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OK, so mom's ALF called at 11 pm to say they were sending her to ER because her sugar was low (paramedic said was at 24). She is a type 1 diabetic. I arrive at the ER just as they as unloading her from ambulance. I go into the entrance asked to wait in waiting room while they settle her in. Fine right. Only have me wait about 10 to 15 minutes, the ER was very busy.
I go back and the nurse tells me her sugar is now 117, but she is not talking. Which I try to say that is normal for her with her dementia. I notice there is a list of test ordered on the wall for her (CT scan, ultrasound and chest xray). I ask the nurse if all that is ordered for her. He said that since she was unresponsive the doctor order to see why her sugar was low. I said this happens as a result of her not eating, can we not do the tests. He says he can send the doctor over.
10 more minutes. Dr. comes over and immediately goes into how no one was here and she was unresponsive and the test were to help figure out what was going on. I say OK, I am here. She has dementia and this is what mostly happened. He interrupts me say well she is unresponsive. I stop and says yes but I rushed here to answer questions and am here. I am ok with CT scan to make sure she did not have a stroke, but why the chest xray or ultrasound? Xray to make sure she does not have fluid on lungs. I said she is here for low sugar, not a cold or cough or chest pain. He they said well she was foaming at mouth and could have shallowed some fluid and that could be on her lungs. Really can't we treat the diabetes? Dr then says well you can refuse but if she gets pneumonia later that is on me. My response was, that was just rude of you. NO xray or ultrasound just CT scan and can we get her some snacks to see if I can get her to eat something to stabilize her sugar. His response, I guess she will eat it. Seriously, because I question you. No one asked he a history or wanted to hear anything I was saying.
I did get mom to talk to me, but she was very combative, which I know means her sugar is still low. Nurse finally brings snacks and checks her sugar and it is dropping again, now at 74. Dr. comes back to tell me what the nurse just told me and that mom has a UTI which could also be cause the problem so going to get her IV for sugar and antibiotics. Me being angry at this point, say I know about the UTI she was being treated at the ALF, if some one would bother to actually speak to me and ask me her history and what has being going I I would have told you. P*ssed off Dr. is like well this is why we run tests and she could not answer. Serioulsy I am her and no one is asking questions. He then says he would like to admit her to her this in control, but I don't have to if I don't want to. I am being a a**, I should just let them run up a huge bill and run every test because she can't answer them. Ask some thing and I will answer you. Jack A**es! Oh course she needs to be admitted, I am not trying to deny her care, just unessary tests.


CT scan done, no sign of any new damage. Another doctor comes over to tell me she is being admitted and then asks me is there any history they should know about. Finally what should have been done over an hour ago. He does ask me what type of diabetes, I say type 1 and he questions if I am right, because doesn't sound right. Really, what is wrong with this place this evening? His also ask why no chest xray, my answer because I don't feel it is nesscary to treat her condition.
He then trys to listen to her chest and mom throws a fit about him taking away her covers because she is cold. Another reason not to do extra test her response is combative, come on.
So, 3 am I leave as they admit her and hope the Dr's on the floor are more willing to listen.
Am I wrong or this horrible person for not just letting do whatever? Just feeling so annoyed

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So, if she's in a NH and she frequently has low blood sugar, why aren't they able to manage it there?

I think with us, as a family, this is why we ended up with the "no transport" order. ERs are not good places for elderly dementia patients.

I am no longer trying to keep my mother alive. Anything that can't be managed by the RNs and Nurse Practitioners at the NH is going to take her.
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My mom is in a NH. We have a "no transport" order now, since mom is on palliative care. What they can't treat at the NH is not going to get dealt with.

When mom was healthier and ended up in the ER, my stance was "I'm not a doctor; do the tests and tell me what you think should be the treatment plan".
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I get what you are saying, but I know what the issues is. Unfortunitly this is nothing new, her low sugar has happen to many times to count over the years. This is even before the dementia issues, as she never took care of herself properly.

So, since I know why her suagr is low, lets take care of it instead of trying to figure out why. She should could have had an IV and antibotics an hour earlier if they would have listened to me and most likely been able to have been discharged.

Sometimes the family does know better and what is going on. Honestly, asking her history would lead to faster treatment instead of just running test because.
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I just want to add that "the reason" someone is in the ER does not always turn out to be the REAL reason.

A story:

Three weeks ago, my husband was feeling kind of "blah" and when I asked about specifics, he said that his urine was dark. It was already 6 PM and it was not one of our doc's late nights, so I suggested we go to the Urgent Care place around the corner. Get him on antibiotics quicker, right?

So we go, and yes, there is blood in his urine. The doctor said "Mr. S, if you were a normal person, I'd just give you antibiotics and send you home. But you're on blood thinners, so we need you to get a blood test tonight. Not tomorrow. You need to go to the ER. I'm sure it's nothing, but we need to make sure".

So, we could have ignored that advice, right? We could have filled the script for antibiotics and gone home and gone to bed. But if we had, my husband would likely be dead.

We got to the ER and they drew blood. His INR (the number that folks on Coumadin live and die by, which should be between 2 and 3) was 17. They sent him via ambulance to the hospital. There isn't much literature on folks whose INR is about 10. Because they have internal bleeding, brain hemorrhages and the like, and they die.

I'm so glad that I didn't argue with either the urgent care doc or the ER docs, who did a CAT scan to check for internal bleeds before they sent him off.
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This is the first time I have had this experience. I am trying to let it go today and chalk it up to a busy ER on a Holiday weekend. My anxiety level is a 10 out of 10 today, as my husband is back out work after a three day weekend and I am on my own to head to the hospital and see what is up. Fingers crossed she is discharged and can go back to ALF.
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I think it is part of the whole ER mindset to swoop in, order whatever test seems appropriate to quickly confirm or rule out conditions and save the day. ER is designed around acute care - heart attacks, strokes, traumatic accidents etc - and for that they need to act first and question later. When people like your mom come in with chronic conditions the ER often has no clue how to react, you were a stumbling block to their normal way of doing things, never mind that their normal was not appropriate for her.
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Tattoochick, in your place I would be tempted to google the ER dr and see how long he's been on staff. Many hospitals have those pages online now. Is this a teaching hospital? Some of the ER residents at our teaching hospital were really screwballs. At the hospital my husband works at now, they hire locum tenens drs to fill in gaps for permanent staff. Sometimes when you see they were just hired a few months ago or something, it's easier not to take it so personally.

Don't feel bad about this -- your mom is ok, that's the most important thing. Your questions were reasonable; the dr sounds like a jerk.
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Mom released from hospital this evening. Still on edge to see what happens. I am afraid now that the sore on her foot is now bandage the ALF will have a problem with that. They spoke with doctors and said OK, but I always seem to expect the worst now. Fingers crossed that there are no issues tomorrow when I visit her at the ALF.
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Nothing wrong with over testings, but I would question the over medicate.

Did the Assisted Living/Memory Care send along a medical history of your Mom? When my Dad went to the ER, the Memory Care nurse handed the EMT's all the paperwork.... so the EMT's and hospital had a list of Dad's medical history and what meds he take daily. Plus the hospital already had on file Dad's Medical Directive, who was his POA, etc. so thankfully this hospital wasn't on bypass because the ER was too full.
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I think she was being sarcastic, saying that despite trying to explain to the dr that there is an established pattern for her mom, and that the daughter wanted to make sure they stabilized her mom's sugar first, the dr got into it with her and suggested that it would be Tattoochick's own fault if she ignored his suggestion for an xray and her mom ends up with bronchitis.
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