Debate is raging in the United States on creating a medical system modeled such efficient socialized systems as Israel’s.
The long and the short of it is “Don’t Do It” unless you plan to emblazon on the entrance of every hospital “Abandon all hope, ye who enter.”
Here is my horror story.
My 87 year old mother Rose stumbled and fell against a door post, lightly hitting her head against the door. She had no symptoms of a concussion but seemed a little dazed so I called her doctor who said that he could not see her that day and that we should take her to the emergency room to see if she had a head injury.
We made the fatal mistake of taking her to Sharei Tzedek Hospital in Jerusalem. After conducting a head CT the ER attendant diagnosed a urinary tract infection without any head injury. We were told that confusion was common in older people who get infections. The doctor said that he was admitting her for the night as she needed an IV antibiotic, once that evening and once in the morning and that she could take pills thereafter. I thereupon asked if I could do the IV at home if I hired a nurse to do it. When I was told that the IV needed a doctor’s supervision, I again requested that the IV be done at home and that I would hire a nurse and a doctor to supervise. The ER doctor refused and insisted that she be admitted for the one night.
While I preferred not to admit my mother to the hospital, I agreed as the condition was not life threatening and the stay was limited to one night. I informed the doctor that my mother did not drink or eat anything the day before as she was unable to eat. She was then taken to the internal medicine ward and placed in a room with a woman who had been struggling with pneumonia for a month. My mother was admitted for a simple urinary tract infection and ended up contracting pneumonia from the ward. When she first got the lung infection she was coughing up globs of blood and could not breathe. The treatment for this was two tablets which the nurses never administered, but just left on her cart. As she was unable to swallow pills at this point, this antibiotic was not administered at all.
The rounds at Sharei Tzedek include two interns visiting each patient briefly. I timed it once and the visit lasted under 60 seconds. When we were able to stop these flying attending interns or residents, we got snippets of diagnosis but were never informed of treatment.
During my mother’s entire stay at Sharei Tzedek, the supervising physician periodically made rounds and always saw me but did not speak to me until the end when her blood pressure could not be sustained. He and the head doctor of the ward were never available to speak to our consultant doctors, the internal medicine specialist, the pulmonologist or her United States doctor, an oncologist. Even electronic communications were blocked. I asked the charge nurse for the e-mails or fax numbers of these doctors and she categorically refused claiming that all communications must be with the attending physicians. I told her that they refuse to talk to me, claiming that they need to continue the rounds. I think that a one- to two-minute examination per day is hardly the usual and customary medical standard.
The nursing staff and aides were even worse. Most times that I asked the staff to help her sit up when my mother was coughing, they were too busy. They were also too busy when she aspirated and almost never took action.
One evening, she was coughing up blood and because she was reclining, was choking and couldn’t get it out. I called the male Arab nurse who looked at her and said that he knows and that she always does that and walked out without taking any action. Finally, a security guard came around when my son came to stay overnight and insisted that I leave right away. I refused until some action was taken on my mother’s coughing up globs of blood and inability to breathe, which left me wondering what sort of a hospital would force me to barter for treatment. At this point the supervisory nurse told me that she would take charge and chastised the Arab male nurse who had contemptuously neglected my mother. I told my son to go home and I stayed with my mother that night.
The doctor, a German gentile who was apparently anti-Semitic, came in later and looked at the blood my mother coughed up, saying that she looked in the chart and that she did this before and this was nothing new. She took no action. The male nurse made the rest of that night miserable for us by putting on the light, but doing nothing in the room. We first went to sleep 3:30 that night and by 5:30 they were back changing the beds and bathing, etc. Depriving even a healthy person of food, drink and sleep would severely compromise the immune system; getting infections is inevitable.
During the following day, I at one point called a nurse when my mother was aspirating and the nurse also said that this was fine and walked out, but after 15 minutes came back with a doctor who insisted I leave the room while he examined her and then insisted that she required a feeding tube. It turns out that he “forgot” to tell us that at this point in treatment my mother should not be drinking water, but only Ensure and thick liquids. My sister the previous day made my mother drink water as she was dehydrated and clearly in pain, triggering fits of coughing up blood.
As the urinary tract infection cleared, she was able to drink, but the doctor nevertheless wanted to put a tube down her throat for convenience. As we resisted, they sent two doctors to “prove” that she could not drink and that anything she drank, she aspirated. They put a stethoscope on her throat and she drank a can of Ensure, some water and some coke proving that she could swallow. Conceding that she swallows fine they posted instructions that she was to drink and eat sitting on a 90 degree angle and should remain sitting for a half hour after drinking. They further instructed the staff to give her soft food to eat, which she found repugnant and would not eat. As this socialized, cost conscious medical facility was severely understaffed and her basic needs would not be satisfied, I and my siblings stayed with her around the clock.
At this point Rose was responding to the antibiotics and getting better. She progressed from coughing up blood to coughing up dark brown phlegm to clear phlegm intermittingly and was able to breathe easily. Her urine infection cleared entirely. She was lucid and certainly could swallow drink and soft food, but was as yet unable to swallow pills. On the eve of a two day Jewish holiday, Rosh Hashanah, we hired an expert pulmonologist, who convinced us to allow them to put the tube in for a few days to give the lungs a break to heal and to ensure that there was no chance of aspiration. As it was going to be a 2 day holiday and they are short staffed, he insisted that she have it. I told him that if it was only for 2 days, I would agree.
Right after they put in the feeding tube, Rose choked when they fed her and coughed up phlegm with the Ensure type drink they were giving her. I kept sitting her up when they fed her and she was fine, but they gave so much at once that she felt nauseous and it came up. If she was not sitting up, she aspirated on the vomit. The next day, the only thing she coughed up was the drink she was given when she was fed lying down. When I told the supervising nurse, she insisted that they feed all their patients lying on an angle of 30 degrees and no one else aspirates. Either the tube was not all the way down to her stomach or because the internal organs of an 87 year old are more flaccid, liquid food does come up. I showed her their doctor’s orders to feed her sitting up and she insisted that this is what they always did this and would continue to do it even if she aspirates.
While the urinary tract infection healed and the lung infection had been healing, the feeding tube caused aspirations EVERY time she was fed. This regression eclipsed her improvement. As my mother’s condition rapidly deteriorated, I called in and paid dearly for a private doctor to examine her. This doctor is a master diagnostician and head of internal medicine in another hospital. He examined the charts, CT report and blood tests and told us that there were insufficient cultures and pathology reports for a definitive diagnosis. As she was coughing up blood he wanted her tested for tuberculosis and lung cancer. He believed that the CT report implied advanced lung cancer. He prepared us that if it proved to be lung cancer it could be fatal as the narrowing of the bronchia and deterioration of D12 may mean the cancer metastasized. He instructed the doctors to give her a unit of blood, test for tuberculosis, take a sample of what she coughs up to send to a pathologist to perform sputum cytology and if negative, perform a brochoscopy to obtain a diagnosis. He further indicated that that the antibiotic was wrong and suggested an alternative. He indicated the potassium and B12 were extremely low and should be addressed. He recommended treating the untreated staph infection.
The pulmonary specialist that we hired disagreed and felt that this mass was just the infection. I consulted with a United States oncologist, trained in Stanford who told us that this is not necessarily cancer as deterioration of D12 is consistent with bone deterioration at her age as is the bronchia narrowing, and said the only way that they can know is sputum cytology and biopsy.
Naturally, my family followed the advice of these outside experts, to whom we had paid thousands of dollars and insisted that the sputum cytology be done. They kept saying that they did it, that they will do it, that it takes a long time, but I do not believe that they ever did.
As she deteriorated, Rose was placed on an oxygen mask for a day and then just a nose tube that provided enough oxygen to sustain her. One early morning, they took her for x-ray and I tagged along, down six floors, wondering why a sick patient would be moved when there was an x-ray facility in the ward itself. It was eerie, when we finally arrived, to find another patient in a bed in the hallway left unattended. My mother went in for the x-ray and I asked the secretary for some paperwork I needed to get a copy of the x-ray and in order to pay for it and bring it back. Although I was the only person there, this secretary busied herself and kept telling me one minute as she shuffled papers around. At Sharei Tzedek organizing office work takes precedence over patients. When the x-ray tech wheeled my mother out I saw she was twitching trying to breathe but could not at all breathe. The attendant had taken the unattended patient back to her ward and was not around, yet another unfathomably irresponsible practice: leaving patients unattended as the aide alternates taking patients to the ward. So I asked the x-ray technician to call emergency. She casually said that my mother hadn’t been breathing much when she took the x-ray and told me to be patient. Then Rose stopped breathing altogether and started to change color. I called out to the secretary to call emergency to no avail. They kept saying someone was on the way to take her. I told them – where – to the cemetery across the street? Eventually the aide returned and attached an oxygen tank to the tube she was breathing from and she started to breathe without CPR. She was definitively damaged by the lack of oxygen as her skin color changed. When she got to the ward, her condition worsened and my sister asked me to call the pulmonologist that we hired to come in to examine her. He changed the antibiotics.
Throughout her stay she was not once seen by any hospital specialist: not their pulmonologist, not their urologist, not their oncologist, not their neurologist.
As Rose kept aspirating from the feeding, she regressed so badly that the ward doctors put her on a respirator. Because ICU is expensive, it is Sharei Tzedek’s practice to intubate on the ward with no monitoring. Instead of being performed by a pulmonologist or surgeon with an anesthesiologist, it was performed with no anesthesiologist present by an endocrinologist who punctured her lung. Rose lost a quart of blood during this experience. Instead of replacing the two units of blood, they gave only one the next day. Keep in mind, the private internist we hired had asked the staff to give Rose an extra unit of blood days previously but they never did. During the intubation, they gave my mother a high dose of the sedative that was supposed to keep her asleep but left her on this high dosage overnight. Naturally, the next day, her blood pressure dipped. Their response was to halve the dosage of this sedative and, later, to discontinue it but Rose never regained consciousness. When I called the private internist and told him that that they gave her Dormicum, he said in a shocked voice “They gave her Dormicum?”
When I first saw my mother after the intubation, I was shocked. Her eyes were turned upward frozen in one position, her eye lashes did not respond to touch reflexively and her tongue was sticking out to one side. As a professor of neuropsychology, I know this is not “just” sedation and I asked for a neurological consult. The attending physician claimed that this is normal and that a neurology consult is not possible until the initial dosage of dormicum wears off. I do not know the original dose when she was intubated but the maintenance dosage was two ml/hr all night and they reduced it on the next day to 1 ml/hr and then gave no more as she never regained consciousness.
When hospital staff asked if we wanted to give her sedatives, our family strongly and unequivocally refused. I do not know if she was given tranquilizers or sedatives to put in her feeding tube or any psychotropic medications as they refused to provide me with any treatment details and the name of the medications she was taking. However this drug Dormicum is a brand name of the same drug that caused Michael Jackson’s death which was declared a homicide. This drug is intended for use only in operating rooms or ICU where it can be monitored second by second and the dosage is constantly adjusted. As in Michael Jackson’s homicide, it was simply administered and in the same way this same drug caused my mother’s death.
As she was now in a coma and continually in worse and worse shape, I asked that my mother be transferred to ICU and our private pulmonologist personally asked, but the doctor from ICU looked at the chart and told me that this is a chronic case with poor prognosis and that they take only people with life expectancy of two years. As the life expectancy for women is 78 and married women 76 and as my mother was 87, she would never have qualified. This ICU doctor signed the death warrant when she refused my mother for the empty bed in ICU.
Later, when my mother was on a respirator the tube filled with phlegm and blocked the oxygen entirely. This required suctioning or she could not breathe at all. The nursing staff was over burdened and did it with long delays. When my sister was there the nurse actually refused to suction her and only after my sister broke out crying hysterically did they do it so she could breathe. While the night nurse suctioned my mother every few hours, during the day, one nurse did not suction her and only did so after we asked more than 7 hours into his shift.
On Yom Kippur, my sister stayed at the hospital while an Arab doctor was working. He told my sister to call the family to come immediately to say good bye as she has only hours to live. Apparently he gave her Dormicum again and the blood pressure dropped to critical levels. They discontinued it, but she never gained consciousness and her blood pressure never recovered. They gave her dopamine to constrict the blood vessels and this raised the blood pressure, but they should have given her the maximum dosage. When he left in the morning, this doctor was visibly surprised my mother had managed to survive the night despite this second, fatal dose of Dormicum.
During Yom Kippur while my sister was pleading with the Almighty to save my mother, a nurse came in and told her that when children are in the room, the soul cannot leave the body and asked my sister to leave the room so that she can die. My sister was too shocked to answer.
That evening, while my other sister was watching my mother, they called me to say that it did not look like she was going to make it through the night as the blood pressure was low. By about 5:00 AM my sister told me to take a taxi as the staff considered her finished and refused to take any action. I came and called the head of ICU for a consult which I was prepared to pay for, our private pulmonologist who we paid over $1000 who called the hospital and finally, the attending doctor called a doctor from ICU who put her on norepenephrine and told them to reposition her.
This ICU doctor told us that she was in sepsis, that the poison from the urinary infection attacked other vital organs and caused the lung and other problems. He pointed out that she never regained consciousness after the Dormicum was discontinued. He believed that she had advanced lung cancer as did the endocrinologist who intubated her. The first mention of lung cancer in the charts was ten days after the CT showed a mass in the lungs. I asked them why my request for an oncology consult was never honored and was told that an oncology consult is appropriate only after they made a definite diagnosis of cancer and if this was cancer, he claimed that it was untreatable and therefore an oncology consult would not be requested.
From the point that she was at the maximum dosage of dopamine and then norepenephrine she was lost. When she got norepenephrine, the blood pressure went up but her hand was turning blue so we had them switch the blood pressure band to the other arm and then the readings were very low so they put it back and it was still low. They kept increasing the norepenephrine to maximum dosage. Her kidneys shut down and her condition worsened. Within hours she was finished completely.
A German doctor was on staff that morning. My mother survived multiple years of selections by Dr. Mengele in Auschwitz, but her life was terminated by a German doctor who cruelly declared to the family in the room “She is dead” and turned off the respirator.
Not only did this hospital in the heart of Jerusalem hire gentile German’s but they employed openly hostile Palestinians. I overheard some of these workers discuss the road blocks from Colandia. It is beyond belief that we would entrust our vulnerable ailing elderly to unsupervised Palestinians!
These Palestinians were categorically cruel. As my mother was dying they openly snickered in delight. On a daily basis, they ordered me to leave the room to change the beds. I had to endure hearing my mother crying out in pain and then crying. That two young Arab young men should be alone with a woman behind closed doors for over a half hour every day is reprehensible and perhaps legally questionable.
As I believe that disconnecting her from oxygen and leaving her unattended in the hallway when she was unable to breathe and other actions by hospital staff amounts to manslaughter or at least criminal negligence, I went to the police to request seizure of the security tapes showing my mother left alone unattended without oxygen. The police detective refused to file my complaint and told me that this is not a police matter and if I had a complaint of negligence to file it with the Ministry of Health.
My father was killed in New Jersey in an anti-Semitic attack in which his head and face was smashed in so that he was virtually unrecognizable, his chest stabbed 36 times and this throat slashed. One penny was put on him while over $3000 in cash was stolen from him. While it was three people that killed him the police did not actively investigate. Those three attackers got away with murdering my father. Now I have to live with the fact that whoever killed my parents can get away with murder, but so did those Nazis who killed my mother’s entire immediate and extended family.
The Nazis did not kill her in the Ghetto, nor Neustadt the slave labor camp where her whole work detail died of poisoning but she was too sick to eat that day, nor on the Treblinka train where the cattle car was gassed and my mother jumped from the moving train after someone punched open a small boarded up window, not in Maidanek concentration camp and not in the two years in Auschwitz. She was the sole survivor of her extended family and but killed by socialized medicine in Israel.
Rose survived Auschwitz and the daily lineup selections by Dr. Mengele only to be put to death by the hospital’s “good” German doctors.
Rose avoided the gas chambers and was the sole survivor of a train going to Treblinka where the acidic gas was released in the cattle car. Miraculously someone punched open a small window which she hurled herself through while the train was racing to Treblinka to “process” the bodies. Here she died from asphyxiation.
Rose survived years of starvation and thirst only to be starved the first days of her hospital stay and deprived of adequate fluids.
People in the Ghetto waited for Rose to bring food as well as a boy hiding in the forest and at the end of her life she waited but did not get food.
Rose was the sole survivor of slave labor camp where they poisoned the crew she was working with as she felt ill and could not eat the food that day. She was here administered poisonous sedatives that directly caused her death.
Rose gave up a day’s ration to give to a nun to cut an infected piece of flesh where she was shot. Here her lungs were pierced and she bled to death.
Rose mother successfully avoided the Auschwitz pseudo-doctors who “experimented” but was butchered by an endocrinologist who punctured her lung while connecting her to a ventilator during which she lost a liter of blood.
Rose crawled through Ghetto sewers to work, buy food and return to feed her family and numerous others. Here she was made immobile and rendered unable to speak while she was starved.
My mother survived. She had such an unbelievable immune system she never contracted typhus or any of the numerous other lethal diseases rampant in the Ghetto, slave labor camps, Maidanek and Auschwitz and the march from Auschwitz to Germany. In the last twenty years, she may have had a few minor infections such as urinary tract infections, but I do not remember her catching cold, certainly not the flu or any other disease. Rose certainly would have survived the treatment: she did not survive the vindictive incompetent socialized medicine hospital staff.