It was four years this week that Lisa left her home for the last time. On the evening of Thursday November 6 she went to the emergency department at Samaritan Hospital in Troy because of what appeared to be a digestive problem related to her diabetes. In the early hours of November 7 she was admitted and moved to a bed in the hospital's Progressive Care unit on the fourth floor....
AFTER FIVE DAYS ON THE HOSPITAL'S fourth floor, Lisa's condition had improved. On the evening of November 10 she told me one of her doctors had said she would probably be discharged the next day.
When visiting hours ended at 8 p.m. I told her I would see her the next morning. As I left her in the care of Samaritan Hospital she said she was looking forward to coming home, and we said goodbye.
It was the last time she would ever speak to me.
THE CALL CAME IN at about 2:20 on the morning of November 11, 2003. The caller identified herself as a nursing supervisor at Samaritan Hospital.
"You should come over here," she said. "Lisa isn't doing too well."
I told I would leave immediately. What could have happened, I wondered as I drove along Route 787. Wasn't Lisa set to come home that day?
By the time I arrived at the building on Burdette Avenue I thought Lisa must have died and they didn't want to tell me over the phone. As I walked toward her room, a woman broke away from a small group near the door. She said she was the nursing supervisor. I think she said her name was Corinne. "They're working with Lisa," she said, and suggested we move to a small conference room next to the area near the elevators.
Lisa had collapsed, the supervisor said. She had stopped breathing and had no pulse. She had been resuscitated and was now on life support.
And her blood sugar had been at 2.
Two milligrams of glucose per deciliter of blood? I was stunned. How could this have happened? A level that low would usually be fatal. Without a constant supply of glucose, brain cells begin to die in seconds. A person can survive unharmed without oxygen for several minutes, but not without the brain's energy, glucose.
What Corrine didn't tell me was that earlier in the evening, just after I had left, Lisa's blood sugar had dropped to 55 mg/dL, just below what the hospital's own protocol lists as hypoglycemic, and that she had been given glucose through an IV. I wouldn't learn about that, and what had been done for a patient who was clearly at risk, until weeks later when some of Lisa's records were handed over.
As we talked, several staff members rolled a bed past the conference room. A thick tube was sticking out of Lisa's mouth, an IV bag was hanging from a pole. On the bed I saw a chart and one of those plastic bags they use for patients' possessions.
"They're taking her to the ICU," Corinne said. "After they get her set up you can see her."
Twenty minutes later I was in a room in the ICU when a very big man came in and began to check the respirator. He said he was a respiratory therapist and had been involved in the effort to resuscitate Lisa.
"Do you know what happened," he asked. "They said her blood sugar was at 2. It’s nice to win one but this is one we shouldn’t have won, but we did.”
THE DOCTOR STOOD at the bedside in the Intensive Care Unit at Samaritan Hospital, where Lisa lay unconscious, and, at least for a while, able to breathe on her own. The doctor was holding a medical chart. And he was puzzled.
“Did this happen at home,” he asked me, referring to her collapse into a coma three days before on the hospital’s fourth floor. “Because there is nothing in here prior to her coming into the ICU.”
Someone, it seemed, had stripped the record. Someone must have something to hide.
The doctor was Ram Agrawal. At my request, he had taken over Lisa’s diabetes care from the endocrinologist who had been consulting on the case since Lisa had been admitted the week before. I had made the change partly because that doctor had apparently been avoiding me, despite a request via the hospital’s ‘patient representative’ for a meeting.
Now Dr. Agrawal was the consultant for her diabetes. And he needed information, information, which evidently had been removed from her chart.
This was on the evening of Friday, November 14. Earlier in the day, Lisa had been taken off the respirator and the sedation. But she was far from normal.
When I had arrived at mid morning, she was sitting up in the bed. But she didn’t speak. Instead, her eyes were rolled up in her head. She was making a strange groaning sound while sticking out her tongue, holding her arms out in front of her as if reaching out to hug someone and turning her body from side to side from the waist. Lisa’s brother had come in while I was there and he was so disturbed by what he saw that he had to quickly leave.
Just before I had left home, I had made yet another attempt to get information from the so-called patient representative’s office. Earlier in the week I had been directed to the office and had spoken to a Carol Febbro. Febbro had said she would make some calls and call me later that day at home.
But there had been no call that day, or on the Wednesday or the Thursday, even after a message was left with a secretary during another visit to the office. Now, on the Friday morning, my phone call was picked up. But it was not to give me any information. Febbro’s tone was defensive, curt, almost rude. She said that without a power of attorney, the hospital would not provide access to any of Lisa’s records or discuss her treatment with me.
Lisa remained semiconscious through Saturday. According to Dr. Agrawal’s notes, she would respond to simple requests, such as ‘lie down,’ or ‘stay quiet.’ Some of the nurses had also recorded similar observations.
Lisa, it seemed, still understood language and presumably was able to comprehend her dire situation and the circumstances that had led to it.
ON THE SUNDAY, five days after Lisa collapsed, I took her hand and asked her to squeeze it.
I asked if she knew who I was, and to squeeze once for 'yes'. And again I felt her grip on my hand.
It was a startling moment. I had just heard from one of the nurses that Lisa had been responding to simple requests. Because she had made no discernible effort to speak, I had seen no sign that she was aware of where, or even who she was. Now I had a clear indication that she was conscious of her surroundings. That meant that she would have heard at least some of the conversations about her condition, and about what had happened to her.
I tried asking more questions, but she seemed to be tiring and stopped responding. I told her I would try again the next day.
It was not to be. At around 1 the next morning a nurse in the ICU called to say Lisa's condition had deteriorated. She had become unresponsive and was having increasing difficulty breathing. She had been placed back on a respirator.
It appeared that there had been a significant change in Lisa's condition.
At first the nurses in the ICU were very cautious and said little about how Lisa's injury might have occurred. But after a couple of days, some of them began to reveal was evidently being said in the department and on the fourth floor: Lisa, already borderline hypoglycemic, had mistakenly been given insulin.
Maybe someone misread the chart and restarted an insulin drip that had been discontinued the day before. Or perhaps Lisa was given a syringe shot that was really meant for another patient. Either way, she was now critically injured and would likely never regain consciousness even if she survived. I sensed that there was both sadness and anger that someone on the hospital staff might have caused such a thing to happen.
And in the four years since then the hospital has not offered any explanation, never mind a credible one for what happened. Meanwhile, one of the ICU doctors would later say that something clearly had gone wrong that night, and he hoped the family would investigate.
More on that next week.
The ICU staff certainly did everything possible for Lisa. And one of the ICU nurses had actually spoken to her the day before she collapsed. This was after several attempts had been made to insert an IV needle. At that point someone said they should call Sharon from the ICU; Sharon would be able to start the IV if anyone could.
Sharon came up a few minutes later and got the line in at the first try.
Two days later, Lisa was on life support.
"I work here," Sharon said to me one day in the ICU. "and I see what happens. I've told my husband, if you get sick, don't come to Samaritan Hospital."
I WAS AT AN AUTO SHOP, about to pick my car after a service when the call came in on my cell phone. It was a neurologist at Samaritan Hospital. He had just reviewed the results of a second EEG done on Lisa.
“I’m afraid it’s not good ,” he said, speaking with what sounded like an Australian or New Zealand accent. The test, he said, showed a significant change from normal brain wave activity.
He said based on the test, it was his opinion that there was little chance Lisa would ever regain consciousness. Asked about the cause of this condition, he said he had no doubt that it was the hypoglycemic event of the previous week.
The neurologist’s findings, although not a surprise, were still a shock. This had all happened so quickly.
That evening at the hospital I had a long discussion about the EEG result with Lisa’s attending physician. Based on her previously stated wishes and her current condition, we agreed that a do not resuscitate order should be place in her chart. This would mean no steps would be taken to keep her alive if she were to have a heart attack or a stroke.
She was already had machines breathing for her and feeding her and would apparently stay that way for as long as she continued to live. She had always made it clear that she never wanted to be forced to stay alive on a machine, if for all intents she was already gone.
The doctor went out to the nurses’ station to write the order and to explain it to the nurses.
A moment later I heard a female voice yelling: “No! No! You can’t do that!”
I heard the doctor’s lower voice. And then the woman spoke again, still protesting a do not resuscitate order.
I recognized her immediately. It was one of the nurses. The last time I had seen her she was working on the fourth floor while Lisa was there.
DURING THE SECOND WEEK of Lisa's time in the ICU, an event occurred that affected her family almost as much as the horrific injuries she had received while in the care of the hospital.
On the Thursday, Lisa's parents come in to see her for the first time since she had collapsed. Her father in particular was having a hard time dealing with the sudden change in his daughter's condition. By this time Lisa was totally unresponsive and the sight of her hooked up to the respirator and other machines was clearly distressing. It had taken him more than 40 minutes after he arrived at the hospital to steel himself to walk into her room.
Just hours after the visit, Lisa's mother started having chest pains. She was rushed to Albany Medical Center Hospital.
The doctors discovered and treated a blockage of the arteries to the heart and she was able to go home several days later. But for a time Lisa's father was facing the real possibility of losing his wife of more than 60 years and his youngest child in the same week, perhaps in the same day.
Meanwhile, Lisa remained unconsciouses, with little change in her condition. At the beginning of the week I had asked the attending physician if she could be transfered to another hospital. I was alarmed by the missing records and the refusal of the hospital's management to give me any information about Lisa's collapse. It was obvious they knew what had happened and that they didn't want me to know.
But the doctor said a transfer would be risky and could not be justified medically. So, reluctantly, I agreed to keep her at Samaritan Hospital. I was still working a split shift and was in the ICU several times each day, some times before 6 a.m., sitting at her bedside with the steady rhythmic hissing of the machine that was keeping her at least nominally alive.
FOR SOMEONE WHO HAD HAD DIABETES for 30 years, Lisa's kidneys were in remarkably good condition. A common complication of the disease is damage to the organs that filter waste from the blood. Lisa's kidneys, though, had continued to function well and tests done just after she was admitted to Samaritan showed that both her creatinine kinase and BUN (blood urea nitrogen) levels were close to the normal range.
But that had changed by the third week following her collapse. A nephroligist, Dr. Leslie Goldstein - one of a half-dozen specialists who were treating Lisa - told me her kidney function was declining, and that he thought that by the middle of the following week she would be on dialysis.
And Dr. Goldstein sad he had no doubt that the change was the result of the near-zero glucose level that had occurred on the night of November 11.
Dr. David Strumpf, a pulmonary specialist who worked in Samaritan's CCU, explained that the damage was not limited to Lisa's kidneys. All her vital organs were affected, he said, and the result was a downward spiral as the decline of one put stress on each of the others.
Dr. Strumpf also said he believed the damage was the direct result of the lack of glucose that had occurred on the hospital's fourth floor on the night of November 11.
On the Friday, at my request, a third EEG was done. After it was completed the neurologist said it showed even less brain activity than had been found by the second one. He also said Lisa lacked what is known as the 'doll's eyes' or oculocephalic reflex. The absence of this reflex, he said, strongly indicated that the brain stem was damaged, which was consistent with her inability to breathe on her own.
I also noticed that Lisa's arms were straight at her sides, with the palms turned downward and out instead of facing the body, a condition I was told is known as decerebrate posturing, a strong indication of brain-stem damage.
I discussed the situation with Lisa’s brother. He had been in contact with Lisa’s two sisters, and with her mother and father. All except her father agreed that Lisa would not wish to be kept living on life support. Lisa also had said repeatedly she didn’t even want to be on dialysis. Only her father had continued to believe that his youngest child might recover.
But by the weekend of November 29/30 he had accepted that even if Lisa did not die from organ failure, she was never again going to be Lisa. He accepted what she had also told him: that she did not want to be a vegetable kept alive by a machine.
IN THE EARLY AFTERNOON OF DECEMBER 1, Lisa's brother and one of her sisters met me at the hospital. We were there to discuss the situation with Dr. Strumpf. The hospital wanted us to sign a statement saying Lisa had told us she would not want to remain on life support if there was little hope of regaining consciousness, and that we were not opposed to removing the respirator. The statement was clearly intended to protect the hospital from a legal claim.
As the statement was being drafted, I recalled how just a couple of months earlier thee had been a story on TV about Terri Shiavo, the Florida woman whose husband was trying to take her off the feeding tube she had been on since she had become unresponsive after a heart attack in 1990. I asked Lisa what she would want me to do if she were to be on life support with no hope of recovery.
"That's not going to happen to me," she said.
But what if it does, I said. By then, you won't be able make the decision.
"I wouldn't want to be kept alive by a machine," she said. Then after a short time, she turned to me and said "Promise me you won't let let them keep me alive like that."
I told her we should get the proper form signed and witnessed. But it was put aside and had not been completed when Lisa went to Samaritan Hospital on November 6.
After the statement was signed, Dr. Strumpf told us he was disturbed by what had happened on the fourth floor three weeks earlier.
“I was not involved with it,” he said. “But for your own peace of mind, I hope you folks will investigate. This should not have happened. Something went very wrong up there.”
That afternoon Lisa's respirator was removed. At 5:46 p.m. on December 2, 2003 and with me at her side, she died.