Splenic Artery Rupture: Right Questions, Wrong Answers
25 December 2004
Last Friday (12/17/04) morning Elliot had a sharp pain in his abdomen on the left side, collapsed at work and was transported to Women's Medical Center. When he got there and it was determined that he had VERY low blood pressure (60/40 or lower) — they drew bloods and they hydrated him. What made them think that he was dehydrated? Did they do a specific gravity test on his urine?
When I got to the ER and began to ask questions about what was happening — the nurse had a nasty attitude when she responded to me. When I questioned things like — "what's going?" and I got an answer from her like, "Ma'am, I can either treat your husband or answer your questions." Or the other question I had about why his PT was elevated to 15.2 — and was told that it was because he takes a baby aspirin each day. She should have recognized the value of my question and looked a little further into my question — as PT measures factor II in the blood; and baby aspirin has to do with platelets, not factor II.
I asked her if he had an internal bleed — how would they determine it. Her answer was: it would show up as blood in the stool. I asked her again — "do you mean that if he had an aneurysm, it would show up in the stool? Again, she answered in the affirmative. I don't know why I thought about aneurysm.
Yes, he responded to the increased fluid volume — but someone should have checked his stomach. Every time he sat up on Friday — he got dizzy and nauseous. He wasn't dehydrated — he was BLEEDING! Thankfully, he was finally admitted to telemetry unit overnight with suspicions of cardiac involvement. Why was his attending physician a Nephrologist if he was being observed for Cardiology problems?
At 3 pm on Saturday afternoon, when the MD saw him — he indicated that his collapse and low blood pressure was probably due to taking 2 blood pressure pills instead of 1 pill and now that he was stable, he could be discharged. I disputed this and said that I had a feeling it was something more serious. I requested that Elliot be disconnected from the NSS IV that was running to determine if he would be able to hold his blood pressure. I was especially concerned because he had complained of abdominal pain all day — thinking that it was constipation. No one EVER checked his belly — in fact his nurse, Gracie confirmed to Elliot in front of me that it was probably constipation.
When I asked about his hemoglobin — she told me it was "fine" when in fact it was 10.1 from the AM labs (a drop of 3 grams from the previous day). Gracie checked with the MD at 4:15pm for permission to pull the IV after running the remaining 250 ml of NSS into Elliot — wide open. At that point I left to go home and get Elliot clothes so that he could leave, only to receive a call from the hospital at 5 pm saying that he collapsed again and he wouldn't be discharged. The MD then got on the phone and informed me that he wasn't doing well and because he was standing when he passed out — they would be sending him for a CAT scan of his brain once they were able to stabilize him. I asked the MD about his stomach pain — and the MD responded as thought this was the first time he was hearing about it.
When I arrived onto the floor — it was like a scene from ER. Elliot was in the Trendelenberg bed position (head down, feet up), he was moaning and screaming, and there was chaos. When they finally stabilized him — about an hour later — the MD informed me that he probably had a "surgical abdomen" and none of the surgical staff was responding to his pages. He would not go into any further explanations, and again minimized my intuition that he had an aneurysm. He said that they could determine more with the CAT scan and if it was urgent he MIGHT need to be transferred. I told him that I preferred transfer to Abington — and that if there were any problems arranging that transfer, I would like to be involved. I have a number of social connections with the staff at Abington and can easily access the staff whom I know personally.
I waited with my husband for 30-35 minutes in Radiology while they completed a CAT scan of his head and abdomen. He was returned to the floor, but transferred to ICU due to being on dopamine and neo for his blood pressure. Upon our return to the floor, the MD informed me that he would be transferring Elliot to Temple Hospital because he did not get a call back when he called Abington Hospital and left a message with the surgical staff. I couldn't believe that he didn't inform me about not getting a call back — or inform me that his thinking changed and he wanted him to be transferred. After all, when I asked Dr. Williamson who accompanied Elliot to CAT scan what it showed — he told me that it hadn't been read yet - there was no one in-house who could read it. I had NO idea what was happening — the severity of the issues and the risks to my husband.
I was able to reach the surgical attending staff at Abington almost immediately and the MD briefed him about what was happening. Within 20 minutes an ambulance arrived to transport him and within 45 minutes of his arrival at Abington he was in surgery because his splenic artery aneurysm ruptured. He received a significant exposure to blood and blood products AND lost his spleen because he was misdiagnosed at first hospital.
Why did this have to happen this way? Why didn't the staff evaluate and assess him PROPERLY? Why was I made to feel like it was WRONG for me to ask questions? Thank God I asked questions — or my husband wouldn't be alive today.
Update: 10 February 2006
I wrote you in 12/04 shortly after my husband, Elliot experienced a splenic artery aneurysm. Seems like just yesterday, I have PTSD...Elliot is fine. After a year, his scar has healed, he has lost weight (about 10 lbs) and feels fine. He returned to work 3 months after his aneurysm and all is well.
I wanted to thank all the "writers" for your support. I really looked forward to the emails during his recooperative period.
Discussion, comments, or questions: Susan Miller
© Copyright 2004 Susan Miller
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