The nurse enters my room. It’s the hourly check up on my vitals, wound dressings, pin care for the external fixator and, of course, taking a peek at the dreaded Foley. This is typically uncomfortable enough, but this time my parents and a few of my high school buds are here for a visit. I am working hard to remind these people I’m still “me” despite the horrible injuries, so these normal, but still invasive procedures are working against me. Not only do I want to refuse the usual care at this moment, but lifting my robe to show the nurse the catheter is beyond humiliating. Granted, I shared the locker room with these guys just months ago when we were all playing varsity football together, but no one wants to be exposed, much less when there are tubes and tape everywhere. The audience just makes this so much more dehumanizing.
My friends are all seated to the left of my hospital bed. The right side, however, is as wide open as the plains of Texas. Yet, the nurse comes around the foot of my bed to position herself on the left. Her back is to my family and blocks their view of me from the abdomen to the thighs.
“Can I borrow one of these?” she asks, giving a quick tug on one of the unused pillows scattered around my bed. When I answer in the affirmative, she takes the pillow and lays it on its side at the edge of the bed, adjacent to her body. The pillow now acts as a makeshift privacy curtain. Between her body and the pillow, everyone is spared the embarrassment of exposing my body – especially me. And my family and friends aren’t forced to leave the room. The nurse has just gained a HUGE amount of respect from her injured patient for helping me retain some degree of dignity.
Vanity is so often lost in a hospital. People who are adamant about showering and shaving every day don’t have that luxury while they’re a patient. Designer clothes are traded for ugly hospital gowns. Hair gel? Moisturizer? Perfume? Not in the hospital!
Yet, these differences between the hospital and the outside world are usually tolerable. Being forced to expose oneself is totally, TOTALLY out of the ordinary. It’s not so bad when the exposure is to a health care professional, but in front of family and friends? Could anything be more humiliating – especially for a teenager?
My nurse knew this. She used what she had; her own body, a pillow and, now that I think of it, the bedside table, too. These all formed a protective visual guard between my nudity and my visitors. That way, the nurse could still “get ‘er done” while helping me retain privacy AND not inconveniencing my friends.
When treating the “embarrassing” areas, you may need to practice some ingenuity. What do you have that can protect your patient’s dignity and privacy? Your body? Pillows? Blankets? – anything that can be a blockade between the visitor’s eyes and the patient’s body. Or maybe distract the visitors by pointing at something out the window or asking about something they just aired on the TV. Don’t forget to get your patients input on when the best time to ask visitors to leave. It’s perfect to play the “bad guy” to protect the patient’s wishes and dignity.
Whatever you can do to help guard the privacy of your patient will, in turn, help that patient feel more like a person and less like a patient. And in that way – everyone wins.
Monday, July 28, 2008
Better to Be Safe Than Sorry
How to Avoid Errors in Surgery
By Elizabeth Cohen,
CNN
filed under: Health News
ATLANTA, Georgia (CNN) -- I thought my husband was crazy.
When our 2-year-old daughter had hernia surgery, he insisted on seeing the surgeon minutes before to remind him that the hernia was on her right side, not her left.
The nurses weren't happy; it wasn't protocol to have the surgeon meet with parents immediately before a procedure.
"Maybe this is overkill," I said to my husband. "He knows what side the hernia's on. He's already seen her twice in his office. Plus, we've told the pre-op nurses 10 times it's on the right side."
But experts tell me my husband was right on. Mistakes do happen, no matter how great the surgeon, and it behooves you to help them get it right. Witness these headlines: Minnesota doctors remove the healthy kidney of a cancer patient while leaving the diseased one behind; California doctors remove the appendix of the wrong patient; one of the most experienced surgeons in a Boston, Massachusetts, hospital operates on the wrong side of a patient. All of these mistakes happened in the past year.
Solid numbers are hard to come by, because most states don't require doctors to report surgical errors. To make sure you're not the next victim, you might have to get pushy, like my husband did.
"You need to be that thorn in their side," said Dr. Samuel Seiden, an anesthesiologist who's co-author of a study on surgical errors. "You will catch things. You might also frustrate the nurses, but you have to look out for yourself."
Of course, looking out for yourself can be tough when you're anesthetized. But Seiden and other surgical errors experts say there are steps you can take to lower the chances you'll become the next headline.
1. Check out your doctor and hospital
Specifically, ask your doctor how many times he or she has done this procedure, and compare that with other physicians.
You can check out the hospital by going to HealthGrades or The Leapfrog Group, which rank hospitals by specialty. (For example, you can find good places to get hip surgery in Topeka, Kansas, or to have a baby in New York.) The U.S. Department of Health and Human Services has detailed information about procedures performed at different hospitals.
2. Tell everyone who you are and why you're having surgery.
You may feel like an idiot, but tell all the nurses and doctors your name, your date of birth, and what surgery you're having (for example, "I'm John Smith, I was born 10/21/70, and I'm having arthroscopic surgery on my left knee."). This can help prevent you receiving a surgery intended for someone down the hall. (Of course, if your name really is John Smith, you might want to give your address, too).
3. Make sure your doctor initials your site
The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site before surgery (shown in the group's public service ads, like the one pictured above). Make sure your surgeon -- not somebody else -- does the signing and that it's in the right place.
4. Confirm the surgery site with the surgeon right before the procedure
You may have already told the nurses, but it's the surgeon who's doing the actual cutting, so you need to tell him or her directly, says Dr. James Beaty, past president of the American Academy of Orthopaedic Surgeons.
"You should say, 'I'm not going back to surgery until I see my doctor and we confirm that this is the right site,' " he said.
5. Train someone to be your advocate
Don't just bring a friend or family member to your surgery; train them to advocate for you. You're likely to be anxious and a little addled before the surgery (not to mention asleep during it), so you'll need help.
"Equip them with the information they need," advised Ilene Corina, president of PULSE of New York, a patient advocacy group. For example, your advocate can help you check the initials on the surgical site or help you contact your surgeon.
So, how did my husband know to follow Tip No. 4, before he had the chance to read his lovely wife's column? He says it was just common sense -- and his submarine training. When you give an order in a submarine, the other person repeats it back to you, and then you repeat the order again. In engineering lingo, it's called creating a "closed loop."
Our daughter had a successful surgery, and I'm sure the surgeon would have gotten the correct side even without our involvement. Still, it can't hurt to check.
After checking, as they were wheeling our precious baby into surgery, my husband looked the surgeon in the eye, put his hand on his arm and said, "I know you've done this hundreds of times. But for us, she's our only one."
I'm sure that didn't hurt, either.
To watch the video, go to cnn.com.
By Elizabeth Cohen,
CNN
filed under: Health News
ATLANTA, Georgia (CNN) -- I thought my husband was crazy.
When our 2-year-old daughter had hernia surgery, he insisted on seeing the surgeon minutes before to remind him that the hernia was on her right side, not her left.
The nurses weren't happy; it wasn't protocol to have the surgeon meet with parents immediately before a procedure.
"Maybe this is overkill," I said to my husband. "He knows what side the hernia's on. He's already seen her twice in his office. Plus, we've told the pre-op nurses 10 times it's on the right side."
But experts tell me my husband was right on. Mistakes do happen, no matter how great the surgeon, and it behooves you to help them get it right. Witness these headlines: Minnesota doctors remove the healthy kidney of a cancer patient while leaving the diseased one behind; California doctors remove the appendix of the wrong patient; one of the most experienced surgeons in a Boston, Massachusetts, hospital operates on the wrong side of a patient. All of these mistakes happened in the past year.
Solid numbers are hard to come by, because most states don't require doctors to report surgical errors. To make sure you're not the next victim, you might have to get pushy, like my husband did.
"You need to be that thorn in their side," said Dr. Samuel Seiden, an anesthesiologist who's co-author of a study on surgical errors. "You will catch things. You might also frustrate the nurses, but you have to look out for yourself."
Of course, looking out for yourself can be tough when you're anesthetized. But Seiden and other surgical errors experts say there are steps you can take to lower the chances you'll become the next headline.
1. Check out your doctor and hospital
Specifically, ask your doctor how many times he or she has done this procedure, and compare that with other physicians.
You can check out the hospital by going to HealthGrades or The Leapfrog Group, which rank hospitals by specialty. (For example, you can find good places to get hip surgery in Topeka, Kansas, or to have a baby in New York.) The U.S. Department of Health and Human Services has detailed information about procedures performed at different hospitals.
2. Tell everyone who you are and why you're having surgery.
You may feel like an idiot, but tell all the nurses and doctors your name, your date of birth, and what surgery you're having (for example, "I'm John Smith, I was born 10/21/70, and I'm having arthroscopic surgery on my left knee."). This can help prevent you receiving a surgery intended for someone down the hall. (Of course, if your name really is John Smith, you might want to give your address, too).
3. Make sure your doctor initials your site
The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site before surgery (shown in the group's public service ads, like the one pictured above). Make sure your surgeon -- not somebody else -- does the signing and that it's in the right place.
4. Confirm the surgery site with the surgeon right before the procedure
You may have already told the nurses, but it's the surgeon who's doing the actual cutting, so you need to tell him or her directly, says Dr. James Beaty, past president of the American Academy of Orthopaedic Surgeons.
"You should say, 'I'm not going back to surgery until I see my doctor and we confirm that this is the right site,' " he said.
5. Train someone to be your advocate
Don't just bring a friend or family member to your surgery; train them to advocate for you. You're likely to be anxious and a little addled before the surgery (not to mention asleep during it), so you'll need help.
"Equip them with the information they need," advised Ilene Corina, president of PULSE of New York, a patient advocacy group. For example, your advocate can help you check the initials on the surgical site or help you contact your surgeon.
So, how did my husband know to follow Tip No. 4, before he had the chance to read his lovely wife's column? He says it was just common sense -- and his submarine training. When you give an order in a submarine, the other person repeats it back to you, and then you repeat the order again. In engineering lingo, it's called creating a "closed loop."
Our daughter had a successful surgery, and I'm sure the surgeon would have gotten the correct side even without our involvement. Still, it can't hurt to check.
After checking, as they were wheeling our precious baby into surgery, my husband looked the surgeon in the eye, put his hand on his arm and said, "I know you've done this hundreds of times. But for us, she's our only one."
I'm sure that didn't hurt, either.
To watch the video, go to cnn.com.
Thursday, July 24, 2008
What the Doctor Thinks...
There's an article on foxnews.com called "What your doctor is thinking (but would never tell you)"
FOXNews.com - What Your Doctor's Thinking (But Would Never Tell You) - Health News Current Health News Medical News
Ya know, we patients do plenty of complaining about the health care providers we see. Some of it's deserved, some of it is just human nature to complain.
This gives some insight to a doctor's thinking and the challenges he/she faces in their work. I work with health care providers and professionals quite often, but I've never put some of these things together. Like, I've been through unnecessary tests. My initial thought is, "The doc is doing this to earn more money from me and my insurance." Yet, due to lawsuits, one of these docs says he orders unnecessary tests because he simply cannot let anything slip through the cracks for fear of being sued.
So many in the public need the good talking to that some docs want to give. Really, who can blame the docs for their frustration? See a patient two or three times per year for Type 2 diabetes and yet they keep gaining weight? That's gotta make the average doc want to pull his hair out! And how do you bridge that conflict with the patient?
Most doctors, as the article says, take the path of least resistance-tell the patient something kind, supportive and helpful...knowing full well the next time they're in, it'll probably be worse, not better.
What are we to learn from this article? First, that docs are people, too. Second, that patients (yes, us) need to take more responsibility for ourselves. Third, a bit of compassion for the physician who is doing the best he/she can.
(http://www.foxnews.com/story/0,2933,388822,00.html)
FOXNews.com - What Your Doctor's Thinking (But Would Never Tell You) - Health News Current Health News Medical News
Ya know, we patients do plenty of complaining about the health care providers we see. Some of it's deserved, some of it is just human nature to complain.
This gives some insight to a doctor's thinking and the challenges he/she faces in their work. I work with health care providers and professionals quite often, but I've never put some of these things together. Like, I've been through unnecessary tests. My initial thought is, "The doc is doing this to earn more money from me and my insurance." Yet, due to lawsuits, one of these docs says he orders unnecessary tests because he simply cannot let anything slip through the cracks for fear of being sued.
So many in the public need the good talking to that some docs want to give. Really, who can blame the docs for their frustration? See a patient two or three times per year for Type 2 diabetes and yet they keep gaining weight? That's gotta make the average doc want to pull his hair out! And how do you bridge that conflict with the patient?
Most doctors, as the article says, take the path of least resistance-tell the patient something kind, supportive and helpful...knowing full well the next time they're in, it'll probably be worse, not better.
What are we to learn from this article? First, that docs are people, too. Second, that patients (yes, us) need to take more responsibility for ourselves. Third, a bit of compassion for the physician who is doing the best he/she can.
(http://www.foxnews.com/story/0,2933,388822,00.html)
Monday, July 21, 2008
The Best...
Best of CraigsList posting I read this "Best Of CL" post and, if you're anything like me, you'll be wiping away tears at the end. To all health care professionals-Tim here isn't the only one who is eternally grateful. We all are. Every single one of us who has been touched by trauma, everyone who's been afraid and hurting-all of us. And to all the docs, nurses and other health care pros-this is what ALL health care pros need to strive for. To be compassionate, to be a comfort, to provide excellent patient care, no matter who the patient is. Tim, I tip my hat to you for the shouts you give to your caregivers...
---------------
I Really Need To Thank These Strangers
Ok, so people often ask, where are the good kind people anymore?
Driving on Mt.Rose Hwy, and serving our communties is where! So I'm coming home to Reno on my motorcycle Saturday Evening after a short ride up to the
top and back down cuz it was too smokey up there, somewhere around 8pm I think? Anyways... Near the bottom, I hit some oil, gravel, not sure what... but
even as an experienced rider for some 30+ years, made my bike wobble so bad, I eventually lost control after doing everything I could try to do to keep
it up. From what I hear, might have even hit a guard rail at some point during the crash, no memory so not sure, all I do know is next thing I'm on the
pavement in a ton of pain. Rolling in the road I think...
Stranger #1 -
Then, there was a hand... holding mine, comforting me thru my gloves... Kept hearing a voice that I think was female telling me "everything was gonna be
ok" and "help is on the way". Couldn't really open my eyes much, that's why I'm not sure if it was male or female, but it didn't really matter at that
point, ya know? I just know 'till the day I die, I will forever remember how comforting it felt to know that "if" I was gonna die then, someone was gonna
be holding my hand while it happened and I would not die alone on some road tasting asphalt.
You have no idea what that meant to me, still does, and always will. You probably also have no idea how much gratitude I would like to express to you for
the comfort you gave me, a complete stranger, when I really, REALLY needed it. I just remember your hand, rubbing mine and your soft, kind, compassionate
words letting me know, someone cared. You didn't just drive by, you took time out of your Holiday weekend to help me - some fat ass biker guy that some
here on CL wish we would all crash and die.
Stranger #2
No clue who this was either, but someone called police/ambulance, etc. super quick and there they were, hot on the spot within minutes. (felt like minutes
to me anyways, damn quick!), can't thank you enough and damn glad ya had signal...hahaha!
Stranger #3
Again, same as the others, no idea who you were, but I heard someone else say something I think about removing my helmet. In my mind I was thinking please,
please don't do that, but I couldn't say it. But you could and did, you spoke up and advised against it. Damn I am glad there are people like you who know
better and again, my sincere appreciation and grattitude to you as well.
Strangers #4, 5, 6, 7, 8, etc..
To all the police firemen/women, ambulance drivers, person in the back of the ambulance.. to all of you emergency responder type people who showed up who
did whatever it was you had been trained to do, and loaded me on some kind of back board or something I think, and then put my big ol' self in the ambulance
and got me to Renown so quickly - my most humble thanks and appreciation as well. I know you were "just doing your jobs", but damn you do them well! You
will NEVER hear me bitch about your pay raises or what it costs for the absolute QUALITY services you provide our community! I do know of one policeman
or hwy patrolmen who I think arranged to have my bike towed and visited me in the ER letting me know it's condition and where it had been towed to, cuz
he put his badge number on my insurance paper, as I get better in the next few days I would like to find you and thank you in person since I have a clue
on maybe how to find you from the badge #. You also gathered my personal belongings I had on the bike that would have been stolen for sure. (cam corder,
etc..) Yes, I know, small things to worry about in that moment, but you made sure I didn't have to, again, thank you for going out of your way for my needs.
To all the Dr.s, Nurses, and whoever else was working in that ER room, my eternal thanks and grattitude as well. Man I was hurting, them ribs are a bitch
when smashed, but you folks all again, did what you were trained to do in the finest proffesional manner (even on the embarssing stuff) and I just knew
from all your demeanors, I was gonna be ok.
I am sure there are some typos and mis-spellings in this post, forgive me as i am on some pretty strong pills for pain, but i just got to my computer and
wanted to get these thank yous out as soon as possible. All of you people just really have no clue what your kindness and compassion meant, and means to
me even now.I would like to let you all know, that from your kindess, skills and so on... I'm going to be ok. Could have been a lot worse, but thanks to
good people like you, a damn fine helmet and a little luck, both I and the bike are fixable.
If there is any chance of any of you "unknowns" letting me know who you are, I would greatly like to thank you all in person, if that's not your style,
I respect that and just know you meant alot to one hurting, scared guy, yeah... I was scared I'll admitt to it no problem!
Last and not forgotten in any way, once I was admitted to the 3rd floor, all the Nurses, CNA's, Orderlies, people waking me up every few hours to check
my vitals and stuff, I also sincerely thank you, but since I know how to re-find you all, i will be seeing you again in person to thank you properly, especially
Melissa, a nurse or CNA not sure, but one awesome lady I did not have enough time to thank properly today as I left! I really wish I could have stayed
and healed longer as today really ended up hurting, but you know why I had to leave. You friggin ROCK!
Sincerely,
---------------
I Really Need To Thank These Strangers
Ok, so people often ask, where are the good kind people anymore?
Driving on Mt.Rose Hwy, and serving our communties is where! So I'm coming home to Reno on my motorcycle Saturday Evening after a short ride up to the
top and back down cuz it was too smokey up there, somewhere around 8pm I think? Anyways... Near the bottom, I hit some oil, gravel, not sure what... but
even as an experienced rider for some 30+ years, made my bike wobble so bad, I eventually lost control after doing everything I could try to do to keep
it up. From what I hear, might have even hit a guard rail at some point during the crash, no memory so not sure, all I do know is next thing I'm on the
pavement in a ton of pain. Rolling in the road I think...
Stranger #1 -
Then, there was a hand... holding mine, comforting me thru my gloves... Kept hearing a voice that I think was female telling me "everything was gonna be
ok" and "help is on the way". Couldn't really open my eyes much, that's why I'm not sure if it was male or female, but it didn't really matter at that
point, ya know? I just know 'till the day I die, I will forever remember how comforting it felt to know that "if" I was gonna die then, someone was gonna
be holding my hand while it happened and I would not die alone on some road tasting asphalt.
You have no idea what that meant to me, still does, and always will. You probably also have no idea how much gratitude I would like to express to you for
the comfort you gave me, a complete stranger, when I really, REALLY needed it. I just remember your hand, rubbing mine and your soft, kind, compassionate
words letting me know, someone cared. You didn't just drive by, you took time out of your Holiday weekend to help me - some fat ass biker guy that some
here on CL wish we would all crash and die.
Stranger #2
No clue who this was either, but someone called police/ambulance, etc. super quick and there they were, hot on the spot within minutes. (felt like minutes
to me anyways, damn quick!), can't thank you enough and damn glad ya had signal...hahaha!
Stranger #3
Again, same as the others, no idea who you were, but I heard someone else say something I think about removing my helmet. In my mind I was thinking please,
please don't do that, but I couldn't say it. But you could and did, you spoke up and advised against it. Damn I am glad there are people like you who know
better and again, my sincere appreciation and grattitude to you as well.
Strangers #4, 5, 6, 7, 8, etc..
To all the police firemen/women, ambulance drivers, person in the back of the ambulance.. to all of you emergency responder type people who showed up who
did whatever it was you had been trained to do, and loaded me on some kind of back board or something I think, and then put my big ol' self in the ambulance
and got me to Renown so quickly - my most humble thanks and appreciation as well. I know you were "just doing your jobs", but damn you do them well! You
will NEVER hear me bitch about your pay raises or what it costs for the absolute QUALITY services you provide our community! I do know of one policeman
or hwy patrolmen who I think arranged to have my bike towed and visited me in the ER letting me know it's condition and where it had been towed to, cuz
he put his badge number on my insurance paper, as I get better in the next few days I would like to find you and thank you in person since I have a clue
on maybe how to find you from the badge #. You also gathered my personal belongings I had on the bike that would have been stolen for sure. (cam corder,
etc..) Yes, I know, small things to worry about in that moment, but you made sure I didn't have to, again, thank you for going out of your way for my needs.
To all the Dr.s, Nurses, and whoever else was working in that ER room, my eternal thanks and grattitude as well. Man I was hurting, them ribs are a bitch
when smashed, but you folks all again, did what you were trained to do in the finest proffesional manner (even on the embarssing stuff) and I just knew
from all your demeanors, I was gonna be ok.
I am sure there are some typos and mis-spellings in this post, forgive me as i am on some pretty strong pills for pain, but i just got to my computer and
wanted to get these thank yous out as soon as possible. All of you people just really have no clue what your kindness and compassion meant, and means to
me even now.I would like to let you all know, that from your kindess, skills and so on... I'm going to be ok. Could have been a lot worse, but thanks to
good people like you, a damn fine helmet and a little luck, both I and the bike are fixable.
If there is any chance of any of you "unknowns" letting me know who you are, I would greatly like to thank you all in person, if that's not your style,
I respect that and just know you meant alot to one hurting, scared guy, yeah... I was scared I'll admitt to it no problem!
Last and not forgotten in any way, once I was admitted to the 3rd floor, all the Nurses, CNA's, Orderlies, people waking me up every few hours to check
my vitals and stuff, I also sincerely thank you, but since I know how to re-find you all, i will be seeing you again in person to thank you properly, especially
Melissa, a nurse or CNA not sure, but one awesome lady I did not have enough time to thank properly today as I left! I really wish I could have stayed
and healed longer as today really ended up hurting, but you know why I had to leave. You friggin ROCK!
Sincerely,
Tuesday, July 8, 2008
"Citizen Service"
My Uncle Steve has recently had three run-ins with EMS. Nothing life threatening (thank God), but with his current health condition of liver failure, he's terribly weak. Two weeks ago, he sat on the edge of the bed, lost his balance and slipped to the floor. My aunt was unable to lift him to get him back in bed, so they called 911. Five minutes later and without the unnecessary spectacle of lights and sirens, the ambulance arrived. The paramedics lifted Steve back to a sitting position, swung his legs into bed and bid my aunt and uncle a good day. When my aunt asked what she owed them, the ambulance driver simply said, "Citizen assistance, ma'am. No charge for something like this."
A week later, Steve again had an episode of being unable to complete a short walk. With another 50 yards to go to the car, his body simply gave out. He sank a knee to the ground, laid down flat and called 911. The ambulance crew arrived, helped Steve to a gurney and lifted him into the ambulance. A mile later, they were home and brought him into the house and put him to bed. Again, "No charge, ma'am...this is a citizen assistance call."
Folks, this is the sort of thing which renews my faith in humanity. Emergency personnel basically volunteering their time to help out folks who, without their assistance, would be sunk.
I'd like to say a personal thanks to the Lake St. Louis Ambulance and Fire guys for helping out my uncle.
A week later, Steve again had an episode of being unable to complete a short walk. With another 50 yards to go to the car, his body simply gave out. He sank a knee to the ground, laid down flat and called 911. The ambulance crew arrived, helped Steve to a gurney and lifted him into the ambulance. A mile later, they were home and brought him into the house and put him to bed. Again, "No charge, ma'am...this is a citizen assistance call."
Folks, this is the sort of thing which renews my faith in humanity. Emergency personnel basically volunteering their time to help out folks who, without their assistance, would be sunk.
I'd like to say a personal thanks to the Lake St. Louis Ambulance and Fire guys for helping out my uncle.
Thursday, July 3, 2008
Columbia University School of Nursing
Tuesday, July 1, I was honored to be the keynote speaker for the Columbia University School of Nursing. Thanks to all the future Nurse Practitioners who have chosen an incredibly special field!
You guys were a fabulous, FABULOUS audience and I'm humbled by the response I got!
Special thanks to Dr. Norma Hannigan and Dr. Cook for making my appearance possible (and thanks to Norma for an awesome fish & chips lunch, too!) Thanks to all for making my journey to Columbia University so awesome!
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