Billy's Case History - 10 day battle to death

[BillysDaughter]

Billy was a wonderful man. He attended and played football for West Point Military Academy, followed by a 20-year military career where he served his country as a great warrior and true hero. Jumping out of airplanes and college football took a toll on his body. After two extremely successful knee replacements years ago, he now needed to have work done on his back. His quality of life was just not where he thought it should be at the ripe age of 74.
My father’s spinal surgery was performed on Friday, Sept. 5. He was released from the hospital on Monday, Sept. 8. While in the hospital, and after returning home, he kept complaining about constipation. He was given several stool softeners while in the hospital, and, after contacting his primary care physician, we continued to give him Senokot (along with V8 juice, prunes, and prune juice – he was on a mission to have a bowel movement.)
By Wednesday, my dad was having diarrhea. Before long, he was no longer able to make it to the toilet, and by Friday, he was wearing Depends. I spoke with the surgeon’s nurse, on either Tuesday or Wednesday, inquiring why his recovery seemed to be progressing so slowly. I mentioned he was not able to move around the way we thought he should be. She asked if we were giving him the muscle relaxants. I told her “no” because the dismissal RN had told us the muscle relaxants were for his bladder control (he had, minimally, been wetting his pants prior to leaving the hospital.) We continually gave him two Hydrocodone every 4-6 hours because he was experiencing pain, and after talking with the nurse, we began giving him the muscle relaxants as well.
Dad was not eating much of anything, and only drinking when I would “force” him to. The amount of diarrhea lessened over the next several days, so we thought he was getting better. We also began checking his temperature, which remained normal throughout this ordeal. However, by Sunday, Sept. 14, he was very weak, and we became concerned. I placed a message with the answering service at the surgeon’s office Sunday afternoon/evening. The “on-call” doctor quickly returned my phone call. I described what was going on, and his thought was that we probably overdid the laxatives. He said if the diarrhea continued into Tuesday, to take him to his primary care physician. The on-call doctor also said to keep Dad hydrated with Gatorade, and that the symptoms did not sound like an infection.
Sunday evening, I noticed that my father was acting very strange. He would say things that did not make sense, see things that were not there, and act very anxious and belligerent. I thought the pain medication may be making him “loopy” or that he was suffering from dehydration. I called the same on-call doctor again, and he said to continue with the pain meds throughout the night, try to get him through the night, and to take him to his primary care physician in the morning (Monday, Sept. 15) to get him re-hydrated.
Sunday night was one of the hardest nights of my life. He would not sleep, he was restless, and totally out of his mind. Monday morning could not come quick enough. We ended up calling the local volunteer ambulance to pick him up (around 8:15 Monday morning, Sept. 15) and take him back to the hospital. After the ER doctor performed his examination, it was determined that Dad’s kidneys were not functioning and that he had a massive infection (probably in his colon), but further testing would determine exactly where the infection was.
My father was sent up to ICU – given fluids, antibiotics, pain medication, and anxiety medication. I went home to gather a bag for spending the night, and when I returned, Dad was tied down in restraints and was talking about all kinds of crazy scenarios. The ICU RN assured me it was just the “medication talking” and that he was going to be okay. That night/morning around 3 o’clock, Dad’s heart slowed down, triggering a “code blue.” The doctors/nurses were able to get his heart back, but from that point on, he was not coherent and breathing only with the help of a respirator.
Tuesday morning, Sept. 16, the ICU doctor gave us the update that Dad had developed toxic megacolon. We were given several options (removal of colon or fecal transplant), but the survival rate for him at this point was close to 0%. Toxins were taking over his body, and the nurses suggested he was probably feeling lots of pain (even though he could not tell us.) Things did not look good, and we decided, as a family, to let him pass on. The cause for his condition was determined to be Clostridium Difficile (or C. diff.)
My hopes for making this post are, by taking certain steps, future lives might be saved. Please consider the following:
1) [Patients will be assisted with hand washing before every meal.] The first day, Dad was not able to get out of bed. After he was able to get up, he could not stand alone (without the assistance of the walker), and thus could not wash his hands by himself.
2) [Doctors will discuss the necessity of administering antibiotics after surgery as a preventative measure.] Of course, I am not a doctor, but maybe risk-versus-reward could be re-evaluated.
3) [C. diff and other diseases or infections (such as MRSA) will be discussed at the pre-op visit.] As part of the grieving process, I keep saying, ‘If only I had known . . . ‘ I realize no one can prevent every negative outcome, but it can’t hurt to make people aware.
4) [As part of the dismissal process, blood will be drawn to test for elevated white blood cell count.] I have no idea if this could/would save a life, but it was just a thought.
Thank you for taking the time to ready Billy’s Case History. His funeral was held on his 75th birthday.

[BillysDaughter]

Hi again. I wanted to add another entry I thought might be relevant. My 20-month-old son was with me at my Dad’s home, in between the two hospital stays, in the midst of the Depends and the Big D. He developed diarrhea soon after Dad’s funeral. I immediately took him to the pediatrician to be tested for C. Diff. After a week, we had the results. Negative. Praise be to God!

Two weeks ago, I took him back to the pediatrician because he had a bad cough for three days, and his breathing had become shallow. The pediatrician was worried he might have pneumonia, but understood my fear of the antibiotics. He did, indeed, have pneumonia, and ended up needing breathing treatments, injections of antibiotics, as well as oral antibiotics. He is now fine. I thank God every day.

After reading other Case Histories, my heart goes out to all of you, and I am here to help fight to raise awareness – for prevention, early detection, and a cure!

[BillysDaughter]

My mom is visiting and brought with her Dad's death certificate. C. Diff. is not even listed! I will be finding out why this is the case. My question is if C. Diff. is not listed on the death certificate, then does my father’s death from this horrible disease not even count towards the skyrocketing statistics? I will find out . . .