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Life Extension Magazine

Life Extension Magazine September 2012
As We See It

A Deadly Waiting Game

By William Faloon
William Faloon
William Faloon

Last year, I described the inefficiencies and incompetence I encountered during a 31-hour hospital stay.

My hospitalization was done as a precaution and nothing serious developed. My outrage was based on the egregious hospital waste I observed, along with what may have happened if I had a critical medical condition.

A few months later, an article was published in the New England Journal of Medicine that made my 31-hour ordeal look like a walk in the park.1 We asked permission to reprint this article, but were refused. We conjecture that the New England Journal of Medicine did not want us to use this article to further discredit this nation's broken sick-care system.

To enlighten Life Extension® members about this particular hospital-inflicted atrocity, I will report here on the article the New England Journal of Medicine denied us permission to reprint.

The Patient Did Everything Right

The Patient Did Everything Right

This tragic New England Journal of Medicine article describes a 69-year-old woman who suffered an acute attack of rapid atrial fibrillation.

This is not about someone without insurance who was delayed medical attention. This 69-year-old woman was not scientifically ignorant as her son was a medical doctor, and she was able to use an at-home device to quickly discern that a serious problem was developing. She immediately was taken to one of the most highly regarded academic medical centers on the west coast of the United States. Unlike so many people who fail to recognize serious symptoms, this woman did everything right!

This woman had mild heart disease, but was otherwise considered in excellent health according to her physician son. Early one day she noticed an irregular heartbeat and felt a bit short of breath. She used her at-home blood pressure cuff to ascertain her blood pressure was stable, but that her pulse was racing high at 130 (normal pulse rate is between 60-80). Most at-home blood pressure monitoring devices also measure pulse rate.

She was driven to the emergency room by her husband and seen within about an hour by a doctor, which is relatively quick by today's sluggish hospital standards. She was diagnosed with rapid atrial fibrillation that Thursday evening and admitted to the hospital.

The strategy was to perform a trans-esophageal echocardiogram the next day to see if there was a blood clot (thrombus) in the upper (atrial) chamber of her heart.9 Atrial blood clots are a frequent consequence of this kind of rapid atrial fibrillation.3 In the absence of a thrombus, the doctors planned to perform electric cardioversion, a procedure in which an electric current is used to reset the heart's rhythm back to its regular pattern. The low-voltage electric current enters the body through metal paddles or patches applied to the chest wall.

The patient was given intravenous heparin to prevent thrombus formation to get her through the night, which is standard therapy in these cases. So far, everything was done according to hospital protocol.

Atrial Fibrillation—An Increasingly Common Problem

As the population ages, an increasing percentage develops an irregular rhythm in the upper chambers of the heart called atrial fibrillation. It is the most common type of heart arrhythmia and approximately 5% of persons over 65 years of age are expected to be diagnosed with it.2

The primary danger of persistent atrial fibrillation is that it can create an abnormal blood clot to form in the left atrial chamber that breaks away and travels up the carotid artery causing a stroke.3

Atrial fibrillation patients are typically prescribed anti-arrhythmic and anti-coagulant drugs that reduce stroke risk, but are far from 100% effective and can induce serious side effects.4-7

Although some episodes of atrial fibrillation are short-lived and spontaneously resolve within 7 days while requiring no treatment, persistent atrial fibrillation that lasts longer than several days often requires either pharmacologic or electrical cardioversion to terminate the abnormal rhythm.8

With cardioversion treatment of persistent atrial fibrillation, an external electric shock returns the heartbeat to normal. If this is not effective, a catheter is inserted into the heart to eliminate (ablate) tissue segments along the electrical conduction tract of the heart that are producing abnormal electric impulses.8

In cases involving symptoms such as shortness of breath and high pulse rate in people over age 65, immediate medical attention is needed to prevent atrial blood clotting, and correct the rapid/irregular heartbeat.

No Room At The Inn…

Despite the life-threatening condition this 69-year-old woman suffered, the hospital had no inpatient bed available. This 69-year-old woman, diagnosed with rapid atrial fibrillation, was kept on a stretcher in the emergency department hallway overnight. The stretcher was uncomfortably narrow. Combined with the all-night noise and bright lights in the emergency department hallway, it was hard for her to get much sleep. She was not wheeled to a real bed until shortly before noon the next day (Friday), which was 24-hours after her symptoms initiated the day before (Thursday).

I have used this analogy for decades, but I am going to repeat it to put this woman's needless agony into context. Just imagine you try to check into a hotel. You wait for an hour (or more) for a desk clerk to see you. You are checked in (admitted) after completing a LOT of paperwork. After you are checked in, you are told there are no rooms available so the hotel staff forces you on to a stretcher that stays in the hotel lobby where the commotion and lights keep you from sleeping all night.

Unlike even low-cost hotels that would never treat their guests like this, once you are "admitted" to a hospital, you give up your liberty. You become submissive to the doctors and hospital staff. If you try to leave, they threaten to tell your insurance company and say that you will personally be stuck with the entire bill. This is a blatant lie, but hospitals don't like their prisoners (they call patients) to escape without permission.

The difference between a hospital and hotel is that those who check into hotels are usually healthy. Yet even healthy individuals would find it miserable to be victimized by standard hospital practices (like being denied restful sleep, edible food, and timely service). The issue here is that when one is hospitalized, it is often the absolute worst period in their life, with vital organs sometimes shutting down. Ironically, at this precarious phase when a human being may be barely clinging to life, they encounter hospital services so substandard that death is often hastened.

What you're going to read next is beyond appalling.

Unconscionable Delay

Unconscionable Delay

Early Friday afternoon, the 69-year-old woman's cardiologist told her that since her admission had been delayed the day before, the hospital staff would not complete her procedures before their Friday "workday" ended. Recall this woman had arrived at the hospital early the day before (Thursday).

Due to the hospital's delay, this woman was to remain in the hospital throughout the weekend. As a precaution against atrial thrombosis, they continued intravenous heparin and initiated oral warfarin. The objective was to blindly rely on these anticoagulant drugs until Monday, when the trans-esophageal echocardiogram and electric cardioversion would be done at the convenience of the hospital staff.

Tragic Outcome!

The next day in the hospital, this woman suffered a massive embolic stroke caused by a blood clot that formed in her atrium due to the untreated rapid atrial fibrillation. The clot blocked her right carotid artery and extended into the branches that feed the brain. The woman was rushed to an operating room where a neurosurgeon attempted to extract the blood clot (embolus) that was suffocating her brain.

During this emergency procedure, her internal carotid artery was torn. Since her system was loaded with anticoagulant drugs, there was rapid intracranial bleeding that resulted in loss of critical brain function. For the next two days, this woman laid unconscious, intubated, and brain dead in the hospital's intensive care unit. She continued to receive mechanical ventilation until preparations for her funeral could be finalized. Life support was withdrawn 112 hours after she walked into the hospital with a condition that could have been successfully treated had the hospital staff not played this deadly waiting game.