'Disappointed': Caraquet senior with bedsore to the bone reacts to hospital care
Family of woman who went into hospital for hip surgery wonders how a bedsore got so bad
Warning: This story contains graphic images
A bowl of cat litter sat beneath Lola Chiasson Hawkins's hospital bed in Tracadie. A nurse put it there because of the smell coming from the wound in the 82-year-old woman's back.
Lola's sons Steven and Wayne, though acutely aware of the smell in their mother's room, were still mystified as they watched the cat litter arrive on April 21.
"So what we did is close the curtain," Steven said. "And I took it in my own hands to go investigate where this smell was coming from."
What the brothers found would make your stomach turn.
Lola's days spent lying in hospital had given her a deep, festering bedsore, a hole her back, right to the bone.
This was a stage four bedsore, the worst you can get.
Lola's family has been trying to figure out how it happened.
Lola, a slight woman who raised four children and worked a variety of jobs in her life, lived in her own home in Caraquet until Feb. 7.
That was the day she fell and broke her hip.
"I heard her scream and I came downstairs," said Steven, who was living with his mother at the time. "I found her laying on the ground."
Lola had successful surgery in Bathurst, but six days later developed mucus in her lungs.
She was sent to the Enfant-Jesus hospital in Caraquet, then was taken back to Bathurst two days later after developing full-blown pneumonia.
Lola was in intensive care at Chaleur Regional Hospital in Bathurst for nine days.
What happened in Bathurst and Tracadie is a tragedy, plain and simple.- Steven Hawkins
After the ICU, she was taken to another floor of the hospital, where the family expected she would soon start physiotherapy.
"We got to the second floor, and they had given her bed to somebody else," said Steven, the only one of the four siblings who still lives in the province.
Bathurst said it couldn't keep Lola because of lack of space, so she was transferred to the Tracadie-Sheila hospital.
At the time of the move, medical staff in Bathurst told Steven his mother had a bed sore.
It was early March.
'Smell coming from the room'
Although Steven visited Lola every day, it wasn't until April 21 that he and Wayne found out how bad the bedsore had become.
"There was a smell coming out of the room … a terrible smell," Steven said. "And we didn't know how bad the bedsore was, OK? So we couldn't even walk in the room.
"So I asked the nurse, 'What's going on?' And she says, well, she came in with this cat litter. I says, 'What's going on? She says, 'We're trying to get rid of the smell.'
"She puts the cat litter underneath the bed, and I told my brother, 'Look, there's something going on here. We can't even stay in the room because of the smell. What's going on with this bedsore?"
When the brothers investigated on their own, they were shocked and sickened.
"When I took the bandage off the bedsore, there it was," Steven said. "And it was, it was just, it totally freaked me out. And I'm talking about it today, and I'm going to cry. It was bad."
There was an open wound at the base of his mother's spine.
And the family wants to understand how it got to that point.
For privacy reasons Vitalité Health Network could not speak to CBC News about Lola's case or her son's account of her care.
But a lot can lead to bedsores, said Johanne Roy, the vice-president of clinical services. People can have multiple, chronic diseases that slow healing, break down the skin or prevent a patient from getting up and off the bed.
"In the literature, we have stage four sores," she said. "And in hospital we are aware we have some patients that develop this bedsore level four. Is it often? I hope not.
"But still, depending on the health condition, of the quality of the skin, [does] the person participate or collaborate with care — it's a lot of things happen. So it's possible."
She said the health authority does everything possible to prevent the wounds and has protocols for care if they do occur.
'An open door'
Dr. Mike Simon of Saint John describes a bedsore as an open door for germs.
The most common locations for the ulcers are buttocks and hips.
"You think about incontinent patients," Simon told CBC radio recently. "You get fecal contamination, you can get blood poisoning, septicemia goes onto kidney failure, and they can die.
"Yes, it is potentially a serious, serious illness if it goes untreated, or you can't improve the situation."
Bedsores are also preventable.
Whoever is caring for the patient must check for signs of bedsores, Simon said, so they can be dealt with before they get worse. And patients must be moved every couple of hours.
"You may use a pillow behind their back, and shift them so they're not on the same hip, for example," Simon said.
Health Minister Benoît Bourque was unavailable for an interview but in a statement to CBC News he called what's happened to the Hawkins family "unfortunate."
"I can tell you that there are policies in place to deal with providing health care services in all our hospitals, including how to prevent and treat bed sores" said Bourque.
He referred questions to Vitalité and said the province's two health networks have "processes" for patients and families to raise concerns.
'Nobody had ever seen the machine'
To treat Lola's bedsore, a machine called the V.A.C. Veraflo was sent to the Tracadie hospital.
The family listened with growing horror as the nurses tried to figure out how to use it.
"We're sitting in the room, and all the nurses are coming in, 'What's this machine? What does it do?' Nobody had ever seen the machine," said Natalie Hawkins, Steven's sister, who had flown in from British Columbia.
So we're losing Mom, when Mom should be home eating codfish and having a good time with her family. - Steven Hawkins
Roy said the VAC system to treat a pressure wound is not often used, but help would be available if a nurse needed it.
"She can be in touch with the nurse at hospital Chaleur at Bathurst, who can help, who can go or can Skype and do some information teaching. But usually, if we have to work with the VAC system, we should have at least a minimum of knowledge about the system."
Steven said that with his mother's permission, he took photos of the wound. After the VAC treatment, the infection appeared to clear, but a gaping hole remained.
The family's questions and requests that their mother be transferred to hospital in Moncton or Bathurst were answered with a growing hostility.
Hospital security was called twice and police were called once to defuse arguments between Steven and staff, he said.
Her children have had no access to her medical file, which they hope can help them better understand what happened.
On the handwritten doctor's note given to Steven listing her conditions, it states Lola gave her permission verbally to share the information. The doctor also notes that the family would need a lawyer to obtain power of attorney and access the file.
Lola's conditions, itemized on the handwritten note from the doctor, include non-alcoholic cirrhosis of the liver, a life-long heart condition, and pancreatitis. The bedsore, with no description, is number five on the list.
Lola remained in Tracadie until, Steven said, she almost died choking on a piece of food. She was transferred to the Dr. Georges-L.-Dumont hospital in Moncton.
In Moncton, a treatment plan confirmed the family's suspicion the bedsore was stage four, the worst possible.
'A tragedy, plain and simple'
Steven and his sister Natalie are worried their mother might never recover. They fear her death will be blamed on other causes.
"I'm talking to you guys, because I don't want it to happen to anyone else," Steven said. "What happened to Mom — she went in with a broken hip. It healed up, even with her diabetes, really, really good.
"And she ended up with a stage four bedsore. So we're losing Mom, when Mom should be home eating codfish and having a good time with her family."
"What happened in Bathurst and Tracadie is a tragedy, plain and simple."
Lola Hawkins gripped the side of the bed rail as her son moved her again in her hospital bed.
Asked what it has been like for her in all these different hospitals, she seemed uncertain how to respond at first.
"You want to know? Between all those hospitals, I cannot say. Ah, I would like to say … but I don't' want," she said as her voice trailed off. She put her head on her pillow and closed her eyes.
Then, one word: "Disappointment."