Monday, April 1, 2013

Automation is No Substitute for Care

I've had four specific opportunities in the last six months on which to reflect on the state of hospital and medical care as a nurse and patient. Twice I was an outpatient and twice I was an emergency room patient. I'd like to share some actual experiences and insights with you and hope you find something useful. I will remind you, right now, that you are a consumer and doctor is not another word for god. I will also say, up front, that no one should be in the hospital without a 24 hour advocate.

Automation is no substitute for care. And many of the people who took care of me were just like automatons. Texting while doing lots of things. On automatic pilot, in cookie cutter mode. When the nurse in the ER asked me for a pain level and I tried to explain what hurt he just said "All I need is a NUMBER" and it reminded me of a painful conversation from a couple months ago. Don't ask me how I hurt if you don't want to know where I hurt damn it!

I received all of my care at a state of the art hospital that most in the community it is found in would tell you is "the best." It is the hospital that folks rush to get into and tell all their friends about. It's why I scheduled my colonoscopy and my endoscopic gastro procedure there. Why not go for the best local hospital?

I had problems getting my tests scheduled last fall. The departments doing the testing/procedures did not communicate well with each other. This resulted in my having to reschedule my appointments out another month. First Grrrrr

For one of the procedures I was instructed to report to a particular ward. I stopped at the check-in desk to ask for directions/clarifications and was told to take a seat with my companions while a phone call was made and was informed that I was to continue to wait. When my assigned procedure time was nearly upon me after waiting what seemed far too long (I had been pacing and grumping) I announced I was just going to go upstairs. I was barked at by the elderly receptionist and told to sit down. Security was at her side. I told her more than once I was sure she was wrong, that she was making me late, that I had to make special arrangements for my ride and she was having none of it. Turns out I was right. I had to talk to the manager of the floor I was eventually sent to. That got me a sympathetic ear and a five dollar "I'm sorry" coupon. Big whoop!

So I next encountered this hospital through the ER a six weeks or so later. I enter with a fever of 104 with a raging kidney infection. It takes multiple trips in and out of an ER room having one test after another to figure out what is wrong. I give the ER doctor credit. He persisted and got me on track with the right medications to start the healing process. I was then taken upstairs where I was glued to a bed for 3 days. No IV pole was found so I couldn't get out of bed to get to the bathroom. Getting someone into the room was hit or miss and I had to "go" right now every time. IV was running fast.  The rail of the bed dug into my leg and made my foot go numb. I reported it over and over but no one took me seriously and I couldn't stand on my leg and pivot without being dangerous. I found out two days into my stay that my call light was broken and it finally was fixed by the manager.

The bed was too high. The bedside toilet was too tall. My meds were incorrectly scheduled. My diet was changed 5 times without anyone telling me. Doctor ordered things without telling me and nurses were hit or miss about what they remembered to tell me. Wrong size blood pressure cuff was often used on my bigger arm. Folks, then and now, often get mad when I make them get the right size cuff but I tired of being labeled as a hypertensive by my doctor because using a smaller cuff will show a false high blood pressure. Except for the midnight nurse and the last evening shift nurse I had most tried to use the wrong cuff. I used to work with the dietician that came and talked to me about the meal changes and she argued about the 60% carb plan that is a relic from the American Dietetic Association from 1990. I argued until I was blue in the face about how I don't eat all the carbs and garbage they serve on the diet plan. I was surprised that we didn't come to blows because I've done my research on behalf of patients over the years. That information is old and she isn't even going to bat on behalf of the patients. At least she didn't have to try to spoon feed me lies. That really got me down that admission! Everyone ignored, anyways, the high fiber diet I was prescribed due to the, then, recent diagnosis of extensive ulcers. When I got out the discharge instructions were fairly useful if just a little confusing.

Recently, I went to the ER again with a significant unexpected blood loss that continued during my ER visit/assessment. By the next morning I needed blood transfusions and surgery to correct the problem. During this stay I was boarded in the ER in order to have telemetry monitoring as the hospital didn't have another tele bed. I was eventually moved to a different room on a temporary floor prior to surgery. In ER during an IV placement attempt the nurse's phone rang and she reached in her pocket and answered it. She missed the IV stick and left the room.  Forty five minutes later another nurse comes in and says "I hear you are a hard stick." I replied "oh, is that what she told you?"

I had anticipated the possibility of surgery so I "made myself NPO" just in case when someone offered food/water as a possibility. Good thing huh?

While waiting for surgery one unit of blood finished. The second one went up late and after the slow "test dose" the nurse accidentally turned it off. I caught that and reported it. I would have just turned it back on but they use pumps these days and I don't know how to use them for blood. But I wanted to have a high enough blood count for the surgery since they didn't plan on checking the blood count again prior to the surgery. Not sure how I felt about that.

I was being wheeled into an elevator and a crowded of a dozen or so folks ran off of it in jackets and hats and the doors closed. I remarked that it was a busy elevator since it was for staff and patients only and was told that it was shift change. I asked "those were nurses, lab and xray folks?" and the guy pushing my cart said "yep" and I couldn't believe that none of them held open the elevator for us to get on the elevator.

My invasive ultrasound was done twice because the computer reading it went on the fritz and had to be restarted.
My doctor saw me in the a.m. and handed off my care to another doctor who then went out of town and handed me off to yet another doctor who I never met.

The entire time I was in the hospital no one asked me if I was taking any medications. I eventually got 'round to asking why and was told that there was a list from the last admission. They "had" them. I said "no you don't. They aren't correct. Read them to me." They were not quite right. So we fixed them but the fix didn't stick as you will hear.

While discussing the merits of the proposed surgery my surgeon suggested I should leave right after surgery and generally agreed with me that Fridays are often not a good day to have surgery due to the surgeon not being there for follow up but noted in my case it wouldn't be needed anyways.

After surgery, I asked that the category of medications known as NSAIDS be put in as an allergy on my record as I think that contributed to the hemorrhaging I had and the nurse put it in but on my way out the door to go home I was offered a shot of an NSAID called Toradol and no such allergy was in my chart in the computer.

My discharge instructions did not have any directions or prescriptions to take iron so I ordered some and called my doctor's office today. Would a patient-not-a-nurse know to do that? I had no instruction on when to follow up, what to look for post op, what sort of pain (if any) was normal or excessive, any instruction on what might indicate infection.

I could go on but IN THE END it just cements my view that there is something wrong with computerized, insurance-driven, slap a bandaid on it care. The only place I found any professional level care was in the checking of the blood routine, the most very basic ER care and the interactions I had with the circulating nurse and the anesthesiologist pre-op.

I know this blog isn't written in my usual style and it feels like I've left things out because I have. If it's disjointed it's because even four days after that adventure started with me feeling the life drain out of me I'm still wondering why it had to be made so much more confusing.

And I was very blessed this last admission to have someone with me the entire time. He doesn't know much about medicine but even he could see how dangerous this place tried to be.

I've toyed with telling the administration how it went. I wasn't in any condition to collect names and times. But I still know how rotten it felt to have to be hypervigilant during a time when I should have felt cared for, not just in a clinical sense, but in a caring sense. In an "I've got your back" kind of way. I have no idea what was hanging in those bags. I tried to ask. Automation is no substitute for care.

Sunday, February 6, 2011

Help Others without Hurting Yourself

It's easy to forget to take care of yourself when you are constantly doing things to care for others. Burnout or caregiver fatigue occurs over time and is important to ward against but I have been thinking more about the recent storms that have ravaged parts of our country and what that can mean to one's health.

Have you been shoveling a lot lately? Have you been moving a lot of snow or doing activities that are unusual for you? We hear about heart attacks that occur with vigorous snow shoveling but there is less said on the news about the damage that can be done to sensitive neck and back nerves and muscles. Our bodies are machines and must be trained to do certain types of work.

There are certain types of work our bodies can not handle but at the time the work is done it is not apparent. Serious damage can be done to the neck that can affect not only the neck but the arms and hands. Signs and symptoms can be pain, numbness and tingling and loss of grip possibly characterized by dropping items. A pinched nerve may heal on it's own or may require anti-inflammatories, traction or the judicious use of physical therapy. Nerve entrapment can become so severe in some cases that surgical decompression could be considered. It depends on how a problem occurs and how dramatic the symptoms are and how they interfere with activities of daily living over time.

Use assistive devices to get things done. It could be a shovel or a snow plow in this case. Think a project through before taking it on. Think before you lift or push or pull. You are only of use to someone if you are healthy. Hurting yourself should not be an acceptable risk. Call or hire help when the job is too big and assess each situation before diving in head first.

There are warning labels on the side of the pool to protect your head and neck but NOT on the snowflakes.


Recovered Access to My Health Care Blog WooHoo!

I finally had a master password reset in my brain and remembered my password. Now I can put this blog to use again!