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Mom and Dad
Seven years ago today, my mother was transferred from Union Hospital to Kessler East Orange, a health care facility where she was supposed to receive post-surgical rehabilitation.
What happened instead was that three days later, on July 18, 2005, she died of sepsis.
We suspect she developed sepsis as a result of the transfer.
Once a patient develops sepsis, there’s as high as a 50-50 chance that the patient will die. The odds are worse if sepsis is left untreated for a long period of time. It’s not just the very old, the very sick, or the very young who are at risk of death from sepsis; read this article from the NYTimes this week about how a healthy 12-year-old boy died of untreated sepsis in one of New York City’s best hospital systems.
If I had known then what I know now about The July Effect, I never would have permitted my mother’s transfer from one health facility to another on a weekend in July.
My brother John and I had secured a promise from the hospital’s social worker and my mother’s personal physician that we would get a minimum of 24 hours’ notice of any transfer; instead, this is what happened.
(The following is excerpted from my memoir-in-progress, Missing Dad. All conversations recounted here are accurate transcriptions, made at the time they occurred. All incidents described here are accurately reconstructed from contemporaneous notes and emails. No names were changed. There are no innocent people to protect.)

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On Friday July 15th, at around noontime, I get a call at work from Maureen. A bed has opened up at Kessler East Orange. Mom is being transferred that day.
No she isn’t. I told you I have to be there for the transfer. I can’t let you just send her and my dad to another facility with no notice. We talked about this. I need to know twenty-four hours ahead, so I can be there to go with my mom, and someone who drives can be there to follow with my dad.”
“She will lose her place if you wait until Monday.”
“Let me talk to Dr. Eisenstat.”
I speak with Eisenstat who says that, in his opinion, she is well enough to go into rehab.
I call the other sibs, only reaching Nancy, leaving messages for Janet, Barb, and John. Janet and Walter are traveling, Barb is at work, John is on the way back home to Ohio. Nancy tells me to do what I think is best.
I call Mom at the hospital and ask her what she wants to do. Mom and Dad both say well, it’s what the doctor wants. I tell them both that we can say no if she doesn’t feel ready.
Mom says, “Do what you think is best. I trust you. Whatever you decide will be the right thing. I love you. You’re my prize.”
(These are the last words I will ever hear my mother say in this life.)

And that is how, nineteen days after her surgery, on Friday, July 15th in the early evening, Union Hospital came to transfer Georgia Karabaic to Kessler Institute in East Orange for post-surgical rehab.

East Orange and West Orange are very different communities. West Orange is an upper middle-class suburb, a bedroom community. East Orange is decidedly urban. According to the original plan, she was supposed to go to Kessler West, but we have ended up in Kessler East instead. I don’t know why. This must be the first Kessler bed that became available. Or maybe they just want her out of Union Hospital and into rehab, anywhere.

Somehow, Janet and Wally make it to Union Hospital from western Pennsylvania in time to accompany Mom on the wild, bumpy ride in the ambulance. They would tell me later that it was worse than a roller-coaster ride. Janet was in the ambulance with Mom, and Walter followed in his car, with Dad.

Note to self:
NEVER DO A TRANSFER FROM ONE MEDICAL FACILITY TO ANOTHER ON A WEEKEND. The A-team has left, maybe the B-team too. You will get the D-team and they do not know what they are doing.
(Years later, I will find out that what happens in hospitals on weekends is exacerbated when those weekends fall in July. It has come to be known as The July Effect; it’s what happens to staffs that are overrun with inexperienced staff fresh out of med school at the same time that experienced staff are taking their summer vacations.)

Walter and Janet are with Mom as she is being admitted. A female doctor who is not wearing an ID badge, who introduces herself as Dr. Vij, examines Mom. She and the admitting nurse, Maryanne, take Mom behind a curtain to look at her back. They take a photograph of her incision. Walter hears them discussing this. They do not tell Janet and Walter why they took a picture.
Mom’s admission to Kessler East is completed; Janet, Walter and Dad leave Mom in her room, and go back to Union. Janet and Walter spend the night at Dad’s.

(Continued tomorrow, with the events of Saturday, July 16th 2005)

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