Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Arthralgia, Asthenia, Blood pressure decreased, Computerised tomogram abnormal
Clinical narrative: See continuation page o Jan 2018 Mom was diagnosed with stage 4 lung/brain/lymph node cancer o Feb 25th: Mom was brought to ER for a respiratory issue.  Full set of tests were done, nothing was found and she was sent home.  ER was happy she was going to see her primary the next day for follow up. o Feb 27th:  Mom woke up feeling ok, by afternoon she was too weak to walk and brought back to the ER.  Lungs shown with pneumonia and inflammation.  Mom was admitted to ICU that evening. o Feb 28th:  Mom seemed ok in ICU, but oxygen demands increased. o Mar 1st:  Mom was placed on bi-pap o Mar 2nd:  Mom was placed on vent o March 8th:  Mom fought back and was able to come off vent o March 12th:  Due to lack of rooms in ICU (from my understanding), Mom was moved to medical  o March 13th:  Mom expressed pain behind knee (maybe referred pain due to bleeding noted on the 14th) o March 14th:  Mom had severe side pain, blood work indicated potential internal bleed.  Hours later a CT scan was done and confirmed bleeding.  Plan was to give her plasma and maybe other drugs to hopefully stop the bleed (that doesn't make complete sense to me, but I'm not a doctor).  Mom said she "Felt like she was dying".  The nurse said that given Mom's condition, it would be best that someone spend the night with her.  I relieved my sister around 8:30 that night.  Mom was receiving plasma and whole blood.  I asked the nurse if her blood pressure and pulse were monitored at the nurses station, she said no but she would come in every hour to check (note additional checks were done every 15 minutes  when a blood transfusion was started).  Mom's door was closed due to 4 other psych patients on the floor making a lot of noise, so I was the only one to hear alarms.  Mom was too weak and couldn't press the nurse button when her side pain increased after 10 pm.  I pushed the button for her, a couple minutes later a nurse came on the intercom wondering what Mom needed, and  what felt like 10 minutes later a nurse arrived.  Around 11:15 pain meds were administered but didn't have any impact initially.  I questioned whether Mom should be in the ICU given the internal bleed, pain, and number of units of blood/plasma she was receiving (in my mind she was critical enough not to be on a medical floor where there is a high patient to nurse count and no continuous monitoring of vitals).   o March 15th The on call doctor came in around 12:30 am, I think, after pain meds started to settle Mom.  His first words, which I felt were said in a stern way, were "I hear you want your Mom moved to ICU".  I expressed my concerns and that I was just trying to do what was best for Mom.  His voice softened and he said there is nothing more that ICU can do.  My impression was that he stated they would give more blood and if vitals drop, then move her to ICU.  Nurse came back in after the doctor left (note I felt the nurse did a great job that night) and said the doctor wanted her to discuss with me re-evaluating whether Mom should be a full code... It is very confusing since I felt the doctor was saying she was stable enough to stay on the medical floor, but then have the full code reconsidered at 1:00 in the morning by family...  I was in full tears after she left, didn't sleep, and said a few rosaries.  At 3:30 am Mom was moved to ICU.  By 6 or 7 am Mom had received 5 units of blood and 5 units of plasmas, which I believe is as much as the body can hold...   Around 7:15 am there was a clear indication on the monitor that Mom's blood pressure was dropping linearly over last hour.  Her breathing over night was 18 and normal, but increased to over 20 was very labored.  Her heart rate went from 90s to 114.  I walked over to ICU nurse with tears and there is a scary trend happening, do I need to call family in.  She stated that "Mom is in the right place and no need to call family".  But took no action to correct decline.  Her only action was to get zophrane (or similar drug) since Mom was nauseous.  It wasn't until after the doctor came in after 8:15 am that the decision was made to transport.  At that point family was allowed to come in 1 by 1.  It was also the same time that the snow storm started and Mom had to go by ambulance, which by time coordinating wass complete didn't happen until 11 am.  Mom was given blood pressure medication which helped initially, but by time Mom reached it we were told her blood pressure was 37/19.  It feels if action was taken over night, Mom could have been flown and the blood pressure might not have dropped that far.  Mom's procedure was successful to stop bleeding. o March 16th:  We were told that given the amount of fluid Mom's lungs were starting to fill with fluid again and given low blood pressure on arrival, her kidneys were shutting down.   o March 17th:  Mom was placed on hospice o March 18th:  Mom was brought home o March 26th:  Mom went peacefully to heaven