Doctors Discharge Summary - FOR THE LOVE OF MOM

FOR THE LOVE OF MOM

This is the official copy of the discharge summary:

Ms. Hogue is a very pleasant 81-year-old white female does have a past medical history that significant for recent diagnosis of COVID-19 back on 12/10/2021 for which she was in the hospital essentially overnight and then discharged home unfortunately only on 4 mg of oral dexamethasone, also with a past medical history significant for A. fib on chronic Eliquis, hypertension. As stated above this patient is from Florida is not vaccinated for COVID-19, had been admitted back on 12/10/2021 overnight after being diagnosed with COVID-19 with mild hypoxemia. Patient had been doing okay at home but unfortunately symptoms have worsened unfortunate the patient was found to be hypoxemic with pulse ox in the 50s and 60s on room air. She was placed on nonrebreather mask in the ER at 10L with O2 sats going up intothe 90s. Currently she denies any overt fevers, rigors, no nausea, vomiting or diarrhea. She is requiring 5 L of O2 per nasal cannula now to maintain sats in the 90s. Currently the patient is going for a CTA of the chest. She has declined remdesivir, I did speak with her about possibly receiving tocilizumab. Patient reports she will think about it and read the side effect sheet. Currently at bedside the patient does have bibasilar inspiratory crackles on auscultation. Course of hospitalization: Ms. Hogue came in with a working diagnosis of COVID-19 that failed outpatient treatment requiring placement in an ICU bed given her worsening respiratory failure. Despite multiple attempts to have this patient treated, this patient's daughter Robin Pickel refused all treatments per her mother despite the fact that the mother was awake and alert and could certainly make her own decisions. Unfortunately the patient seemed to take the daughter's advice which was ill advised if not lethal. I provided many opportunities for this patient to receive active treatment and at least try to give her every chance possible with medications that her daughter would allow her to have and did attempt to give anti-inflammatories i.e. colchicine along with vitamin D3, vitamin C, melatonin, zinc. The patient's respiratory status worsened each and every day and yesterday 12/24/2021 I advised the patient's daughter that she should at least get on BiPAP to see if this could provide rescue ventilation as she was struggling to breathe. The daughter only allowed the BiPAP on for short period of time before she had it removed. At that point time I did confront her and felt that her and expressed my extreme dissatisfaction in the way that she was trying to micromanage her mother's medical care despite the fact that the daughter has absolutely no medical training. The daughter even refused the patient to receive morphine which would have the least made her breathing easier if she was going to die anyway since she was not allowing any treatment and this was also refused. The nurses who have taken care of this patient have documented that the daughter thwarted every effort for them to give her medications as well stating that her mother could not swallow them which was untrue. Daughter also would not allow this patient to get out of bed and did not promote positional changes as indicated for the treatment of COVID-19 pneumonia. As I presented to work this a.m. noted that patient was extremely tachycardic on telemetry with heart rates up in the 140s before becoming bradycardic and then going into asystole. This case is going to be brought up with ethics next week after Christmas when staff is around to review this case.