Case Study Conclusion
A memorial service was held for my father-in-law on a Saturday. Although my mother-in-law had some diarrhea, she also was vomiting and was anorexic. She traveled by wheelchair from the skilled nursing facility to the funeral home, not believing her husband had died, barely holding her head up. She was able to garner enough strength after the service to address the assembled family, saying only, "Love each other."
I returned her to her bed, where she slept all night. On Mother's Day, she complained of nondescript pain. She begged us to take her to the hospital, but my assessment yielded no source of pain, stable vital signs and, importantly, a soft, nondistended abdomen with normal bowel sounds. The nursing staff drew electrolytes; a potassium reading of 6.2 was her ticket to the hospital.
We arrived to hear the familiar sounds of a code in progress. The look on the paramedic's face was enough to know who had arrested. The message from the emergency department attending physician was this was obviously an old woman from an SNF with no meaningful life. We pushed back; we had just buried one loved one and she had made it clear that a DNR was not to be considered.
A surgeon came in with the results of the CT scan, which depicted a perforated bowel. He offered surgical options with a 40 percent chance of recovery. I then asked if a history of unresolved C. difficile would have any effect on his ability to repair the bowel. He retreated to reexamine her chart and returned to share that the damage was diffuse disintegration of the bowel. With chronic C. difficile, there was no possibility of repair. Shortly, her cardiologist came to discuss how to assist her to a painless and peaceful death.
So CHF led to C. difficile, C. difficile led to a fall, and on and on. Ultimately, C. difficile led to death.
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1. Association for Professionals in Infection Control and Epidemiology. (2008, Nov. 11). National prevalence study of Clostridium difficile in U.S. healthcare facilities. Retrieved July 9, 2009 from the World Wide Web: http://apic.org/AM/CM/ContentDisplay.cfm?ContentFileID=11410
2. Safe Patient Project. (2009). Hospital-acquired infection public reporting and MRSA related bills under consideration by states in 2009. Retrieved July 9, 2009 from the World Wide Web: http://safepatientproject.org/2009%20state%20legislative%20web%20chart.htm
Julia Aucoin is an adjunct professor at Nova Southeastern University, Ft. Lauderdale-Davie, FL.