Tuesday, February 22, 2011

My Stay at the Hospital

My Surgery

My surgery was successful and as I was resting in the hospital recuperating.  Although everyone was friendly and charming, I was amazed at what I saw unfold in front of me.

My experience started when I walked into the operating room, able to see the Time Out poster on the wall. It wasn’t the interactive Check List Board  I would have preferred, but it made me aware that this group had some idea of the importance of cooperation. The anesthesiologist, who had many years of experience, gave me a calm and reassurance I needed knowing what I know about surgery and surgical complications. I also am well aware of the miracles of surgery and how often a patient’s quality of life is improved following surgery – otherwise I would not put myself in this position.

 I asked, in the operating room to be part of the Time Out procedure which address The Joint Commission Universal Protocol of wrong site procedures I was asleep before that ever happened.

I won’t share all the details here, there are just too many, but I will tell you that my name and birthdate were rarely verified. I can count one time, when I first arrived and the second when the nurse was telling me something that was contradictory to what the doctor had said. “You are Corina, right” she asked. I said “yes” and then she asked me my birthdate.

 My medication, only one, came only on the first day in it's original wrapper even though I asked for them all to be delivered that way. I was told that Percocet  does not come individually wrapped and I cannot see the wrapper that this pain reliever, narcotic was being delivered in. My advocate was with me, but I asked him not to say anything. By this time, I was preparing to go home.

15 minutes later, when the Colace was delivered in a small cup, without the wrapper, by the same nurse, I asked if these also were not available to be delivered in their original wrapper. The nurse asked if this “annoyed” me. I explained I wasn’t annoyed but for both of our safety – so she doesn’t make a mistake and so I get the proper medication, it makes sense that I, or my advocate with me for the days I am here, verifies this information. She left the room with no response.

I was given a shot for blood clots that were also not marked for my verification. My doctor never told me I would be receiving shots. Given late at night, after my pain killers and after my advocates went home because the room was too small and crowded, I gave in.
The privacy curtain for my roommate, broken for at least 2 of the days I was there was not fixed when I asked the nurses or aides to fix it but was finally fixed when I asked housekeeping to fix it by hammering a small nail that slipped out and kept the curtain from sliding. Her lack of privacy made it difficult for my advocates to feel comfortable in the room.

 Rarely would anyone introduce themselves when entering. A new resident or doctor would explain why they were there, but people from housekeeping, or pain management didn’t. When a woman came in, touched the IV and wrote down numbers, my two visitors stopped her and demanded to know who she is and why she didn’t introduce herself. Obviously embarrassed, she explained herself and apologized. It should never have to go that far.

 As someone who has been an advocate at the bedside for approximately 40 patients in the last 4 years, I have never witnessed this sort of careless behavior. When I asked a nurse why, after I know that The Joint Commission was there just the week before (I heard staff talking) would they not check my name or arm band, introduce themselves to me or deliver my medications so I know what I am getting, one nurses response was, we know who you are, it’s not that busy here.

 Fortunately, hand washing wasn’t the biggest issue. I watched as everyone coming and going used the wall hand sanitizer. When my advocate didn’t see the surgeon use it, he asked her to. She said she did already but would do it again.

 Unfortunately, immediately following surgery it didn’t go as well which is probably why all the other incidents stay close at hand. The morning after surgery, two residents arrived and said they wanted to check the site of surgery. I asked them to wash their hands first. “I did” said the one who now had her fingers on my stomach. “And I showered this morning too if that helps”

Yes, I am grateful to my outcome but nope, not a happy hello to my stay.  We still have a long way to go.

Feel free to leave a comment.  I have 4 more weeks to read them.

Wednesday, February 16, 2011

Choosing a Surgeon

How I Chose a Surgeon

Some people have asked me how I chose a surgeon. It isn’t easy, and the one I chose isn’t the one I might expect others to choose. Choosing a surgeon, like choosing a family healthcare provider is very personal.

I trusted a friend who runs a large surgical office. Though the surgeons she works for do not do the surgery I need, they work for the health system I trust. I chose the health system, or hospital, first. I needed to know that the leadership at this facility go to conferences and are involved in patient safety initiatives nationally. The leadership is on boards and involved with organizations that promote patient safety. This health system encourages patient participation. If something goes wrong, I am confident that this institution has had the training to disclose to my family and do what is right.

That is no excuse for my choosing a surgeon who is fairly new to her field. Her profile says that she has been licensed for three years and board certified in 2009. Another surgeon I saw for another opinion said she was doing this procedure for over ten years. “So why” asked a friend / colleague / surgeon who is 64 years old and has more experience than these two others put together, “would you use someone with such little experience?” “Because”, I explained, “I don’t want someone who has been trained with the dinosaurs”.

When physicians complain about change, and I hear the words “that’s the way we always did it” I fear that they are not willing to learn important things such as hand hygiene, time outs and communication. I fear that the “way we always did it” is outdated and possibly what has caused the patient safety problem in this country to begin with.

By using a younger surgeon, I am choosing someone who has been recommended, does not come with the “holier than though” attitude and maybe has been to some of the patient safety conferences that I have been to. Chances are, some of the other hospitals in town may not even know about them.

Monday, February 14, 2011

Pre-Surgical Testing

My Day of Pre-Surgical Testing

I went for my pre-surgical testing. I was asked if I wanted my name called or would I like to use a number. It was a wonderful offer since because I am a private person, I didn’t want to run into people I know. I chose to be called by number.

I was handed a stack of forms to complete. I was not asked if I could read them or if, in fact I needed help. I have learned to always ask people if they need help writing, if they forgot their glasses or couldn’t see well. Reports are that as many as 90 million Americans have low literacy so the chance are that one of these people will be standing, at some point in front of this woman handing me the forms. But this hospital did not seem prepared to make me feel comfortable if I couldn’t read the forms. I may have sat in a corner signing for things I had no understanding.

After being called in, I was greeted by a young woman who sat with me and explained payment, insurance and some other incidentals. She was calm and made me feel that I was not a burden. In this private area I may have been able to tell this woman I couldn’t read or, I couldn’t understand what she was saying.

 After a long wait, about 30 minutes, I was seen by a nurse practitioner. Because there were two women, I had to ask if one was in training. No explanation was given why one was going to watch my intake until I asked. I was never told that this may be an all -day event. Were I planning to go back to work or had other plans, I would have, at this point needed to cancel.

The nurse practitioner talked fast, and pushed papers in front of me to sign, barely giving me an opportunity to read them. I was sure to block out her continued questioning while I read the forms. She was eager for me to sign. I wasn’t sure if this was the way she was training the other woman, chatter the procedure, ask patient to sign, chatter the procedure, ask patient to sign. Never was she asking me if I had any questions or if I understood. Maybe I just looked like someone who would speak up if I needed to.

 When I left, and was brought to the x-ray department, I waited another 45 minutes with only one other patient waiting. I assumed it was lunch time and we were just left there, but you would think, being left alone, in a strange place, at such a vulnerable time, one of the 4 or 5 women chatting about their family’s vacation may have explained what the long delay was. But, I had to assume that wasn’t their job.

Sunday, February 13, 2011


The Advocate Listener

I am surprised how many people ask if my surgery is an “elective” procedure. I’m not sure why a woman would choose to have a hysterectomy unless the pain, discomfort or quality of life has diminished because of it. Do people ask if knee surgery is or gall bladder surgery is elective? I couldn’t even imagine asking someone if their nose job is a choice or liposuction is elective. Obviously, the person getting the surgery feels this is important, for whatever the reason.

In learning about empathy, we learn that being present and sometimes saying nothing is ok. Society hasn’t learned yet that we don’t have to compare our injuries or illnesses. It takes work to just be present for someone as they share something important. We want to show that we understand by explaining we have been their too. That’s not always necessary.

Expressing anxiety or fears over their surgery is supposed to help a patient feel they are not alone. But, everyone is different. My anxiety may not be because of the actual surgery but instead, being away from my children and home. While someone may want to downplay a patients fears with “don’t worry, you will be fine”, the listener has closed the door to what the patient needs to express to help relieve the anxiety.

Being the patient for a change has helped reinforce what I have been learning and teaching about communication. As a patient’s advocate – there is a strong need for being a strong listener. So much about patient’s safety is about communicating. Patient’s won’t always get those skills from their healthcare provider.

Thursday, February 10, 2011

My Own Surgery

Planning for My Own Surgery

As I plan for my own surgery, it has given me yet another aspect of healthcare. I get to see some of the details advocates for others may often forget about. I am a very private person but thought it might be helpful to tell my own story as I move forward.  And, of course to look at it from the eyes of the patient will be helpful in many ways to my work.

I am in the business of patient’s safety, for the simple reason healthcare is often not safe, I have my doubts about entering a hospital and subjecting myself to a knife, while asleep to remove the same organs which have given me my wonderful children. Unfortunately, almost my entire adult life has been surrounded by only the less positive outcomes of healthcare. Though a realist, I do know that there are hundreds of thousands of surgeries that have great outcomes. I just don’t get to hear about them nearly enough.

Errors can start anywhere, such as the paperwork I received saying I will be admitted 2 days after my surgery is to take place. I didn’t call to question this because I knew I would get a series of phone calls from the surgeon’s office. But, when I did mention it, instead of an apology I received a comment “Oh, you know when the surgery is”. Because it was changed, that date was never on the form, and she was not planning to send me a correction. “Just change it on your sheet” she told me.