Six Nights in Hospital

 The health issue I referred to in my previous blog eventually led me top the right specialist. He spotted possible root causes of concern and referred me to the emergency room as the quickest place to get necessary scans. So last Thursday morning I got up and drove to our local high quality teaching hospital. I emerged only seven days later, having been sent for four CT scans, an MRI and a surgical biopsy. Now I have to be patient while awaiting the biopsy findings – the range is a large one.

 

I suppose we should all be prepared for the sort of life changing shock that my wife and I have just endured together. After all, it can happen to any opf us at any time. There are many outcomes which can be more positive, but I suppose that last week my healthy life expectancy went down by quite a few years. Ideally I would have had prior discussions with my wife about morbid items like living wills and mundane matters like where to find the everyday financial papers needed to operate and what my computer passwords are. Heck, I never bothered completing an organ donor form, and I suppose it was hardly helpful to ask for one during pre-surgery preparation (they could not get it done).

 

We should do all this, but is it a very human thing to do? Before we were married, I raised the option of a pre-nup agreement, and my wife hit the ceiling. I was trying to help her to be well covered in case of a contingency, but of course it was interpreted as a lack of commitment. We all find such things difficult, and many of us can become suspicious and even superstitious. I don’t really blme myself for being unprepared, but it would have saved me some serious unpleasantness in the days before the surgery when I tried to play catch up at a time of extreme emotional vulnerability. I suppose there are some useful tips online, but how many of us really want to go there?

 

The hospital experience was intense and revealing. We all know that the US healthcare system has clinical strengths but is woefully wasteful. In this emergency environment I saw the strengths, and plenty of human competence and empathy, and I did not witness too much waste either, although I could certainly see the benefits of being a medical device manufacturer servicing the US.

 

I had eight different rooms during my stay. Mercifully each of them had a bed, but some had little more than that. I started in a post-triage room in emergency, with two of us cramped into too small a space. My buddy had his wife with him, and they were not acting well as a team under pressure. After a few hours they found me a solo cubicle in emergency, still loud and chaotic but at least spacious enough to receive a litany of scary news and suffer tearful incidents with some degree of privacy. They soon admitted me to the main hospital, but I was told I had to wait for an available bed.

 

I had the MRI during the night and was returned to my cubicle, but no doubt they faced pressure from more urgent cases so at 5AM they moved me to another section of the emergency room, a sort of waiting area for hospital admission. This one was shared and even more crowded. Every time my buddy or I needed some treatment or test, the poor nurses had to move one bed right into the corner of the space so they could do what they needed to do.

 

Mid morning, I expect the next stage involved frantic negotiation between overcrowded emergency and the main hospital trying to stick to its policies. The hospital relented, and I ended up spending several hours in an alcove on their ward before finally getting a shared room that evening. The next evening, pointing out that my bed was defective earned me the reward of a private room, which actually proved serendipitous for the hospital staff too, for my buddy in the shared room tested covid positive and all sorts of isolation protocols kicked in. A day later, no doubt it was these that led them to move me to yet another shared room, where I stayed until discharge, though much of the intervening time was spent in the peace of the surgical recovery ward.

 

Sadly the same impermanence extends to the staffing. I must have met over 200 staff members while in hospital. Most of them I met only once. Most of the rest I only met during a single shift. Only a handful really got to know me at all., and I must have explained the same story at least fifty times. This cannot be good for patients and must also work against job satisfaction for the staff.

 

Perhaps there is no good alternative. They seem to operate with a matrix structure. A few leaders are responsible for a ward. A single resident doctor has a holistic role for a patient, and, within each shift, the same applies to a nurse. But most people are functional specialists, turning up to do their thing and then disappearing. The junior ones pay respect to the ward and patient leaders, but the senior ones seem to just do as they wish, no doubt valuing their own time as the most precious commodity. Hence, the resident doctor is somewhat constrained from doing the job well: they are often chasing information, and reduced to offering platitudes to the patient. Like many matrix systems, it probably looked great to those who designed it, but it struggles when confronted with reality.

 

Each of the areas where I spent time had their own cultures, no doubt heavily influenced by their leadership. In the emergency area, pace and adaptability were key, getting things done the mantra, neatness, some protocols and even courtesy sometimes sacrificed. Patients and (it seemed, especially) their relatives, are desperate and often thoughtless towards staff, and staff have to be thick-skinned to cope under such stress. Fair play to them.

 

The post-operation setting was completely different. Hear precision and consistency are key. They have the space, time, equipment and staff to do as they need, and they jealously guard them all. In this environment the smallest mistake can have major consequences, so they make sure they don’t make such mistakes. Again, fair play to them.

 

The ward lies in between these extremes. They aim for the peace and precision of post-op, but my ward at least felt closer to the emergency atmosphere, such was the pace of activity, the lack of space and staff, and the sheer number of people passing through. The losers are the staff and the patients.

 

One example is the routine at the start of the day. The day shift comes on at 7am and is immediately drowned in familiarisation, an introduction round, crises, paperwork, discharging, preparing procedures, and even breakfast trays. As a consequence, the night shift are asked to complete a full round before leaving, dealing with blood work, vital signs, medications and anything else that is routine. How do they achieve this? By starting at 5am! The night is short for the patients, despite sleep being so important. I noticed that most of my emotional progress came when emerging from a decent spell of sleep, but these were rare. Add in the inevitable visits during the night for me and my roomy and the constant background noise of medical devices, and it is no wonder that sleeping is tough.

 

Patients have a neat remote control unit with a single button to call for assistance. The problem is that all the staff are always busy and they have to judge the seriousness of the calls, which of course can range from a request to find a channel on the TV to an urgent medical crisis. I tried to minimise my calls, but when I needed a pee somebody did have to unhook my medical devices. Sometimes it took fifteen minutes for someone to arrive, which is surely dangerous in some situations.

 

Even so, most ward staff were wonderful, so fair play to them too. I felt that the most serious flaws come in the area of patient communication, which was haphazard and sometimes rather thoughtless, especially from the senior visitors. I felt that one junior neurosurgeon in particular could hardly wait to operate on me!

 

The hospital no doubt produces feelgood marketing material showcasing their diverse staff, and indeed the staff is highly diverse, but unfortunately also highly stratified by hierarchy. I saw nobody except African-Americans fulfilling roles such as emptying bins or cleaning rooms, and few African Americans doing anything else beyond a few on graveyard nursing shifts. I noticed a particular cadre, mainly mature white long-islanders, who seemed to have relative sinecures, perhaps MRI operators being an example. And the senior medical teams are very homogenous and rather masculine, though some Asians are starting to be included. I have no evidence that any of this is a result of prejudice, but I find it a sad reflection of the society we live in.

 

I did not realise this was going to be such a long blog, and I did not even start to cover the emotional aspect. So that is good material for next week.