by Reid Fitzsimons
Back sometime in the late 1990s, beginning on a Monday at 8am and ending at 8am the following day, I was scheduled as the medical officer on-call at the NY State facility for mentally retarded/developmentally disabled people where I worked from 1986 to 2001. The on-call person is the primary medical contact for his or her own caseloads along with the patients of other providers who happen to be off the schedule at the time, and for everyone after normal working hours. Soon after my shift began I received a page from one of the outlying residences. The concern was an elderly lady who had been ill onset the previous Friday evening and continuing to the present. Her presentation included recurrent vomiting of blood, poor to no intake of fluids and in general looking very sick. I told the direct care staff to bring her to our clinic immediately and it was obvious she was in extremis, requiring an acute care hospital and operating room, well beyond our clinic capabilities. I made the arrangements for transfer to the hospital and got her on her way with haste, but sadly she died later that day.
My inclination was to always treat the lower paid direct care workers with respect, but in this case, knowing the agony this innocent person suffered over the preceding weekend, I very pointedly inquired as to why they let her deteriorate and failed to contact the weekend on-call person. To my surprise they said, with some frustration, they in fact had made the call. I asked what the on-call physician told them, and they replied, “He said give her Mylanta.” Though I don’t specifically recall the cause of death in this case, it was probably complications of hemorrhagic erosive esophagitis, the sometimes fatal end of the spectrum that begins with what is commonly called heartburn or reflux, and not uncommon in our patient population. At some point this patient was perhaps salvageable and, if seen and properly treated, her suffering certainly could have been diminished.