A Brief Song From Broadway
Act III- I Need Morphine
While I live and work in New York I don't get much of a chance to get to Broadway. Living in the suburbs and being a surgeon doesn't allow me the hours to take advantage of one of the greatest streets in the world. I recently realized, though, that I never need to go. the reason is that I send my patients to the Recovery Room politically correct- the Post Anesthesia Care Unit. On a brief tangent, if the recovery room is the Post-Anesthesia Care Unit and the Holding area is the Pre-Anesthesia Holding area- what does that make the Operating Room- the Anesthesia Unit" Just a thought.
No matter how much we pride ourselves on sensitivity to patient issues like pain, we all seem to have our breaking points. I think, periodically, an angel is sent down to test our resolve. Invariably there will be a test we fail. Probably daily. But, with resolve, we forge ahead. Wings are heavily overestimated anyway.
So I walked into the PACU about a month ago to a whirling dervish of activity. Every cubicle was filled, doctors and nurses where chatting away, one of the general surgeons was checking Internet information for upcoming rotisserie baseball leagues- all the usual emergency medical stuff you'd expect from a top institution.
After checking my 62,000 junk mail messages on my Blackberry I could not help but hear, through the chaos of the moment, suble 152dB bloodcurdling screams coming from a cubicle that I thought my patient was in. My patient? No way. I love denial.
I walked over to the Medical Demilitarized Zone only to find 3 PACU nurses- hey I just figured out why they are called PACU nurses instead of Recovery Room nurses- they travel in packs. Nothing seems to change from Junior High School.
There on the stretcher was my patient whom I had just drained a blood collection from her hip. She was thrashing back and forth, gesturing with her hand over her forehead, proclaiming massive, intolerable pain. You gotta love the nurses. They actually listened to her and tried to calm her down. Nurses got it all over doctors- they actually have not had the last bits of sensitivity and feeling snuffed out of them as effectively as a surgical internship does. She was already up to 18 mg of IV morphine- enough medicine to stop a Mack truck, an elephant, and a Democratic Judicial Filibuster in Congress all at once. She was screaming, she was panting, she ran through emotions that I didn't even think were in the dictionary. The nurses were concerned.They looked at me- the wise, older (48 years old BTW- don't rub it in- I am getting a bit touchy about this lately) clinician. What words of wisdom would I come up with to help control the situation and maintain the dignity of the nurses, the patient, and ther relationship.
I slowly turned toward this patient, a patient of mine, a former IV drug user and more and put it all together:
"What the hell do you think you are doing? What, do you think we are on- Broadway and you are going for a Tony award? Just stop that thrashing and gesturing and dramatic yelling."
I was actually taken aback by my statement- for about a nano second. She immediately stopped, looked me straight in the eye and quietly said "I am just expecting it would hurt more later so I wanted to get pain medications now." This was really odd. She quietly sat there for the next hour with little to no pain. So why all the drama?
I think there is a huge lack of trust going on in medicine today. Patients don't trust hospitals, hospitals don't trust doctors to be loyal, patients don't trust some of their doctors and so on and so forth. I seems that when anyone wants to make a point they feel it must be extreme. Everyone who waits more than 15 minutes in my office complains they were wating more than 2 years. Doctors complain that insurance companies pay them 3 cents. It is all a poorly produced Broadway show.
The problem is that no one is directing medicine and certainly no one is producing the show anymore. All the worlds IS a stage but unfortunately we are not merely players- we are stooges to the special interest groups who care more about day to day profit than long-term health.
So when the Recovery nurses come up to me and remind me that that was a great line that night about Broadway I remind them that it is unfortunate it even had to be said- no matter how funny it appeared to be. Either way, the show must go on...
Dr. K.
Related Topics: WebMD Survey: The Lies We Tell Our Doctors, Getting the Care You Need
While I live and work in New York I don't get much of a chance to get to Broadway. Living in the suburbs and being a surgeon doesn't allow me the hours to take advantage of one of the greatest streets in the world. I recently realized, though, that I never need to go. the reason is that I send my patients to the Recovery Room politically correct- the Post Anesthesia Care Unit. On a brief tangent, if the recovery room is the Post-Anesthesia Care Unit and the Holding area is the Pre-Anesthesia Holding area- what does that make the Operating Room- the Anesthesia Unit" Just a thought.
No matter how much we pride ourselves on sensitivity to patient issues like pain, we all seem to have our breaking points. I think, periodically, an angel is sent down to test our resolve. Invariably there will be a test we fail. Probably daily. But, with resolve, we forge ahead. Wings are heavily overestimated anyway.
So I walked into the PACU about a month ago to a whirling dervish of activity. Every cubicle was filled, doctors and nurses where chatting away, one of the general surgeons was checking Internet information for upcoming rotisserie baseball leagues- all the usual emergency medical stuff you'd expect from a top institution.
After checking my 62,000 junk mail messages on my Blackberry I could not help but hear, through the chaos of the moment, suble 152dB bloodcurdling screams coming from a cubicle that I thought my patient was in. My patient? No way. I love denial.
I walked over to the Medical Demilitarized Zone only to find 3 PACU nurses- hey I just figured out why they are called PACU nurses instead of Recovery Room nurses- they travel in packs. Nothing seems to change from Junior High School.
There on the stretcher was my patient whom I had just drained a blood collection from her hip. She was thrashing back and forth, gesturing with her hand over her forehead, proclaiming massive, intolerable pain. You gotta love the nurses. They actually listened to her and tried to calm her down. Nurses got it all over doctors- they actually have not had the last bits of sensitivity and feeling snuffed out of them as effectively as a surgical internship does. She was already up to 18 mg of IV morphine- enough medicine to stop a Mack truck, an elephant, and a Democratic Judicial Filibuster in Congress all at once. She was screaming, she was panting, she ran through emotions that I didn't even think were in the dictionary. The nurses were concerned.They looked at me- the wise, older (48 years old BTW- don't rub it in- I am getting a bit touchy about this lately) clinician. What words of wisdom would I come up with to help control the situation and maintain the dignity of the nurses, the patient, and ther relationship.
I slowly turned toward this patient, a patient of mine, a former IV drug user and more and put it all together:
"What the hell do you think you are doing? What, do you think we are on- Broadway and you are going for a Tony award? Just stop that thrashing and gesturing and dramatic yelling."
I was actually taken aback by my statement- for about a nano second. She immediately stopped, looked me straight in the eye and quietly said "I am just expecting it would hurt more later so I wanted to get pain medications now." This was really odd. She quietly sat there for the next hour with little to no pain. So why all the drama?
I think there is a huge lack of trust going on in medicine today. Patients don't trust hospitals, hospitals don't trust doctors to be loyal, patients don't trust some of their doctors and so on and so forth. I seems that when anyone wants to make a point they feel it must be extreme. Everyone who waits more than 15 minutes in my office complains they were wating more than 2 years. Doctors complain that insurance companies pay them 3 cents. It is all a poorly produced Broadway show.
The problem is that no one is directing medicine and certainly no one is producing the show anymore. All the worlds IS a stage but unfortunately we are not merely players- we are stooges to the special interest groups who care more about day to day profit than long-term health.
So when the Recovery nurses come up to me and remind me that that was a great line that night about Broadway I remind them that it is unfortunate it even had to be said- no matter how funny it appeared to be. Either way, the show must go on...
Dr. K.
Related Topics: WebMD Survey: The Lies We Tell Our Doctors, Getting the Care You Need
2 Comments:
I was not only thoroughly shocked by your post but also thoroughly
smart enough to know that it was
all too true. I could write a book
on my experience about my mother's
hospital stay in North Carolina.
She was visiting from out of state
and became ill while visitng me.
I do live in the biggest metro city
in N.C. I will try to make this brief but that won't be easy.
She had been a stable kidney patient who saw her Nephrologist
regularly. Upon visiting, her
kidneys worsened and I immediately
took her to a Nephrologist. Of
course, he made sure that Blue
Cross would cover treatment in
this state. So he made us wait for
another month. Finally, when we
saw him, he informed us that dialysis was necessary. No xplantion, no education, just go
and get a cather put in your neck.
My mother was extremely cautious
and preferred to initiate dialysis
in a "safe" ha ha setting, called
a hospital. I agreed. Big mistake!
The dialysis initiation turned into
a two month nightmare. Dialysis
itself went fine and was well
tolerated by my mother. The nurses
and doctors were like characters
from a horror show. My mother
was blind and the nurses would
come into the room, not identify
themselves and leave her food in
the corner. No mention of feeding
a blind, elderly person. They
refused to turn her in the bed
and she got stage IV bedsores. They
coughed in her face and didn't
wash their hands and she caught
pneumonia twice. They didn't
empty the urine cather and she
got a urine infection. She even
had unknown infections. There
were too many accidents to list.
One day, they left in restrained
in a chair with a food tray locking
her in. The food of course was
unrwrapped and untouched. She
was left this way for four hours.
I found her having a seizure from
a medication. She had torn all
the skin of her arm and heels
from struggling. The nurses reaction, total outrage that I
was mad and complaining about
their underpaid jobs. They laughed
as they put my mother back in bed.
They said they needed Advil from
the stress my mother had created.
When I filed a formal complaint
with the hospital, my mother
was found lying on the floor
crying for help for two hours.
The last ultimate crime for these
people called nurses and doctors
was my mom's final day of life.
Her main doctor was on vacation and
his thirty year old replacement
was playing doctor. He does dialysis on my mom three days in
a row and then decides that she
needs, palliative care. I didn't
even know what that was. he
transfers her to critical care
and gives orders that palliative
care may be needed. Domino effect?
The nurses and doctors follow this
note. They don't give the heart
medicine or any medicine that last
day. My mother tells me her last
words and they are that the doctors
don't want her to live and she
will die. Little did I know that
she must have overheard them.
Sure enough, several hours later,
the nurse leaves early and there
is not nurse for two hours. The
heart monitor goes off. Nothing
is done for two hours. When the
next shift comes in, they take two
hours to get a hold of the cardiolgist. By the time, he gives
orders for heart medicine, she
is in cardiac arrest. They call
me and tell me that they didn't
know if they should resusitate.
Evidently, they didn't. There
was no DNR. I had told the doctor
that a full code applied in every
situation per my mother's instructions. The doctors didn't
even know that she had died and
didn't know why. Their voices
quivered when I angrily called hem. No explanation, nothing.
This nightmare of cruelty, mistreatment and neglect of my
elderly mother haunts me daily.
I am so disillusioned knowing that
we live in a society of sick
I believe that I know all this
because I was at the hospital
every single day and witnessed it
all. My complaints brought no
results. This happened almost
two years ago and I am still
struggling with it. No peace
for our family knowing that our
mother was made to suffer because
of indifference. I will never
understand it and I now have
a huge fear of people in the medical field. If I even see a
nurse in public, I have a panic
attack. So how will I ever be
able to go near a doctor or nurse
for treatment? Your post confirmed
my biggest fears. The hospital and
staff are just one big drama from
Broadway! But if someone took the
time to realize the impact they
have on people. I am psychologically scarred for life.
There needs to be a big wake-up
call for medical staffs! Go
back to bedside manner 101
I regretfully understand each and every word shared about the dialysis patient. My mother was treated horribly during her 19 month treatment, and when I complained, the abuse became worse. This poor woman weighed 113 pounds and was continually told she was too fat. In time, she was terrified to put a single bite of food in her mouth for fear of being scolded and punished for her weight. She also suffered with osteoporosis and died after being released from the hospital as a nurse refused to let the ambulance drivers touch her on 'their' property. She attempted to single-handedly lift my mother from her bed, and dropped her to the floor. Her ribs were crushed into her lungs, each breath became a gasping struggle for air. This lasted 3 1/2 days until her merciful death. Now my father is on home dialysis, which is no better now that he must be in a nursing home because of a stroke. All dialysis providers are obsessed with being in total control. You can sneeze without their permission and their hand out. This combined with the substandard care he is forced to endure, because of the refusal of most nursing homes to accept dialysis patients makes for a terrifying situation, for both the patient and the family. I try to make the 100 mile trip to visit my father twice a week, but I shudder sometimes when the horrible thoughts of what he may be enduring on those days when I am away flood my mind. I have been dealing with feelings of failure and guilt, fearing I have signed my own fathers death decree.
My heart goes out to anyone facing this same diagnosis and their families. As for myself, a 50+ woman with a family of 4 dialysis patients, I have explained to my physicians that if I should ever be facing 'the machine', they had better find me a kidney or just buy me a coffin, because I will never be hooked up to one.
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