Posts Tagged Things Patients Say
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Uncategorized, Warm Fuzzies on Friday 20 April 2012
Some real nurse love — and incidentally reminding us why we have the most tremendous profession in the world and how we each day make a powerful difference in the lives of our patients. Via the blog The Spohrs are Multiplying, Mike Spohr writes about the day his child died:
On the horrible day that Maddie passed there was a nurse who stayed by Heather’s side the whole time, and I am so thankful for her kindness to my wife. There was a nurse that mattered to me too that night, though she didn’t stay by my side, bring me a glass of water, or even say a word to me. In fact, I don’t think I saw her until the last few seconds I walked out of the PICU, but she made a difference nonetheless.
You see, that day my life shattered. I watched my daughter die in front of me, and it was an experience so horrific that even now it seems almost surreal, like, “Did that actually happen? To me and family?” But it did, and one of the things I remember most about it was how the key medical personnel there didn’t make me feel like they found Maddie to be beautiful and strong or amazing and a gift. The lead doctor, for example, was under a great deal of stress, but the way he pronounced her dead was not right. It was more like a referee calling the end to a heavyweight fight than the end to a beautiful child’s life. Then, as we held our dead child in our arms and kissed her goodbye, doctors stood behind the curtain discussing the specifics of what had happened with about as much feeling as mechanics discussing a broken down car.
It was only as I left the PICU that I felt humanity from the medical staff. There, sitting on a chair with a single tear rolling down her cheek, was my nurse. Her tear told me that she cared. About Heather, about me, and most importantly, about my beautiful Madeline.
That’s what nurses do that is so important. In addition to all of their medical expertise, they bring a human element to the cold, sterile world of a hospital. Doctors do great things, but have a heavy case load that means they can only visit each patient briefly each day, but the nurses will hold your hand – figuratively or literally – and remind you that you are not alone, and that your life is valued even if it can’t be saved.
A good and valuable antidote to the river of treacly pronouncements and saccharine encomiums we are about to receive from our employers, nursing leaders and other power centres in the nursophere in anticipation of Nurses’ Week. Worth about a million of ’em, I think.
For my American friends and readers, we’re having a provincial election here in Ontario. Since health care is deemed a provincial responsibility (though funded extensively by the federal government), it’s naturally a hot topic of discussion. At the televised leader’s debate a couple of days ago, New Democrat leader Andrea Horwath managed to step in it, just a little, by suggesting Emergency Department staff at Hamilton General Hospital treated her son inappropriately or even incompetently after he injured his elbow skateboarding. “He went to an emergency ward in my community,” she said. “They didn’t do anything for his fractured elbow. They sent him home, said it doesn’t really need anything, they can’t afford a cast, and go home and somebody will help you figure out how to put a sling on it.”
Unlike St. Joseph’s Health Care Centre in Toronto, which took a pasting in the Toronto media after an elderly man made allegations of abuse, Hamilton General pushed back:
Despite her clarification Wednesday, some hospital staffers felt Horwath’s comments were unfair, said Jeff Vallentin spokesperson for Hamilton Health Sciences.
“All I know is there are lots of folks (working here) concerned about the comments … some feel it’s an unfair representation of the hospital.”
He added that no one has made an official complaint about Leonetti’s visit to the ER.
The hospital’s chief of emergency medicine would not speak on the specifics of the Horwath case, but said it is common for elbow fractures not to be put in a cast.
Dr. Bill Krizmanich works in emergency at McMaster University and said there are many degrees of fracture, from a hairline to a full-out break, and each is treated differently. The elbow is a very complicated joint because of its range of movement and the treatment depends on the severity of the injury.
The most common elbow injury from skateboarding is a radial head fracture, which normally heals permanently in about four to six weeks with very few future problems.
“In those, we don’t splint and we don’t cast. It heals on its own … (and) early mobilization of joints is helpful.”
At the end of it all, Andrea Horwath walked backed her comments, somewhat: her intent, she claims, wasn’t to attack staff but to highlight systemic problems. “The example,” she says, “was meant to illustrate that people are disappointed with the service they’re getting at the hospitals. In the event, it turns it turns out Horwath was not even with her 18-year-old son during the visit; her retelling of the story was at best second-hand — and 18-year-olds are not known for taking direction well.
I guess, to be charitable, Horwath was trying to personalize a complex issue, i.e. validating through personal anecdote reports of poor care at Ontario hospitals. Unfortunately, the leader of the party of the Left managed to fall into the trap of repeating the same tired meme (ironically!), beloved of right-wing politicians and pundits that Canadian public health care is The Pit From Whence Few Return Alive.
We all have stories of poor treatment by health care institutions, and I am sure this is a commonality of both Canadian and American health care systems. My own story relates to being seen in the ED of Belleville General (I was passing through) presenting with sudden onset of severe headache. I was treated badly by the Emergency physician who plainly thought I was some drug-seeking tourist from The Big Smoke. (The nursing staff, I hasten to add, were superb and professional.)
But anecdotal evidence, while having the power of making the complex real and personal, is also the worst kind of evidence. It’s pretty difficult to generalize conclusions from anecdotes. Even if Horwath’s story is true and my story is true, you can’t point to a larger conclusion, as Horwath does, that “people disappointed with the service they’re getting at the hospitals.” It’s logically faulty. In any case, the larger point it isn’t actually true, and illustrates nicely the problem of using anecdotal evidence for anything: more often then not you’re going to be caught with your pants down. Statistics Canada has the data.
In Ontario, 86% of people were either very or somewhat satisfied with the health care received. Is there room for improvement? Absolutely, and I am a bit worried about the gap between “somewhat” and “very”, which the StatsCan study does not elaborate upon. If we’re going to talk reasonably about health care reform, let us at least speak rationally, and use evidence and best practices. Bashing health care agencies and professionals isn’t helpful, especially when (I suspect) large number of health care professionals are sympathetic to the New Democrat message.
I look around.
There is no ward clerk in sight.
I answer. “Emergency, Charge Nurse.”
“Can I ask you a question?” The voice on the other end sounds flat and tired.
“Sure,” I say warily.
“I came to see you guys a three days ago and I had a sore chest and you guys did a whole bunch of tests even though I told you my Ventolin had run out and my asthmas was real bad, and you did nothing for it, and the nurse was real rude, like, and you guys took blood and, and did a heart test I did an xray, and I was real afraid of the xray ’cause of the radiation, and I don’t want to get cancer or nothing ’cause i already got cancer like my mother who died of breast cancer and the doctors didn’t do nothing, and then the doctor told me I had an infection in my chest and I think it he said it was pneumonia and he gave me a prescription and I got it filled and I took the first dose tonight, and it didn’t do nothing, and now I have a rash on my arms and stomach and it itches real bad —” The caller paused for breath.
I jump in, wondering where exactly the question lay. “Are you asking for medical advice?”
“I guess. Can you help me?”
“We don’t give out medical advice,” I say. “You can call Telehealth, and they should be able to. You have pen and paper and I’ll give you the number?” I think, please let me give you this number, so I can end the call. She’s not having any of it.
“Are you guys busy?” she asks. Every emergency nurse knows this question, and we all have the same answer.
“I can’t answer that,” I say. ‘It depends on how sick the patients are, and how many people come into the emerg.”
“How long is the wait?” she persists. “Will I have to wait long?”
“I can’t answer that, ” I repeat.
“Can I pre-book an appointment?”
“I’m sorry, no.”
“Well, thank you for fuck all!” She bangs the phone down.
Thanks and you’re welcome, I mouth. Another happy customer who has made me very glad to be a nurse. And ten minutes of my life gone for ever. I swear I will never pick up the phone again. Really. I mean it.
The phone rings.
I look around.
There is no ward clerk in sight.
In the Resus Room the other day, the patient an elderly female patient presenting with a vague chest pain and a pair of (overly) doting children, a son and daughter. The patient herself is quite stoic and calm, bemused by all the ado, the children less so.
We generally allow only one visitor at a time into the Resus room. First up is the daughter. She fusses and coos and adjusts the blankets. The patient pats her daughter’s hand and says, “This is my favourite child. She’s the best.”
“I’m sure,” I say, “you say that about all your kids.”
“No,” she says firmly. “She’s my favourite.” The daughter positively beams.
The son trades places with the daughter. He fusses and coos and adjusts the blankets. The patient pats his hand and without batting an eye, she says, “This is my favourite child. He’s the best!”
A few nights ago I was working in Fast Track, where the walking wounded go. It was insanely busy. Volumes were high, many of the patients were unexpectedly complex, and since the rest of the department was stuffed with then more acute ill (as usual), admitted patients began to fill Fast Track beds. In Fast Track, this has two consequences. First, there is physically fewer places to see people, and second, one of the Fast Track nurses is essentially seconded to assume care of these patients. The effect is to significantly disrupt patient flow. Delays, as they say, were significant, though we were working furiously hard to get patients in and out of the department.
After about five hours of wading though patients, I was flushing an IV line just outside from the Fast Track waiting room when I heard part of a conversation within.
“. . .I have never seen such slow and stupid staff as here,” a woman was saying. Someone else said something inaudible, and there was general laughter.
Nurses in the ED are generally very conscious of the public overhearing conversations, especially if the subject is sensitive or confidential. The walls have ears. On the other hand, patients don’t generally realize there is no sound bubble that prevents their conversations from being overheard elsewhere in the department. And I get that patients are in pain, are frustrated, are angry. But to say this woman’s comment was bone-breakingly demoralizing would be an understatement.
I wanted to take this woman around the department, to show her the challenges of running an Emergency Department when it’s full of admitted patients.
I wanted to give her the private Blackberry number of the hospital CEO so she could complain to him, directly.
I wanted to explain to her that I had been nearly continuously on my feet for those five hours, without a break, and my only sustenance had been two stale chocolate-glazed Timbits from God-knows-when.
I wanted to toss in my stethoscope and leave.
I wanted to tell her to shut the fuck up.
I didn’t do any of these. Instead I went to start the IV: a chronic anaemia patient who needed a top-up of a couple of units of packed red cells. Not complicated, but time-consuming. She would be taking a geri-chair for four or five hours, and when the transfusion was running, she would need frequent nursing assessment and documentation. She was sweet, patient and even grateful and marvelled I had the time to find a warm blanket and a tuna sandwich for her. There wasn’t any Hallmark moment in this, if you’re wondering. There was no object lesson, no redemption, no new courage to carry on, et cetera. She brightened my sour mood, but only a little. Being human, the comment lingered like a bad odour — C. diff, maybe — for the rest of my shift.
I mentioned the comment to my colleague of the day. He thought about it for a minute. “Maybe,” he said, “we should fulfil public expectations.” We didn’t, of course. But the thought was enough to bring the merest smile to my lips.
Overheard at Triage:
Youngish Woman: (overly distraught) The room started spinning, and I started feeling all weird ‘n’ stuff, and lightheaded, and I don’t know what’s wrong with me! Also, I got really really hungry!
Boyfriend: We were smoking marijuana.
Triage Nurse: Isn’t that the desired effect, guys?
A Tragedy and Farce in One Act.
(Curtain rises to reveal a busy Resus Room setting, full of patients, families, and nurses. Occasional moans, and nurses calling out, “Can you bring me a syringe?” and “I need the doc in here stat!”)
(A patient’s husband approaches a Nurse, who is drawing up some drug or another.)
Husband: (very angry and yelling loudly) My wife is having a stroke! I have never seen her act like that? There is something seriously wrong with her! And you guys are doing absolutely nothing! I have never seen such incompetence!
Nurse: (calmly, looking at syringe) She’s receiving appropriate treatment. We have assessed her, positioned her so she maintains a patent airway, started an IV, drawn bloods, and monitoring her heart rate and rhythm. . .
Husband: (the same) I’m an RN in the ICU at Holy Somolians Hospital downtown.
Nurse: But. . .
Husband: I know when someone is neurologically impaired! You guys don’t know you ass from your elbow! She needs a CT, stat!
Nurse: (a little exasperated) If you work in an ICU, you would surely recognize an ethanol level of 83.*
Husband: What? That’s impossible! (voice trailing off) She doesn’t drink, she quit a couple of years ago. . .
*In perspective, you’re considered legally impaired with a level of 17.
Overheard at Triage:
Male patient, 20ish, vomiting violently (and dramatically) for one hour, arrives via EMS accompanied by his overly distraught girlfriend.
Off to the waiting room they go, the Girlfriend, all silver bangles and dyed black hair, silently crying, the tears streaming down her face and making her mascara run, wailing about the cruelty of a certain triage nurse. Can’t you see he’s seriously ill? And then, the tell:
“Can he have some water? He’s, like, dying!”
That would be a big fat no. Giving water to vomiting patients would cause them, like, to vomit.*
Five minutes later, Girlfriend comes up to Triage, all teary and emotional.
“I have to go now,” she says, her voice breaking just so. “I left him some water.” Then in a whisper that would cause the heavens to weep, she adds, “I hope he doesn’t die.”
She shouldn’t have left: Boyfriend was discharged 20 minutes later.
*I thought the word “like”, used as a filler, was no longer hip. I guess I was wrong.
Had another one of those interminable discussion with a patient’s son about advance directives that started by him saying, “I don’t want anything done, just want a little shock for her.”
Oy. “A little shock” — defibrillation — is never as simple as just plugging in the zapper and pushing the red button. Oh no. You have to do other things, like CPR, and ventilation and drugs. There isn’t actually much point in defibrillating, except maybe the quickly passing sense of actually doing something for the patient, without the chest compressions, the drugs and the ventilation. There is no such thing as non-invasive Acute Cardiac Life Support.
All of which I explained to him in careful, excruciatingly painful detail, careful not to use words of greater than two syllables nor technical jargonese.The son, God bless him, was attentive and serious, but clearly out of his depth. Round and round we went. He asked questions. I answered as clearly as possible. I used every technique short of interpretative dance and sock puppets.
In the end, I’m not sure if he even vaguely understood anything at all, except he decided his father should be a full code.*
Maybe I should’ve used the sock puppets. With the interpretive dance.
*That is, do every and all heroic measures.
Overheard at Triage:
Youngish Female Patient: (at Triage Nurse) Do you have to go to school to do this?
Triage Nurse: Ummm. . .
Youngish Female Patient: Do you get to hook up with the doctors?
Triage Nurse: (makes retching noises)
*** *** *** *** ***
Overheard at Triage:
New Paramedic: (to Triage Nurse, excited) We have a new onset CVA* here, 49 year-old female, slurred speech, ataxia, and decreased LOC†. You guys going to call a Code Stroke?
Triage Nurse: Okay. So what’s the story?
New Paramedic: Her husband says she was drinking today, and then he found her like this about an hour ago.
Triage Nurse: Waiting room, boys, and thanks.
*CVA: Cerebral Vascular Accident, i.e. a stroke.
†LOC: Level of Conciousness.