Urgent Concerns: Family's Struggle with Father's Neurological Condition - Neurosurgery

A family member's inquiry about a patient with an urgent medical condition?

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Dear Dr.
Ding,
I am a family member of a patient.
My surname is Lai, and I live in Miaoli.
I would like to ask some questions regarding my father's condition.
Two weeks ago, my father fell at home and sustained a head injury.
On the day of the injury, there was a large bump on his head, but we did not take him to the emergency room immediately; instead, we applied ice and monitored for signs of a concussion.
Throughout the day, he did not report any discomfort, so we temporarily felt reassured and did not take him to see a doctor.
However, starting the next day, he began to complain of headaches.
He has a history of insomnia and takes a high dosage of sleeping pills.
We assumed his headaches were due to lack of sleep, so we took him to a nearby clinic for pain relief injections.
After several days of persistent headaches and the onset of vomiting, we finally took him to the hospital's emergency department.
The doctor performed a CT scan, which showed no abnormalities.
We informed the doctor about the head injury, and he examined the bruise, which had turned purple and black, and advised us to apply heat at home.
After returning home, my father's headache symptoms did not improve.
The doctor only prescribed pain medication, which was ineffective, and he continued to complain of headaches.
Two days later, we took him to the emergency room again.
This time, he underwent a chest X-ray and blood tests.
The X-ray results were normal, but his white blood cell count was over 19,000.
The doctor inquired if there were any wounds on his body.
I mentioned that he had a previous bacterial skin infection on his leg, which had caused some skin breakdown, and he was undergoing treatment with dermatological medication.
The doctor attributed the elevated white blood cell count to the skin condition and sent us home.
A few days later, my father became unsteady on his feet and walked as if he were intoxicated.
Since we were all at work, we did not notice his abnormal behavior and assumed it was due to the heavy dosage of sleeping pills.
He did not express any discomfort until the morning of May 12, when he was completely unable to stand.
Upon attempting to stand, he collapsed and vomited black liquid, also experiencing a loss of consciousness.
We called an ambulance to take him to the hospital, where he underwent a chest X-ray, CT scan, and blood and urine tests.
At this point, his white blood cell count had risen above 20,000.
The examination revealed (1) mild bleeding in the head, (2) fever, (3) pneumonia in the chest, and (4) vomiting of black liquid.
Tests suggested that he might have gastric bleeding due to excessive medication (he has a history of stroke and is on medications from neurology, psychiatry, and pain management).
He was then admitted to the neurosurgery department.
Since his admission, he has been receiving antibiotics and hemostatic injections, but his headache persists.
They also administered medications to reduce intracranial pressure and additional oral pain medications.
The doctors discontinued all his usual medications for stroke and psychiatric conditions.
His headaches have been intermittent, and his blood pressure has remained around 170.
Although he responds when called, he spends the entire day in a stupor, gradually eating less and has not had a bowel movement since May 11.
During this time, there have been no consultations with other specialists.
When we inquired about the ongoing headaches, the doctor stated that the bleeding in the brain would be reabsorbed and that we could follow up in outpatient care.
However, he mentioned that there was water accumulation causing increased intracranial pressure, leading to the headaches, and that the area of accumulation had become compressed and stagnant, requiring a minor surgical procedure to place a drain to remove the excess fluid.
However, due to concerns about pneumonia and infection, no procedures can be performed at this time.
My father is over 70 years old, and we are worried that the continued injections without further examinations of his chest and brain may worsen his condition.
It is concerning that the doctor mentioned that the first CT scan should have detected the fluid accumulation, suggesting that the emergency physician was not sufficiently skilled to notice it, which raises doubts about the professionalism of the medical staff.
Additionally, we are dissatisfied with the attitude of the attending neurosurgeon, who spoke casually and dismissively, did not conduct a thorough patient assessment, and left without addressing our concerns.
If we had not asked, we would still be unaware of the fluid accumulation and the need for surgery.
We would like to know what steps we should take now.
Should we consider transferring to another hospital, or do you have any other recommendations for our family? Thank you for taking the time to read this letter.
We look forward to your response and sincerely appreciate your help.
Best regards.

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Miao Miao, 40~49 year old female. Ask Date: 2011/05/14