The more things change, the more things stay the same.
Eleven years ago I wrote an article for Medical Economics on a recent hospital stay:
R&R in a hospital? Surely you jest
After major surgery, the author discovered firsthand
why some of his inpatients go downhill.
"Many of my patients over the years have left the hospital in worse condition
than when they were admitted. Now I understand much better why they succumbed to
the "cascade of deterioration."
Recently I had a total hip replacement due to dysplasia. I was told to arrive
at the hospital at 12:01 am on the day of my surgery, to avoid being billed for
an additional hospital day. My wife’s parents came to our house to watch our two
children, both of whom had the flu. My wife and I got to the hospital at 11:45
pm and were told to sit in the emergency room waiting area until called by the
admitting clerk. The ER was packed with people with different ailments, and
periodically a rescue squad would pull up outside. At about 1:15, the clerk
called us, and I got to my room at approximately 1:45.
A nurse met us on the orthopedic floor. He seemed annoyed that it had taken
me almost two hours to get admitted. He completed his paperwork and nursing
physical in about 15 minutes and asked me to stay awake because the lab tech
would be up soon to draw my blood. After that, he said, I could sleep until 5
am, when it would be time for my shave and body scrub in preparation for surgery
at 7:30.
When the lab tech hadn’t arrived by 3:30, I walked to the front nursing desk
and was told the tech would be in as soon as possible. At 5:45, I reminded the
staff that I hadn’t been given a gown, razor, or scrub brush. I was handed these
items and told to take a shower.
At 6:30, the lab tech arrived. She was upset because it was so late and she
was going to have to take my blood down to be tested stat. She didn’t wear
gloves when she drew my blood, but I decided it wasn’t a good time to remind her
about universal precautions.
Minutes later, the OR aide arrived to take me down to pre-op holding. He told
me to give my glasses to my wife, even though I protested that I couldn’t see a
thing without them. He had forgotten to bring a blanket for the transport
stretcher. I was wheeled through the hospital and down the elevator
sleep-deprived, cold, and unable to see.
When I squint, I can focus slightly without my glasses. The woman in the
pre-op holding slot next to me was yelling, cursing, and being restrained while
having an ABG drawn. The man on the other side of me wasn’t responsive and
appeared to have an intracranial pressure monitor in place. I could see how
frightening this could be to other patients.
The surgery went well. Eyeglasses were allowed in the recovery room, and one
of the aides was nice enough to get them for me. I remember how much better I
felt when I could see again. I got up to my room about noon. After a while, I
told my wife I was fine and suggested that she go home to our kids. The man in
the next bed had been operated on the day before. He spent most of the day
snoring. I spent most of my time pumping my feet and squeezing my buttock
muscles. Despite TEDS and Lovenox injections, I was sure I would develop a DVT
without this effort. The same technician as before drew my post-op labs. She
didn’t wear gloves this time, either.
My IV alarm periodically sounded throughout the day. Sometimes it would take
only 15 minutes for the nurse to reset it so the piercing sound would stop. A
nurse came in about 10:30 pm and woke my roommate to see whether he needed
anything to help him sleep. He said he hadn’t slept all day, so she gave him a
sleeping pill. The snoring restarted. Now he had long apneic episodes. Every
time I feared he might be dead, he would let out a loud snort and begin snoring
again.
About two hours later, the night shift nurse came by to take vital signs. She
turned on all the lights in the room, waking my roommate. She asked whether he
needed anything to help him sleep. He said Yes. She gave him another sleeping
pill. Shortly after she left, he resumed snoring, with even longer apneic
spells.
I was able to catch some short naps, interrupted by the IV alarm. In response
to the call button, the nurse would usually yell, "WHAT DO YOU WANT?" She would
turn on all the room lights in order to press the alarm reset button. My nearly
comatose roommate didn’t notice. An overhead announcement was made at 2 am to
let all hospital staff know that the cafeteria would be closing in 15
minutes.
At about 2:30, I was rolled on my side with a foam wedge strapped to my legs.
The nurse said she wanted me on my side for about an hour. I didn’t notice that
the call button was out of reach. The nurse closed the door as she left. For the
next three or four hours, the IV monitor alarm sounded. I couldn’t reach the
reset or call button. The staff couldn’t hear the alarm with the door closed. My
roommate was unresponsive with his double-dose hypnotics. The room started to
seem hot. It was a long night.
At about 6:30 am, the room door opened. The night nurse was getting ready to
leave. She was shocked to find that the room temperature was over 100 degrees
because the thermostat had malfunctioned. She was also annoyed that my IV had
infiltrated. Why hadn’t I called? She didn’t seem concerned that I had spent
four hours, instead of one, rolled on my side.
That morning, three air-conditioning troubleshooters weren’t able to fix the
thermostat. A single room became available, and I moved in. I saw my previous
roommate’s physician making rounds and let him know his patient probably had
sleep apnea. I suggested it might be a good idea to discontinue the sleeping
pills.
The nurse admitting me to the new room realized that I hadn’t voided since
surgery. She said she would be back shortly to in-and-out catheterize me.
Motivated by my memories of patients who had had traumatic in-and-out urinary
catheterizations, I declined and assured her that I would go on my own. My wife
arrived at the same time. After about an hour of concentrating while she made
the bathroom faucet drip, I was able to fill the bedside urinal.
My wife stepped out briefly to get some food. Soon afterward, a nursing aide
arrived, with a big basin of soapy water and a washcloth. . "Good morning! Time
for a bed bath," she chirped, and whipped off my blanket and gown. I told her I
could bathe myself, with a little help from my wife, and she left abruptly. When
my wife got back to the room, I was still lying in bed naked and uncovered.
The physical therapist came in later. It felt great to get up on the walker.
The orthopedic surgeon was making rounds and was happy things were going well. I
let him know I was planning to leave the next day. "None of my patients have
ever left that soon," he commented. I didn’t tell him I thought I’d feel much
safer at home.
That afternoon I started having myalgias, arthralgias, and fever. I was sure
I had the same flu my kids did. I was terrified that my surgeon would call in an
infectious disease colleague, who would then surely send me for a bunch of
X-rays, labs, and cultures. I decided not to let the nursing staff know. My wife
gave me a bottle of acetaminophen that I kept handy and out of sight, and I
chewed on ice chips before the nurse came to take vitals.
That night was one of my longest ever. The nurse covering my room had never
worked on an orthopedic unit. He apologized whenever he turned me in a way that
caused pain. He said he’d never had training or instruction on how to do block
turns with patients with hip replacements. Through the early morning hours, the
smell of everything in my room gave me the sensation that I wanted to throw up.
The sheets, towels, soap, and water all had a distinctive objectionable odor.
At 5 am, I called my wife and told her to pick me up when our kids woke. I
asked the nurse to call the orthopedic surgeon and tell him that "Dr. Sheahan’s
hip is doing great but he has the flu and is going home." When my wife arrived
at 8:30, I felt like the cavalry had arrived. Within an hour, I was home in my
own bed. One of my partners called in a prescription for antiemetics and
analgesics. My rehabilitation went great. At six weeks post-op, my orthopedic
surgeon was happy with the results, and so was I.
Hospitals are short-staffed. Nurses seem to spend more time charting than
doing patient care. Brief clinical assessments often trigger a series of
treatment decisions that may not be in the patient’s best interests. Night shift
workers seem to have little regard for the importance of maintaining patients’
circadian rhythms.
My experience has made me an advocate for outpatient treatment whenever
appropriate. When hospitalization is necessary, I encourage a family member or
friend to stay with the patient as much as possible.
My three-day hospital bill–without the surgeon’s fee–totaled more than
$25,000. You would have thought I was staying at the Ritz."
My wife had a thyroidectomy yesterday for papillary cancer. The surgery should be curative but she's sure hoping to come home today. I stayed with her until about 830 PM last night and she sent the following text early this AM: "Someone in here literally every 20 minutes since you left. Room clean at 130 AM, labs at 230 AM, new psycho roomie at 4 AM."
