Today I helped a family friend in a medical crisis. My friend’s elderly mom had been admitted to the hospital after a series of falls. In hospital medicine, this is a tale as old as time. Falls often herald the beginning of a downhill trajectory.

Experienced docs know to look for urinary tract infections, electrolyte abnormalities, dehydration, constipation, over-medication and more. We know that delirium (an alteration in mental status that can look apathetic or agitated) occurs frequently in the elderly and requires careful management.

Somewhere along the line, this elderly Spanish-speaking woman was medicated with benzodiazepines, a class of sedating medications known to cause all kinds of complications in the elderly. Following this, she stopped eating and drinking despite having been walking around and exercising at rehab just two days prior.

Her daughter called me in a panic: “Mom has not eaten or taken anything by mouth in twenty-four hours and I think she has been abused in the facility; she has a new bruise on her leg and arm and is yelling and inconsolable. They gave her Zyprexa yesterday and she has not been right since then. I think I need to call an attorney!”

Me: “Is she getting IV fluids? Has she had labs drawn today? Have you spoken with her hospitalist?”

“She had a small bag in the ER twelve hours ago. She has barely made any urine in the last twenty-four hours and the urine she has made looks like tea. They are asking me about CPR/code status and I am so scared. She was fine two days ago.”

We used FaceTime. My friend’s mom had a bruise on her calf that enveloped the entire circumference of it and a similar hand-shaped bruise on her upper right arm. She was listless and lethargic. Her dry tongue was hanging out of her mouth. There were no fluids hanging despite the daughter having asked for them two hours prior. She had missed the hospitalist’s rounds while stepping out for coffee. There had been hesitation on ordering fluids, citing heart failure risk, despite a history and physical exam with clear evidence of volume depletion.

My advice to my frazzled friend: Your brain is trying to simplify this into a story of wrongdoing. That is natural; but right now, your mom needs you focused on the present. Keep your attention there. The rest can be sorted later. If harm was caused (by medications, by rough handling), that can and should be addressed. But today we have a frail woman who is dehydrated and not getting timely treatment. That is the urgent problem.

Here is what to do:

• Ask the bedside nurse to page the doctor.
• If no response, ask for the charge nurse.
• If unavailable, ask for the unit director or house supervisor.

Speak calmly and with accuracy. Exaggeration undermines credibility. I gave her specific words to use: agitated delirium, acute dehydration, acute kidney injury, dry mucus membranes, decreased responsiveness, bolus fluids. I also reminded her: conversations about code status are appropriate, but comfort care is premature. And I suggested a psychiatry liaison consult for delirium support.

Her mom got fluids. Her familiar Spanish-speaking caregiver came and coaxed her to eat and drink. The nursing director listened and escalated care. Things are looking better.

But, my friends, this is how things go wrong in hospitals. This is how having an inside connection and advocate can make all the difference. Right diagnosis, right treatment, right timing… or not.

Anyone can tell when they are in a high- or low-quality restaurant. But even the most discerning folks sometimes struggle to recognize high- or low-quality medical care. It is easy to second-guess your own experience; because so much of what matters in medicine is hidden, technical, and inaccessible. Without the discrete language of the hospital, even the most capable people can feel helpless, adrift in a system with no clear rules or roadmap.

You are at the mercy of the system and the overworked individuals within it. You have to trust. And hope it all works out.

On our good days in medicine, we earn that trust and many things do work out. We extend loads of discretionary effort. We protect patient safety. We communicate with clarity and respect. We show up with interest, humanity, and we center dignity. Coaching for clinicians matters here; it keeps us sharper, steadier, more resilient and boundaried so we have more good days.

But the bad days come. The days when a single hospitalist is stretched across twenty-plus complex patients, juggling discharges, admissions, and emergencies, with no bandwidth left for nuance or extra calls.

If you have been here, you are far from alone.

A 2023 Harris Poll showed over seventy percent of U.S. adults believe the health care system fails to meet their needs; this paints a troubling picture of communication and navigation challenges across all domains of health care. And it even happens to us as physicians when we or our loved ones are on the other side of the equation. When my mother had a below-the-knee amputation in 2020, her surgery team forgot to order IV pain meds. If I had not called the covering hospitalist directly, she would have suffered in agony overnight. And even then, I got pushback. From my own colleague.

One thing that unites us is that most of us will at some point be at the mercy of our health care workers and health care system for one reason or another, and if not us, it will be our closest beloveds. When that time comes, what matters most is knowing how to navigate effectively and get the care we need when we most need it. Who to ask for and what words to use. A growing number of physicians now serve as inside-the-system advocates and consultants to help families navigate these moments, educating, interpreting, and advising in real time. If you or a loved one is in need of advocacy or direction in a complex time, find one of these advocates; it can make all the difference.

Chrissie Ott is a multi-passionate, multi-board-certified physician, professional certified coach, and well-being leader with broad experience across life stages and care contexts. She has spoken to national and international audiences about burnout and the healing power of coaching, and has personally coached dozens of health care professionals back to a sense of wholeness. With a background in human nutrition and food science, Dr. Ott integrates clinical knowledge with holistic approaches, including nutrition and purposeful supplementation. She is also a skilled communicator, dedicated to bridging the information and bias gap between health care providers and recipients for improved outcomes. Her work is featured on chrissieottmd.com, her writing and reflections are shared at solvingforjoy.com and on Substack, and she connects regularly with her community through LinkedIn, Facebook, and Instagram.