A Daughter's Journal

An Outside Visit to the GI Doctor

by Ann D. Gross

I felt like I had been dropped onto the set of a Fellini movie, asked to play a leading role with a script I'd never even seen before.

My Mom, too weak to get herself to the toilet, and feeling her intestines at war with her stomach, mustered her strength to hold up the long leash of her call button and push. She watched to see if the red light went on, and dropped the cord when it did, that part of the mission--the part she allegedly had control over--accomplished. She was exhausted, but needed to get to the toilet. And fast.

I looked down and saw my feet, indicating I really was there, in the middle of this scene. "I'll help you," I said, trying to sound like I wanted to help, hoping she'd turn me down. But modesty and role boundaries were apparently left behind, back in her empty apartment by the ocean.

"Would you?" she said, in a way that was so helpless that I was ashamed of myself for hesitating. I was more ashamed when we went in to the bathroom and struggled together to get her to the toilet. I was assaulted by an odor so foul, I gagged. Obviously the evil visitor, C. Diff, had returned.

I pretended to be clearing my throat, so she wouldn't be embarrassed--but it was too late. I was embarrassed by my reaction to my own mother who, I'll bet, never hesitated to change my nastiest of diapers.

Heroes & Heroines

When I confessed my sin of gagging to my friend and soul sister, Everlena, a CNA at a nearby hospital, she said, "yeah, that takes some getting used to." Everlena told me that her first time, she threw up all over the poor patient. How I loved her for telling me that story.

My Mom wasn't embarrassed. It had gotten down to a hierarchy of needs, and embarrassment was way down on the list. We were talking basic human need. And abject misery, mixed with a terror that her body could betray her and sap her of such basic abilities as getting to the toilet in time.

I remember the first time I watched her lie on her bed as the CNA, a man, had to change her. She didn't look up, but said, "I've lost all sense of modesty. I just don't care anymore." This from a lady with perfectly manicured nails in the latest autumn color. This from a lady who, sick as she was, wouldn't be seen without her cutest wig with every gray strand in place. This, from my mother.

The Journey Begins

The SNF sent a lovely young woman, Tracy, the secretary from Mom's floor, to accompany us to the doctor's office. In the van, I felt it was my job to amuse Tracy and my Mom and driver Al, but no one seemed interested. So Al and I discussed the route he was taking, and I had no idea what I was talking about, but I couldn't stand the silence and the suffering.

At the doctor's office, we waited only briefly. I gripped the meticulously prepared paperwork from the SNF, feeling it was our lifeline to wellness--the secret code that served as the communication between the people who housed my mother, and the clinician on the outside on whom we were pinning our hopes to sort things out and help Mom back to wellness.

I was hardly prepared for the scene that ensued.

When it was our turn, Tracy stayed in the waiting room, and Mom and I went into the examination room together. Her wheelchair fit through the door--seemingly a miracle, given the slick, corporate look of the offices. This was a "specialty digestive disease center"--really just another fancy name for helping people with stomach aches. About half a dozen young, attractive women wearing matching navy blue T-shirts, sporting the practice name, were bustling along a long countertop that looked a lot like a bar. I wanted to order a double whiskey, but instead, I handed over the paperwork on my Mom, relieved that I had finally gotten the missive into the right hands.

"A Lack of Communication"

The doctor entered several minutes later. By then, Mom was staring blankly. I tried to get her to drink the water I'd brought, and she took it to her mouth, but seemed unable to take any water in.

We're OK now, I thought. He's here and he'll understand everything and Mom will be OK.

"How are you?" the doctor asked my Mom cheerily. My Mom just shook her head.

"Not good, doctor. Not good at all."

"What seems to be the problem?" he asked.

"Well, I haven't been feeling well," she said.

"Really? How long has this been going on?"

He may as well have asked her how many hours there have been since 1927. She barely knew where she was at this point, let alone how long it had been going on.

"Oh, I don't know, a day or so," my Mom replied.

I shifted uncomfortably in my seat. In fact, today was Tuesday, and the stomach ache had begun on Saturday. By Saturday night, she was feverish, spiking a temp of 101 degrees.

"Hmm," he said.

"Uh, well, actually, she started not to feel well on Saturday," I ventured.

Mom shot me a nasty look. Even in her weakest state, she would show me that she didn't need any assistance.

"Well, I think we should run some tests," was his reply. "We should get a stool sample and a urinalysis as well."

What Records?

Now I was really uncomfortable. I knew the SNF nurses had taken great care to document Mom's symptoms, chart her temp over several days, and surely include the tests, if not the results, by now. All this, in the envelope I had brought with me.

"OK," Mom said.

"Um," I said.

They both looked at me.

"Actually, I think they took all of those tests, and sent them to you. Didn't they send the labs to you?"

"No," he said, looking at me blankly. "I didn't order any tests."

"Well, Mom's primary care doc ordered stool samples. Where did they send them?"

"I don't know," he said. "I didn't order them."

I get it, I thought. You didn't order them, so they don't exist. But I know they do. By then, Mom had had it. Several minutes had passed, and although she was weak and dehydrated, she realized we were all going around in circles and that meant there was no immediate end to her misery in sight. Clearly this doctor was not the savior she thought he would be. She slumped down lower in her chair.

That was the signal I needed to start speaking up.

"She presented with a stomach ache and nausea on Saturday. By then she would barely eat or drink. She spiked a fever of 101 on Saturday night, which resolved in a few hours. But she has barely eaten or drunk anything since then. They knew she had this appointment with you, so she hasn't been seen by a physician. They took care of her symptoms and tried to get her to drink, at least." There, I had said my piece.

"It was all in the envelope we brought you," I continued, angry that he didn't seem to know this. "All the tests they already took, and all the documentation on Mom's symptoms."

He looked at me blankly. "What envelope?"

Now Mom's despair and the lunacy of this situation were upon me, and I was less restrained than I should have been.

"Didn't you get the envelope? I gave it to the women outside. Didn't you see it?"

"Um, why don't I go and check. But I didn't order any tests," he answered, slipping out the door.

The nurses at Mom's SNF worked so hard to get the information to you. Maybe you could take a moment to look at it! I wanted to scream.

Mom didn't say a word. And I knew, as dehydrated as she was, she would never remember any of this. Little did I know that months hence, I would tell her about this adventure, over and over again, and she would listen with rapt attention each time. "Really?" she would ask me. "And then what?"

Unappreciated Efficiency

The doctor returned.

"Whaddya know?" he said. "They did take the tests, and they're here. Looks like you do have the C. Diff back and you also have a urinary tract infection," he reported to us, with all the self-righteous authority he could muster.

"Whaddya know," I muttered. They both looked at me. But I didn't care at this point. I was trying not to think about the danger to Mom had I not been there.

"I'm going to have to hospitalize you," he said to neither of us in particular. Then, looking at my Mom. "Do you want to go to the hospital?"

Mom started to cry.

"It's OK, honey," I said. "We're just going to take you across the street to the hospital so you can get some fluids and they'll make you feel better." Mom stopped crying.

The doctor put on his best false, reassuring smile.

"Excuse me a moment," he said, and walked out the door.

"Ann, what's going on?" Mom asked.

"Well, honey, I think we're going to take you across the street and get you a room until you feel better."

The doctor returned.

"You're going to have to go to the emergency room, and wait there," he announced, with no explanation.

"Why?" I asked. "Can't she just get admitted?"

"Her doctor is out of town, and there is no answer in the on-call physician's office."

"Can't you admit her?" I asked.

"I'm not her attending physician. She'll have to go and wait in the emergency room, and get admitted through there," he answered.

"No." I said.

The doctor looked at me. Mom just stared straight ahead, resigned to my fighting for her, at last.

"We'll just wait here in your office until you get hold of her physician."

"Um, would you excuse me?"

"Sure," I said.

Two minutes later he returned.

"It's all set," he said. "She can go to Admitting."

"Thank you doctor," I said, seething. As we went out, Tracy seemed shocked that we were heading to the hospital. She made arrangements to get back to the SNF, and Mom and I wheeled across the crosswalk.

While in Admitting, Mom sat quietly, resigned to her fate.

The young woman in Admitting looked at the paperwork and asked me the diagnosis.

"C. Diff," I said, "and possible UTI. Isn't that what the doctor wrote?

"They left out the diagnosis," she said. "I'll give a call to confirm."

I just rolled my eyes, too exhausted to vent my rage. I was just glad Mom was in the hospital for treatment. And I couldn't wait to see my CNA friend, Everlena, who I knew was working the 3-11 shift upstairs. I knew she would look out for us.

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