Tangles and angles - 50 shades of white

Today was one of those days where I spent the day in bed. I had a shower, got dressed and left the house with no nod towards hair and makeup. When I arrived at work I stripped and donned the gown of no dignity. (Luckily I had a clean out of my underwear drawer yesterday and can vouch for the decency of all my undies.) At the mention of a set of nasal prongs, a sling and a strap on IV, people start to give me funny looks. No, I wasn't filming the sequel to "50 Shades of Grey". I was working as a simulated patient for physiotherapy students today.

I love working with students who are still relatively inexperienced in their profession. It's so interesting to see the problems they encounter and be in a position to give really useful, practical feedback.

It was all about tangles and angles today. My left arm was in a sling after a (simulated) shoulder reconstruction. My right arm had the IV line for my PCA (patient controlled anaesthesia). That was simulated too. No drugs were flowing. Suddenly, a simple action like sitting on the side of the bed becomes a manoeuvre requiring a project manager and a crane booking. Adding to the drama is a very short gown, an educator sitting at the foot of the bed, and sheets that slip and slide and stick to the gown of no dignity. 

"Just swing yourself over and sit on the side of the bed." I hear the instruction and know that even with a simulated post-operative site, I'm not going to ":just swing" myself anywhere. They give detailed instructions about bending my knees, pushing down with my heels and using my right hand to lift and shift towards the edge of the bed. Bending the knees involves giving the educator full view of my nether regions. Lifting and shifting involves all the bed clothes shifting with me. The hospital gown seems intent on moving in the opposite direction to me and soon I am marooned on the very edge of the bed, gasping for air as my windpipe is almost severed by the demon hospital gown. (Who called them "gowns"? They are the least gown like garment I can think of. When I think of a gown, I'm thinking Christian Dior and red carpets, not this white apron masquerading as a functional garment.)

Compounding this is the fact that I'm wearing a sling. I'm then offered another "gown" to cover my back because "we're" going to try walking. They're very focused on the walking, even though it's my shoulder that's had the operation. Obviously, my briefing left out the information that I work as a circus acrobat where I'm regularly walking on my hands. The second gown is tied on the back "like a Superman cape", but of course, is as much like a Superman cape as the first gown is red carpet worthy.

There's a realisation that I've gone one way and my IV and nasal prongs are coming from the other side of the bed. They're also attached to me. We go through a further set of complex movements to reduce the risk that I will be mistaken for a chicken trussed and ready for the oven.

The students were terrific today. They're still at the stage where their thinking processes are slow and deliberate and nothing is really instinctive. I was often left in an unsustainable position while they discussed what needed to happen next.

The one thing I can't simulate is blood pressure and oxygen saturation - it's actually mine they're measuring. My sats were a bit low today - probably because I was holding my breath as I was precariously balanced on the edge of the bed. On the other hand, my blood pressure was a bit higher than usual - again probably because I was being choked by the hospital gown.

Oscar-worthy.
© 2015 divacultura

Angles and tangles seems like an apt description of life as a physiotherapy student.

What did you do today?

Spectacular trip and I'm off to hospital

Regular interaction with the health system is a feature of my working life, but usually I'm a simulated patient, rather than a real one.  Today I experienced the emergency department of one of Melbourne's main hospitals from the perspective of a real patient.

Following my usual routine, I had enjoyed the walk from Flinders Street station to the office South Melbourne.  There's something refreshing about a brisk walk in the cold air.  I arrived at the office just after 9am and entered the foyer.  I took one step, felt my left ankle slip, I corrected and over-balanced the other way, landing on my right knee as I went for a spectacular slide on the ground.  I lay on my face for a moment (elegant!), gathered myself together and sat up.  Several people walked past and then a woman stopped to help me up and ask if I was okay.  It was then a few steps into the office.  I sat in reception, burst into tears and announced that I had just had a fall.  

An icepack was brought immediately and a team of people sprang into action.  I had been able to walk, but bending the knee was causing a nasty twinge at the back/side.  I peeled back my leggings and discovered a nasty bruise and some swelling.  We quickly decided that I should head to an emergency department for xrays and assessment.

I arrived with a work colleague at 10:10am and could immediately see that it was busy.  My colleague joined the queue for me while I sat and waited for the three people ahead of her to be seen by the triage nurse.  She was lovely but had an unusual definition of pace and urgency.  I was thankful that I had someone with me and that I wasn't really, really sick or injured.  Several people in the queue looked terrible and there was no one to go to for help except the slow moving triage nurse.  

After about 30 minutes I made the front of the queue.  I gave my name, date of birth, address and gave a description of what had happened and a rating for the pain.  I was directed to take a seat and wait to be called by the administration clerk.  After a further fifteen minutes, I was seated in front of the administration clerk and asked exactly the same questions again as well as details of my Medicare card and employer.  These two people were sitting a metre from each other and using computers, so it seems incredible that my information hadn't been passed on.  Several times when I was trying to respond to questions, the administration clerk turned to talk to other people or answer the phone.  

Soon a very friendly physiotherapist came to see me.  She did a quick examination and then took me for an xray which was done quickly and I was back on a bed.  It was good news: nothing broken or torn, but some local bruising, likely deep bone bruising and soreness.  I discovered that one part of my knee is very sore to touch normally.  I nearly jumped out of my skin when she pressed somewhere that I hadn't realised was sore.  When she checked the other knee in the same spot I had the same reaction.  Apparently I just have sensitive knees.

Two hours and ten minutes later I was in a taxi on my way home, wearing a sexy compression bandage with a list of instructions for regular application of an ice pack.  

When I came back to the waiting area, there were more people and people who had been there before me were still waiting.  None of them looked happy or comfortable.  All the seats are upright and there wasn't even any way that I could sit with my leg elevated while I was waiting.  

I put my brother down as next of kin and called him to tell him what was going on.  He's a veterinarian and immediately performed a lameness exam over the phone and promptly ordered a full body cast while laughing maniacally.  I started to reconsider my decision to have him as next of kin.  After I had been seen and was waiting for the paperwork to take with me I called him again.  He obviously still thought the whole thing was hilarious and asked me what  he should say if he got a call that said I was unconscious and they needed to know whether or not to amputate.  My response was "wake me up and ask me!"

My final instructions to him were that he wasn't to plug me in or unplug me.  Nothing like a sympathetic little brother to lighten the mood.

A weekend of lying in bed reading or lying on the couch watching TV with hourly trips to the freezer to retrieve the icepack stretches before me.  And I don't have to feel guilty!  I'm pleased that I haven't sustained a serious injury  and can't imagine how much pain I'd be in if I had!

Ouch! When the "care" is missing from healthcare

This year I've been focussing on communication and empathy in health care.  Working with undergraduate students in a range of health care professions, I was heartened and optimistic about their views towards patients/clients and thrilled that they seemed to want to work with patients and their families in an empathetic way.  It was hard to reconcile their attitudes with the studies done by Monash University that show empathy declines during the course of study and falls off a cliff in the first year of work in most health professions.

This week, I've been face to face with the health system in New South Wales and I am completely disheartened and appalled.

My Dad required emergency treatment for a potentially life threatening condition.  He lives in rural NSW near a large regional city and another smaller country town.  He was admitted to hospital in the large regional city, but required a surgical procedure which could only be done at the nearest "tertiary hospital" which is the John Hunter Hospital in Newcastle.  After four days he was transported by air ambulance to Newcastle.  He was treated yesterday and seems to be on the road to recovery.

He's also on the road to nowhere.

We needed to get him back home after his treatment, about four hours or so away by road.  All family members who live nearby are unable to drive and the rest of us live in different states at opposite ends of the country.  We would need assistance to get him home, but were being told by the Doctor he could not travel by bus or train and then by a very cranky nurse that the Doctor didn't know what she was talking about and that of course he'd be fine to travel on the train.  Who should I listen to - the cardiologist or the nurse?

I swung into action, calling my contacts in ambulance and health to find out how to solve this problem.  All the advice I was receiving was that he should be transported home in the non-emergency patient transport provided by the ambulance service.  As a paid up member of the ambulance there would be no cost to him and there would be no cost to the hospital, but a Doctor needed to authorise the booking.

Hospitals are impenetrable.  They are lumbering institutions that require insider knowledge to get what you need and find who you need.  I took a deep breath and called the one number listed on the website.  I was put through to information.  Information put me through to a lovely Doctor who was in the intensive care unit and had not met Dad and knew nothing about his case.  Dad wasn't in the ICU.  I explained the situation to the Doctor and he agreed that suitable transport should be arranged.

No one called me back, so I called again and was put through to the Registered Nurse on Dad's ward. This nurse had the tone and attitude of someone who has forgotten what their job is all about.  She spoke to me like a naughty child, talked over the top of me, was impatient when I asked her to listen to me and dismissive of my concerns for my father.  She said she would talk to the social worker and hung up the phone while I was in the middle of explaining the family situation, including the fact that Dad had no clothes with him, only his pyjamas.

After 20 minutes, I called again.  I asked her why she had hung up on me.  Her response was that she told me she was going to speak to the social worker and she already knew what I was going to say.  Again, her tone was horrible.  I told her that I wanted to have a conversation with someone about my father's situation to get a better resolution than putting him on the train to a town he doesn't live in.  She then argued the point with me about where my father's home is, interrupting me again to confirm with my father where he lives.  As if I don't know where my father resides! I asked her to change her tone and speak to me with some respect and empathy for the situation and she told me that wasn't possible.  Apparently I had offended her when I said she was wrong about where Dad lives.  I asked to speak to someone who was interested in helping us, she said that wasn't possible either.

She then proceeded to shrilly tell me that I shouldn't be concerned.  He'd had his procedure and lots of people have the same procedure and he's fine! What's the big deal?  She said - in the most condescending tone possible - that Dad was sick when he came in and that's why he needed an ambulance.  The hospital had made him better, so he wasn't sick anymore and now he just had to go home.

Here was a blinding lack of empathy for me to confront.  I heard myself echoing something I said in the empathy workshops I facilitated during the year:  "This might be routine for you, but this is the most serious health concern my father has ever had.  It's the first time we've dealt with something like this and it is not routine for us.  I'm a long way away and trying to be supportive and organise everything on the phone from Melbourne, I need your help!"

She then advised me that normally the family would collect a patient.  Just what I needed - judgement.  I'd had no impact at all.  She had become institutionalised and part of a system that obviously sees the people who are meant to be served as an annoying inconvenience.

I asked to speak to the social worker.  "That's not possible," came the reply.

"Why not?"

"She's gone home for the day."

"What's the social worker's name?"

"I can't tell you."

"Why not?"

"I don't know her name."

"How many social workers are there?"

"One."

"And you don't know her name."

"No."

"Not even her first name?"

"No."

If this nurse had been empathetic to our situation she would have just told me that the social worker had gone home for the day and that she wasn't sure of her name but would leave a message for her to call me in the morning.  It didn't need to be that hard.

Even when I explicitly said I wasn't looking for a fight, she expressed frustration that she had become the meat in the sandwich.

"Why? What's the sandwich? Aren't we all working for the same thing?"

"What do you mean?"

"To look after my Dad and make sure he travels home safely."

She had no answer.  She was clearly viewing us as a battle to be fought and won.

It appears that the clinical care has been great.  Hopefully the procedure will make a big difference to Dad's health and well being.  Clinical care is not the whole picture though and I'm surprised at just how lacking the broader care has been.  In regional Australia, in this hospital, it must be common for people to be admitted to a hospital far from home and need to get back to where they came from after they've been treated.  I hate to think of all the other people facing the same dilemmas.  To be a patient subject to the a nurse who is a bully is a significant power imbalance - all at the time when you're trying to recover from surgery.  How can you advocate for yourself in this situation?

I've been researching about the hospital.  Like most big organisations these days they have a statement of rights and responsibilities for patients, including values.  Sadly, there is a big gap between the big statements of values and the lived reality for one patient and his family.

I really hope the awareness of the need for an empathetic approach to care will make a difference in the future.

Now, I'm off to research the complaints process.

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You might like to read this earlier post about empathy.