The View From The Other Side of the Bed
Thanksgiving was a difficult day for me this year. It was filled with the things I am traditionally thankful for: my wife, my family and my health. The family gathered and there was feasting and frivolity, but I didn't get to enjoy it because, in addition to being a day of Thanksgiving, it was also a day of personal tragedy.
At 6:00 a.m. on Thursday my mother-in-law woke us up unable to breathe. She quickly progressed to cardiac arrest. The cardiac arrest was caused by a spontaneous pneumothorax. Once that was treated, regular cardiac rhythm returned, but not before she was in profound coma from hypoxemia. She is currently comatose in a hospital bed in an ICU in a small town in the south. For her privacy, I won't reveal her name or the hospital. I will call her Miss Mary because that is the way the hospital staff addressed her. And I will take a moment or two to comment about my observations about the care she received and the way that care was administered.
Generally speaking people with a health care background are the most critical of their own professions when someone they love is lying in the hospital bed. They look to make sure clinicians wash their hands. They check the charting to ensure ventilator checks are done on time. They ask direct questions. They expect to have direct answers. Let me say, from the outset, that I believe that the majority of people who go into health care go into it with the idea of helping people, and for the most part do a great job. Most do their job competently. Most do it pleasantly. But some go above and beyond.
Take the respiratory therapist who cared for Miss Mary. Every time he approached her and even though she was comatose, before he touched her, he would speak softly to her and say "Miss Mary, I'm just going to listen to your lungs for a minute." He would then do his job, get his readings, and then just as before, he would say "you're doing very well, and I'll be back to see you soon." To him, Miss Mary was not a lump of flesh in a bed, she was a real person. She was someone who had wants and needs. She was someone with a family who loved her. She was someone who had seen and endured much in her life. And even though she was comatose, he talked to her with respect. He understood the concept of patient dignity.
The night-shift nurse, however, was not quite so pleasant even though she was technically very competent. Surely she was angry to be working Thanksgiving night instead of spending it with her family. I'm sure she was annoyed that the evening shift had let us stay in the room a little longer than the visiting policies provided. Maybe she had burnt chicken for dinner, I don't know. But while she gave Dilantin in the central line and then flushed it, she worked silently, neither talking to Miss Mary, or to us. She checked lines, gave meds, and did measurements all without saying a word. It was like she wasn't even aware that Miss Mary was there in the room with us. When she went to check blood sugar, I could bear the cone of silence no more. I told my mother-in-law "you're going to feel a poke in your finger because they're checking your sugar."
The nurse looked at me and said, "She's in a coma!" I nodded, and said, "Yes, but that doesn't mean she doesn't hear you." I got the standard "you don't know what you're saying" look from the nurse who wordlessly charted the numbers and left the room. Miss Mary was a clinical problem. She was the patient in 109. She was the "post-arrest coma" in bed 1. She was a constellation of symptoms, not a human living person. Whether communicated in words or wordlessly through actions, it denotes a lack of respect for the dignity of the patient.
So, today's teaching point, if there is one, is that the one thing that gets more hospitals and nursing facilities sued is treating patients without dignity. It is acting like the patient is a mass of cells laying in the bed, not a human living person. It's the view that the people in the beds are no more than potted plants, and you're delivering the Miracle Gro®. People will tolerate all kinds of errors by well-meaning staff, but they won't tolerate their loved ones being treated like they are not there.
The fact is that every one of us, whether a caregiver, a lawyer, a doctor or a plumber, will one day face the end of our lives, or be in a comatose condition through no fault of our own. If you have burnt toast for breakfast, if you have a fight with your spouse, if you are angry about the election, or your favorite college team's defeat in football, leave it at home! The people who you care for on a daily basis have a right to expect the best of you. That means they have a right to expect that you will do what you are trained to do both with competence and compassion. And while both are important, it is the compassion that is remembered by the patient and family long after the stay in the facility is done.
As I have said many times, people do not sue people they like.