Monday, June 30, 2014

Bedside Story


Are There Any Real Changes?

I walk down hospital hallways narrowed by the clutter of computers on wheels, food and linen carts and staff standing in clusters talking amongst themselves. A loud machine waxes the floors as a man pushes it down the hallway and people barely move out of his way.
I’m visiting a patient who has been diagnosed with cancer, and his family. The prognosis is not good. I was there when he received the diagnosis from a physician eager to start chemotherapy that another physician later said surely would have killed him. Information is constantly being thrown at the patient’s loved ones, who are scared and lost in a cloud of emotions arising from fear, confusion and lack of sleep. Words are often unheard, instructions are a blur.

I remember the doctor telling this recently-married man the bad news — stage four cancer with “nothing” to do but palliative care — and recommending treatment. I asked the doctor, “What do you think he heard after you said he has stage four cancer?” The doctor continued to tell the patient what the treatment options were even though he had strict orders not to share this devastating news without the patient’s wife present. “I need you to sign a consent form,” the doctor told him.

Now the patient is in a third hospital and being treated for breathing difficulties. The medical staff kept telling the patient and family there is nothing that can be done for his cancer. Exhausted from lack of sleep, his wife constantly reminds staff that he is not there for cancer treatment. They had a plan. He is there to be treated for his difficulty breathing.

On each of my visits I notice the standard of care he receives. The only sink is in a bathroom near the window, yet no one ever walks past me to wash their hands. The gloves, closer to the door, were easier for staff to reach. They didn’t wash before grabbing them.

I suggest the family goes for dinner when I arrive. I do not need to be entertained. They go to dinner and I notice that the compression stockings are not connected. One of the visitors who stayed behind with me said that if they needed to be connected, they would be. I knew better. When asked, the nurse says someone “forgot” to hook them up. In the times that I visit, no one ever shifts him. He gets bedsores that the family explains, “can’t be helped.”

The patient is critical and might die soon, but for now, he wants to live. Still, in the 2½ hours I was there one evening, no one washed their hands, no one shifted him, a hose from his breathing treatment dropped on the floor and before I could stop the nurse she reconnected it.

I saw that the antibacterial gel container was taped over. I asked the patient’s family why. “Because he had c-diff,” his wife explained, and the antibacterial gel won’t work on c-diff. I asked if anyone ever washed their hands and the family said “sometimes.” Never while I was there. But I wasn’t there the 24 hours a day that his wife was there. Maybe they just didn’t wash while I was there.

Maybe everyone gets infections in the hospital. Maybe all hospitals “forget” to plug in the compression stockings. Maybe all hospital staff don’t wash. Maybe in all hospitals bedsores are acceptable. Maybe in all hospitals the patient doesn’t need an oximeter on their finger, or staff don’t shift the patient? Maybe all hospitals have cockroaches and the nurses argue over who will be the one to kill it late at night, like this one did. The list is so long.

But the family was happy because the nurses were “nice.” Families of sick patients don’t know what to look for. Hand washing becomes trivial. Families have no idea that the policies and requirements are not being followed: the patient and the family are happy if everyone is nice.
The family probably knows that the patient would have died anyway. I will always wonder what he died from. 

Rest in Peace. 

1 comment:

Anonymous said...

Probably died from care more so than the lack thereof. Know what I mean?