The Crimson Press Curriculum Center

In early June, Hilda Cook, a 90-year old widow, living alone, began to experience discomfort in her bowels. Mrs. Cook was generally extremely healthy. She was a non-smoker who drank in moderation (one cocktail each evening), and took no medications. Until her 90th birthday party in January, most of her friends thought she was in her mid-70s. She had low blood pressure, was only slightly overweight, walked with ease, drove a car, played bingo two or three evenings a week, and traveled to a local Indian reservation once or twice a month to gamble. At the time of her illness she was serving her third term as president of the local women’s club.

Mrs. Cook had been hospitalized only twice in her life, once at age 35 when she had a caesarean-section in conjunction with the birth of her only child, a son, and once in the mid-1980s when she had a mild and non-recurring case of phlebitis. She was insured by Medicare, and had a “Medigap” policy that covered the majority of her deductibles and copayments.

Concerned about her discomfort, Mrs. Cook called her primary care physician, Dr. L, to make an appointment. Dr. L was on vacation, and could not see her immediately. Dr. L’s nurse made an appointment for 23 June. A chronology of events between 23 June and 20 July follows:

23 June	(Monday). Mrs. Cook saw Dr. L and had some tests, including blood tests. Dr. L called the local hospital, and ordered a CAT scan for next day. She told Mrs. Cook that after the scan, she would be drinking something. Dr. L checked with Mrs. Cook on allergies, and learned that she was allergic to iodine. Dr. L informed the hospital of this fact.
24 June	(Tuesday). Several events occurred:
6:30am	Mrs. Cook arrived on time for the CAT Scan. The receptionist in radiology knew nothing of the test, and told Mrs. Cook that “Kevin” knew.
6:45am	Kevin arrived. He knew about the iodine allergy, and told Mrs. Cook that she needed to drink barium for 1.5 hours prior to the scan.
8:00am	Mrs. Cook had the scan. She was told that there was some lack of clarity, and that she also needed an ultrasound.
8:30am	Mrs. Cook had an ultrasound. Because the CAT scan showed some spots on Mrs. Cook’s liver and because of what looked to be a mass of some sort in her small intestine, Dr. L decided to do more tests. Because of dietary restrictions needed for the tests, Mrs. Cook was hospitalized. Dr. L called Mrs. Cook’s son (who lived in the area, with his wife and two small children) to tell him of her plans for Mrs. Cook.
9:00am	Blood tests were taken (Mrs. Cook was told that the hospital needed to take its own, although it used the same laboratory for much of its blood work as Dr. L had used on 23 June). Chest X-Ray also were taken.
10:00am	Mrs. Cook was taken to 7th floor, and admitted to a room with 4 beds. In one bed was a patient in great pain, who groaned continually. In another bed was a person who could not feed herself. In the fourth bed was a patient who actually was occupying a chair in the middle of the room. Mrs. . . .

Assignment

What, if anything, should the various individuals involved with Mrs. Cook's treatment have done differently?
What should Dr. L do now?