Thursday, January 12, 2012

The patient experience…one’s evidence

The patient experience…one's evidence
Torrey Orton
Jan. 12, 2012
A bit more than 21 grams…??1

From another frontline much like the Fertility Control Clinic one, but more common – the medical frontline where the vast bulk of the patient experience is provided by body movers (orderlies, …) and nurses and food service staff and cleaners…with registered medical practitioners ranging from interns thru registrars to fully fledged doctors and the pack leading consultants far in the distance, and often hard to see even when present (they're moving so fast) and smiling so hard …

…it seemed they all went to the same faux intimacy training programs down to the modulation of lips and expression brightness with smoothly patterned discourses of their respective domains. 'Hi, I'm X and I'll be doing Y for you for the next …hours…minutes"… I was rendered "Torrey" by fiat and minded the presumption, since I know my barber better than I will ever know any of them.

Sure the dependency's different: my barber might on a bad day nick an ear (which he hasn't in 36 years), while the more present life vs. deathness of a faulty organ creates an intimacy which is too close and at the same time massively distant, especially when the actors in the hospital drama had almost no time to know me in any other than the piece of meat sense I had experienced with my first hospitalisation 10 years ago (a pacemaker precipitating one).

"Occluded" IVs
Actually every one moved fast all the time, leaving me with a sense of being in the hands of a system with somewhat less than the optimum capacity to function safely…it felt like it wouldn't be hard for an error to arise. For example, I was on a drip from 4 hours after arrival until an hour before departure five days later…sometimes two different intravenous infusions in tandem… especially post-operative2. The drip monitor signalled persistently under two conditions: one, I had "occluded" the flow at the point of its entry to my body – the cannula – by moving the arm which held it (this time in the crook of my left elbow which meant occlusions abounded for days and nights due to spontaneous arm movements).

In the process of trying to rearrange my troublesome cannulations three efforts by three different nurses failed, largely due, it seemed to me, being overtired, stressed or both. One stopped after three tries saying she'd lost her "mojo". One pretender to the role arrived saying he'd try but call another if he failed. He never started because I told him to go away if he wasn't sure of himself. I guess he was offended; I was already irritated. My release from the irritation (not anger nor pain nor anything like that; I'm relatively impervious to the pricks that presage a cannulation) came from a 60 year old who did it in 32 seconds (the others were under 35, years that is, at a guess). My reverse ageism?

The second condition
But cannulations were more than an irritant. The possibility of a mix up in the drip lines were another matter. Heavy antibiotics prefaced the op by one day and succeeded it for three days. These were sent by IV, in tandem with the permanent fluid input. BUT, the two were chemically incompatible, requiring the shared mainline to be "flushed" with a chemically neutral solution preventing contamination of the one by the other, both before the antibiotic and after. In the flashlight reduced darkness of middle night I had the impression that shift nurses were not always on top of these delicacies, though the fact I'm writing this three weeks after the fact suggests I needn't have worried, but how was I to know then?

These sorts of things are the memorables of my "patient experience" because they occupied my waking and sleeping days for the duration, interrupted by workable, and better, nurse and supporters efforts to minimise their effects. They happened in one of the best private hospitals in Melbourne which I've used before for related matters. My impression of contextual stress was not an artefact of my degraded physical defences.

I spent 4 hours waiting for a first assessment in emergency after entry triage, followed by nearly a whole day on an emergency gurney before transfer to a regular bed. This was not special treatment for me; they were full to the eyebrows. As a full fee private patient I did not get a sole occupancy private room until after the operation, another day plus later. These are system redundancy problems – ones which preoccupations with profit and profitability have removed from the vocabulary and practice of organisational competence in many of our core systems, hospitals among the most important (shortage of retail service staff really doesn't matter in the bigger scheme; it's an irritant without a serious consequence).

Such things do not matter to me a great deal; the double I shared for a day before the op worked fine, though the other guy was having a hard time in recovery from a knee reconstruction. He and I passed on my way out of Intensive Care: he arriving for more serious pain management I guessed and I departing with infection controlled and pacemaker3 unimpeded by the op electricals.

I think there was another move in there but my recollections of the pre-post op period are a little fuzzy. These are, of course, my perceptions. I am a reasonably skilled observer of behaviour, with allowances for memory fudges arising from the tiredness of the gallbladder infection I was carrying and being treated for pre-operatively. I am agile at talking to all kinds of people in all sorts of personal states about how they are finding their life at the moment. Some staff were self-immunized from that level of communication but many were accessible to observations about their apparent pressured work, explicitly confirming my impressions above.

1-As the first major loss of a body part (teeth excluded) in my medical history, my gallbladder excision on Dec. 16th, '11 roused a wonder as to how much I'd lost, prompted a bit by the notion that a soul was a measurable 21 grams of something. Chasing down the bladder weight query went nowhere, though bilious content volume and dimension, on the average, were readily available. Midst the mild disappointment I realised that I'd already compromised the materiality of my spiritual equation by acquiring a pacemaker 9 years ago after a similarly unprovoked attack by nature on my being.
Three weeks later I got the lab assessment of the offending organ. It was rated as "gangrenous" and a day or so off bursting when the op was done.

2- The op itself was a marvel of keyhole work which, among other things, left me fully operational 10 days later and almost undetectably unwounded at three weeks post-op, plus nil internal wound pain. It took about 1.5 hours, extenuated some by the offending bladder having been "the worst we've seen in years" – made their day, so to speak, the backup surgeon opined the morning after. This led to additional infusions focussed on killing possible bugs which might have escaped from the ravaged bladder before the heavy hitters got to it with their extraction tools.

3- One risk associated with the keyhole surgery was that the electrical aspects of the process might disorient the pacemaker's little brain (it didn't). Had it done so, no worries anyway, perhaps. The techy at my most recent end of pacemaker battery life check-up said in reply to my wonder about a power down, "If it stopped now, it wouldn't make any difference to your life." How was I to know?

No comments:

Post a Comment