time of year I would go down and pick out a Father's Day card for him; I have very high standards in picking out cards. This is the first time since I was a young kid that I didn't wish him Father's Day. I wish I still could. I love you, Dad.

[NOTE: I circulated a note to my family and the grandchildren asking for any contributions to the blog. None to date, but if I get any, I'll post them. My Dad's remaining sibling, Uncle Ray, passed a few months back. Remember the peach story at the burial? Three of the 4 Guillemette brothers passed within a 2-year period. Uncle Ray was Dad's best man. Ray had a number of serious health issues over the years, and most people felt that he would be the first of the brothers to go. I don't know if and when the next post will be published, but I expect to prepare a post on the anniversary of his death.]