Get Me Out Alive!!!

[Guest guest]

My brother, a neurosurgeon, always told me: " Stay out of the hospital. They kill people there " . Here is one woman's story.

As a Nurse, She Knew the System. Then She Became a Patient

By lind Feldman

Special to The Washington Post

Tuesday, May 2, 2006; Page HE01

I used to pride myself on my knowledge of the health care system, gleaned from many years of experience as a nurse. When I needed to make personal health decisions, I reviewed medical research and called friends who worked in nursing and medicine. Then I acted with confidence.

That was before my accident last spring.

Entering the house one night after cutting across the wet lawn, I slipped on the ceramic tile. Hearing my femur crack was the beginning of my firsthand education on the acute care health system in my suburban land community.

My initial aims were simple: to fix my femur and end the stabbing pain I felt whenever I tried to move my leg. Two days into my 10-day hospital stay -- five in acute care, five in rehab -- I revised my goals. I emerged from surgery wanting something more basic: to survive the microbes and risks of deep vein thrombosis, the ineptitude of some staff and the malice of others.

Assuming I made it, I wanted one thing more: for others to understand the extent of basic patient-care problems in hospitals today and take steps to make the system address them.

Things started out well enough -- or about as well as anyone with a freshly broken leg could expect. Based on my husband's experience a few months earlier, I knew we'd be headed to the nearest hospital, rather than my hospital of choice. That's the price for calling 911 for emergency medical service. All right, I can deal.

In the emergency room, staff were kind, removing my dress rather than cutting it off. My real problems began after I was moved to the orthopedic unit to await surgery. Moving my right leg or hip brought waves of pain.

That didn't stop a nurse from scolding me for not eating the breakfast placed on a tray beyond my reach. When I said I'd been slated for surgery and told not to eat, she scoffed. " Sweetie, your surgery hasn't even been scheduled. "

A second nurse checked my ID bracelet and told Nurse One she had me mixed up with the bed's previous occupant. Great.

I awoke from surgery, strapped to a wedge between my legs. I vowed not to moan. From years of observation, I know that it is essential to maintain control to avoid upsetting others, especially -- and this may surprise you -- health care workers. But advocating for myself proved difficult.

Earlier a nurse had inserted a Foley catheter to drain urine from the bladder -- something I'd done many times -- without first prepping the area with bactericides. It was over too fast to complain. As I silently predicted, I later developed a urinary tract infection.

I was more vigilant with the pneumatic compression boots that encased my legs up to the knees. For immobile patients, it's important that the fabric boots inflate and deflate regularly to stimulate blood flow and prevent blood clots. I had to ask many times to have the machine properly adjusted. I also had to ask to be repositioned twice a day to prevent bedsores. Student nurses are taught to reposition immobile patients at least every two hours.

No wonder some families contract with independent sitters to help with personal needs and to alert nursing staff to patients' complaints and unexpected reactions. The woman with whom I shared a room had at least four sitters rotating during the five days we shared a room. None had their credentials checked by the hospital, the director of nursing told me later. They could have had communicable diseases, been criminals or been mentally unstable, but since the family of my roommate paid them directly, they were deemed appropriate to be there with her -- and with me.

Some of the sitters were better than others. One hissed " bitch " when I woke her by pressing a call bell for a nurse. Another asked if I would need help when I returned home. Before I could reply, she added, " I work for everyone but Jews. " I said nothing at the time to hospital staff because the sitters were upright and I was flat on my back attached to a catheter, intravenous bags and tubes.

Take Two

The rehab hospital where I was transferred provided good physical therapy to get me walking again. It also had a physician astute at diagnosing the conditions (urinary tract infection, bedsores) I had just acquired, and a number of caring nurse assistants. But here, too, patient affronts lay in store. Among them:

· Faulty equipment One of the fundamentals of nursing is patient safety. Yet staff kept using an automatic blood pressure cuff that malfunctioned. When they couldn't get a correct reading on one squashed arm, the other was put into service.

· Gaps in hygiene Good hygiene is an important part of patient comfort, nurses are taught. It was disappointing when staff refused to provide toilet seat covers for my shared bathroom, where cleanliness was not the best.

· Rush to overmedicate A fill-in physician, whose knowledge of me was limited to a two-minute bedside chat, offered to prescribe medications that were of questionable value and to significantly increase dosages of medications already prescribed. He had no plans to consult with my regular physicians. I declined.

· Short memory The physical therapy staff provided fine service -- for five of the seven days they were supposed to provide it. The other two -- Saturday and Sunday -- they provided it only when I insisted.

· Lack of discretion Hospitals give a lot of lip service to patient confidentiality, posting signs in elevators and cafeterias reminding staff not to talk about patients in public places. The rehab hospital, like the other hospital, distributed literature about privacy policies. Yet, in each of the rooms I shared, physicians conducted confidential patient interviews within my hearing -- in one case, discussing my roommate's history of herpes. There must be offices where physicians and patients can speak privately. If a patient cannot be moved, a noise machine can block sound.

Rx for Change

I returned home relieved and disturbed by my experiences. A hospital stay doesn't have to be so negative. Nurse supervisors need to test regularly on basic skills such as ascertaining a patient's identity and following treatment protocols.

If hospitals were as committed to patient well-being as to the balance sheet, more resources could be devoted to supplies such as bed linens and toilet seat covers, to having more full-time nursing personnel and to reevaluating nurses' skills and providing refresher mini-courses.

All hospitals have quality improvement programs and education departments. The first step in improving care is honesty in recognizing weaknesses. State and voluntary agencies that accredit hospitals can make extra site visits separated in time from the accreditation visit. Medicare can also be diligent in investigating complaints relating to hospital care.

Personally speaking, I am thankful to have been restored to health -- and to have little in the way of lasting complaints from my experience.

Well, okay. My handicapped parking placard has expired and my titanium parts set off buzzers at airports. But that's about it. Thanks to the care I received, I am active and pain-free. I am also, sadly, wiser. ·

lind Feldman is a registered nurse with a doctorate in nursing science. Comments:health@....