Saturday, March 19, 2005

The Passing of Chester Yerger Jr. Or a lesson in how Fayette Piedmont Hospital can engineer the death of a loved one.

My stepfather, Chester Yerger Jr. was found to have prostate cancer in 2003. It actually happened in that a blood clot formed in his left leg. He was given a kind of hormonal therapy and released, but with subsequent treatments, or so I am told.

After a few months, the entire problem resurfaced in October -- the blood clot in his leg, but this time two blood clots in his lungs. He was sent to Piedmont hospital, remained for about two weeks, and then sent home. On Thanksgiving he was active and walking, though weak. He used a walker to get around.

On Christmas, he was still weak, and didn't use the walker as much; he was content to sit and watch TV -- a lot of football (GO BEARS!)

Anyway, when I returned in early February, he was still sitting in his chair, but would go to sleep more. His breathing was weird. On February 4th, Mom took him to the hospital where it was found that he had an irregular heartbeat. He was treated for what turned out to be 10 days and released.

Someone talked Mom into having him in a hospice program called Odyssey. But he was only in this home hospice care program for about a week.

When I came to Atlanta - Fayetteville, GA this time on Wednesday March 9th, he was in a special bed set up next to his bed. He was with an oxygen tube. Then, at about 8 PM the night I arrived, he started wheezing and coffing -- as the night wore on, it sounded like he was drowning.

We called the hospice nurse.

She said, "You're watching a person who's dying." (No kidding) She said this four times. "There's nothing you can do."

I disagreed with her and called 911.

They took him to the closest hospital: Fayette-Piedmont Hospital in Fayetteville, GA (Fayette County). Here, they said he had pneumonia.

When Mom and I arrived, the hospital Chaplain came out and we thought the worst. But he was just there to introduce himself. He was with two physicians and two of the ambulance crew and a nurse. They asked us a set of questions regarding what kind of care we wanted for my step dad.

We said that we wanted them to do everything to keep him alive. What was interesting to me is that they asked my Mom this question three times and in three different ways. Had I not been there, and given how upset she was, she might have given three different answers.

Instead, once she understood what they were asking, and with my warning to them to ask the same question and not play “tricks,” she gave them the same answer. Finally, she signed a contract that – we believed – was to bind the hospital to our wish to keep my stepfather alive.

What they did when we first got him here (and placed him in ICU) was to pump the fluid out of his lungs that built up. Then, doctor Larry Vaughn put him on Calodex for the cancer.

What upset me at first was that the Dr. ordered the nurses to take him off the narcotics he had in his system and as they did he shook in pain, with no one other than me and Mom to see him in the room, with no nurse or physician present. So, I went to ask what's going on.

The nurses were not even watching his vital sign monitor.

The nurses said that the physician was evaluating him without the narcs. I said, "Isn't someone supposed to be there to monitor him?" They said "Good point."

So, I personally got the doctor off the phone and had him come in the room. He said, “I’m on a call.” My response was “Five seconds.”

When Dr. Vaughn came into the room, he explained that he needed to take the narcs out to see how the "patient's" resperatory system responded and that sometimes it's better for them to breath without the narcs. I explained that the reason I was questioning him is that his own nurses were saying that he should have been in the room. Dr. Vaughn said -- after a long pause -- "They were being honest."

I also asked for a second cancer opinion. They called in a Doctor Jonathan Bender, MD. But this was not the person I asked for. I requested a Dr. Kamwashi (misspelled name here) He said that there was little that could be done, and that I should look up "Hormone-Resistant Prostate Cancer” So I did -- in fact I collected about 200 pages of information starting on Thursday and through Friday and stayed up until 4 AM Saturday morning.

I called Dr Bender -- who was more concerned that I called his cell phone than what I had to say -- Saturday morning. It was because I found information online about how his condition could be treated, where Bender TOLD ME it was not treatable. Keep that in mind.




What caught my eye was Dr, Leibowitz finding that:

He presented in February 1995 with a PSA of about 2400. He had obvious metastases to bone and lung. He was treated with 13 months of triple hormone blockade, then about 18 months of Proscar maintenance therapy. His PSA was unmeasurable when we stopped triple blockade, and slowly rose on Proscar alone to 23.51. He was treated with "The Magnificent Seven" protocol (triple hormone blockade, Aredia, T/E/D), and his PSA became unmeasurable again. At present, his only medicines are once a month Aredia and daily Proscar maintenance therapy. He is OFF triple blockade; and has been off Taxotere since 12/4/97. His PSA is still unmeasurable, and his testosterone level is returning to normal.

The FDA as a subsititute, I learned, approved Zometa, for Aredia.
When I presented this information to Bender, he claimed that Potite, the first cancer doctor for Chester at Piedmont Hospital, said this was done. They've not seen his medical records, so Bender's only going on what Potite told him.

Finally on Saturday, they got a room ready for him -- Room 337. By Friday and through Saturday, there was improvement by my observation: 1) his arm movements were less frantic 2) he would occasionally eat and talk two sentences each day, not just moaning, 3) there was no wheezing and the drowning sound was gone.

The one problem was constant pain, which caused him to moan and moan. We figured maybe there was not enough pain remedy, so they did give him some. And that seemed to work. I must add that through this entire episode when he arrived at the hospital, he was not talking.

On Saturday, and after continuing treatments to suck the mucus out of his lunges, he would say a few sentences – “Hey Baby” to my Mom, for example. But he also explained in a strained voice where his pain was. First, he said it was all over on Friday. But on Saturday he was more specific. He pointed to his groin and to his leg, where there was a blood clot before. It had not hurt for a while, until after he arrived at the hospital this trip.

But even with that, we left Saturday night with better feeling.

Today, he was -- it seemed better -- he ate for my Mom. I walked in and he raised his hand. But for some reason at about 1 PM he seemed to wheeze again and he would wail his arms, which he does when he’s in pain...,and moan.

Then at 3 PM the moaning continued and he at times looked like he was in a catatonic state, then would come out of it. It turned out that they gave him a new pain patch called Duragesic and placed it on his left upper pec area. There seems to be a correlation between that and his current state.

I just talked to my Mom while writing to this point on Sunday evening; they took the patch off him. He was still in his semi catatonic state.

As I wrote to this point last Sunday March 13th , they had him on antibiotics rocephin and zithromax for his pneumonia; the Calodex was stopped when Dr. Vauhn discovered that my Step Dad’s prostate cancer was hormone-resistant. He learned this from Dr. Bender, but no alternative was applied.

Meanwhile, my stepfather slowly emerged from the state he was in. At points on Sunday night he would follow you around the room with his eyes. I felt there was improvement.

Dr, Vaughn admitted this to me during an argument he and I had over how they were treating my stepfather on Sunday, March 13th. When I asked Dr. Vaughn why my step dad could not talk and why he was in so much pain, he responded haughtily “Have you ever had a cold?”

Not appreciating unstructured and illogical debate, I quickly reminded him that the minor cold in no way compares to pneumonia, which I’ve never had. I explained that all I wanted was data: his blood count is this; it was that, and so on. Instead, what I got from Dr. Vaughn was a rather rambling lecture on God and the scriptures that I did not ask for or need. So, to make him think I agreed and after a heated and draining argument, I just listened to what he said and responded little.

He -- like Bender -- was trying to get me to accept that Chester was going to die. But the point is that they signed an agreement to do everything to keep Chester alive. They were not supposed to give us silly “God v. Science” lectures or not try – which is what they did. And what I got when I asked questions were God and Science lectures most of the time.

Some of the nurses explained that “doctors are God” in the South and don’t like to be questioned. My response was consistently that we were trying to save his life, not kill him – to not ask questions and not try is to kill Chester. By Sunday, and before what happened, I was convinced that they were trying to kill him.

For example, there was a breath treatment that Dr. Vaughn had ordered to be administered every 4 hours and as needed at night. I calculated that his mucus would accumulate to a point where it impacted his breathing every 2 hours and 23 minutes. After my and Mom’s constant calling for treatment, the mucus buildup slowed to 2 hours and 45 minutes by Sunday. A clear sign of improvement.

But on Monday, two things happened, both tragic and hospital actions. Dr. Bender ordered his antibiotics stopped, and his breathing treatment frequency was just “as needed” – with the argument that they were not working. They were working.

But what the hospital tried to do all along was push him over the cliff. In other words they tried to kill him, and developed a rationale for doing so.

They figured that we weren’t’ going to question them. In fact, Dr. Bender asked my Mom what I thought – even though I wasn’t in the room. I later informed him that my feeling – that Chester could be saved and given a longer life, even if he lives just for another month – remained. Neither he nor Larry Vaughn had convinced me. I told them that we wanted Chester to live and if we had another week or month, great. At least try.

The doctors not only didn’t try, but also gave some of the dumbest reasons for not trying. Like his age of 82 – so what? The contract we had with the hospital directed them TO SAVE CHESTER, not play the debate game with their patients, or their patients' loved ones like me and Mom.

In fact, it was getting to the point where I simply didn’t like Dr. Bender and to reflect this, I would only call him John. Not doctor. John seemed to have an argument – and not a good one – for everything. What really pissed me off and sent up my red flag was his assertion that the previous doctor “tried all of that” I mentioned in the research I uncovered, even as he admitted he didn’t see Chester’s medical records. He was just trying to cover for Dr. Potite. Trying to save his ass.

I was more certain than ever that they were trying to kill him. To get Chester out of what was going to be a long hospital stay. So, by Tuesday, I was trying like heck to get another cancer doctor involved and get Bender off the case. But by then, the doctors informed Mom that Chester wasn’t going to make it.

Strangely, I had a dream that if we placed Vick’s Vapor Rub on his chest that it would loosen his mucus and help clear his lungs – much as was done for me when I had terminal asthma as a small boy. So, I left for the hospital to help Mom (in fact, I felt like I lived at the hospital) and when I got there, asked the nurses for Vick’s. They didn’t have any.

But they did encourage me – the nurses – to go and get some. So I did. I applied it while Mom covered his chest with towels. And by nighfall, it worked. I got the suction tube, and got the stuff out of his mouth, and with his help. Chester knew what we were trying to do and would try and – with his weakened condition – spit out what he could. But he could barely eat.

On, on eating. He could not chew with ease let alone swallow. He would hold the food at the roof of his mouth. So, to get him to eat, we ordered his food pureed – we Mom and I, not the doctors. Then later we asked them to give him food via some kind of injection. Remember this is part of the contract of keeping him alive.

They were either slow to do this on the weekend, or did it on Wednesday March 16th --- and after his condition had worsened via the hospital’s other actions of taking away his antibiotics and breathing treatments. Both of which we asked to be reapplied. That was enough to push him over the edge.

But the final last straw was after they said he wasn’t going to make it. I got on the plane to come back to California – unsuccessful at getting a flight out later the following week so I could stay.

As soon as my plane landed in San Francisco, I got a call from Mom that he was still alive and now he had a fever, which the hospital declined to treat. For me that was it. I called the hospital and said to explain to Dr. Bender that if he so much as stepped near my step dad, I was going to have him arrested.

Then, about three hours later, Mom called and told me Chester passed away.

For me, the best satisfaction is the legal and binding punishment of Fayette Piedmont Hospital in the name of Chester H. Yerger Jr.