Graces

Story Grace Smith was a 50 year old successful business woman for an international fashion design company located in New York City. She travels internationally at least twice a month mostly to Paris and London. A recent change in the companys Board of Directors had created an increased work load and she had gained about 30lbs. She had hoped her new exercise routine including jogging at 4am before work would help combat the increased stress and weight gain. One morning, frustrated by a text message that her flight would be delayed, she fell on the jogging path, hit her head and severely broke her leg. Upon arrival, she was in so much pain and was so upset at the site of the bone sticking out of her leg; she demanded to be transferred to Hope Hospital immediately. Despite repeated questions from the emergency medical technicians, she was focused on calling her assistant to inform her of what had happened and did not report that she had hit her head. At the hospital, the emergency nurse did the best she could to get a medical history on Grace. Grace offered that she was excellent health and that she had never even been in the hospital before. Grace reported that the only medications she took was vitamins and recently started hormone replacement therapy. Graces administrative assistant walked in and asked the nurse to step-out of the room for a minute causing the nurse to stop completing the history including writing down the hormone replacement therapy and vitamins. The nurse was informed that Grace sat on the Board of Trustees of the hospital. The ER nurse was too nervous to go back in and ask Grace any more questions. While the nurse was talking to Graces assistant, Rob Hendricks, the orthopedic surgeon on call, went in to exam Grace. This was his first year at Hope Hospital after completing his residency at a much smaller hospital. He had been just been in the OR for the past 8 hours. He had been up for 26 hours and recalled thinking about stories he had heard in the physicians lounge of senior surgeons who bragged about working 36 hours straight. Despite his best efforts, Graces brevity and distraction with work calls and emails caused brief one word answers. When he asked Grace about her family history she quickly told him everyone was alive and well. Grace forgot to mention that her brother who was only 42 years old had recently had a recent heart attack although he had a similar high-stress job. Rob reviewed Graces x-ray and informed the OR to prepare her for surgery. Given her history, Rob considered her bleeding risks. Although the hospital where he did his residency had a Venous Thromboembolism (VTE) Risk Assessment and protocol, Hope Hospital did not and each physician usually wrote individual orders dismissing Hope Hospitals protocol as too complicated for the nursing staff to follow. Rob performed the surgery without incident. Grace was admitted to post-operative orthopedic floor.

Amy, the nurse admitting Grace from the PACU, reviewed her orders and was surprised to find no VTE prophylaxis ordered. Amy had worked on the orthopedic unit for 12 years and pretty much knew each surgeons VTE orders by heart. She had had several bad interactions with Rob since he arrived. At first she thought he just needed to get to know and trust her but despite her repeated efforts he continued to be condescending. So nothing for VTE? she asked. When she got no response from Rob, she walked away.Im just the nurse. Grace did well and worked on her laptop most of the following couple of days. On the third night, she experienced leg cramps but when she called the nurse, she just told her she needed pain medication for leg cramps. Around 4am she woke up short of breath and put her call light on. Although the nurse was informed that Grace had called, she was in the middle of working with another patient and did not get into Graces room immediately. Grace died of a pulmonary embolism at 5am that morning. She was survived by her husband, four children and a newborn grandchild.