Friday, June 29, 2007
I wish I'd had a tape-recorder. I'd have gotten it all and sent a copy to the doctors and the nurses. If I were nasty, I'd have sent it to the hospital administrator...
Having had a number of people close to me in the hospital lately, I've spent plenty of time at the bedside. It leads me to conclude that if every doctor and nurse did the same, without letting on that they were "medical," they'd change their behavior overnight. I was a visitor in a hospital just this morning, in a two person room. The roommate was a nice lady, fresh from surgical repair of a broken leg. A few months ago, she'd had breast cancer. A doctor came to see her: thin, dressed in a crispy thigh-length white coat, dark slacks, academically correct glasses. Medical guy, clearly.
"Hello," he said. "How are you feeling?"
"Hi. I'm ok, I ...."
"I saw your scan. It doesn't show the cancer. Does it hurt when I press here on your liver?"
"That doesn't hurt, but..."
"Are you feeling better than yesterday? Does your liver hurt when I push here?"
"A little, maybe..."
Seriously. That was the exact interaction.
Meanwhile, the lady had called the nurse because her drain had come apart, leaking into her bed. As the nurse checked it out, she noticed what was evidently more than the usual amount of swelling in the lady's leg. "Oh, this is pretty swollen. Is it bigger than yesterday?"
"I don't know. I guess so, looking at it..."
"I'm going to call your doctor." Exits. Returns with another nurse in a couple of minutes. "Does this look swollen to you?"
"Yes, and it feels tight."
Someone sticks her head in the door. "You page Dr Ortho?"
"Yes, I'll get it." Exits, returns in a couple of minutes. "He said not to call him urgently, it scared him. He's coming." Rustling around, passing back and forth in front of me and the person I'm visiting, urgent, but no eye contact our way.
Dr. Ortho shows up in about five minutes. "Let's have a look... You have some bleeding into the muscle. It happens. We cut apart the muscle to fix the bone. And you're on blood thinners. You need to be on them, but when they cause problems, we have to stop them. We'll take out the drain. Try to lie right on the leg. The pressure will help."
"Thank you, Doctor."
"You're welcome. Goodbye."
Nurses return to patient, and talk while changing the bandages: "He acted like it wasn't important, like I didn't need to call him. I think it was important."
"So do I. It's a problem."
"Well he sure acted like it isn't."
No point in listing the issues: I assume they're obvious, and that if the people were to see or hear a playback, they'd feel bad. Nor did I say anything, because I wasn't part of it. Last time I was, I did.
When my dad was admitted for what turns out to have been his final hospitalization a couple of years ago, it was first to a room on the medical floor. (I arrived a few hours after admission, to find him working quite hard to breathe, and asked the nurse how long it'd been since his oxygen level had been checked. "It was fine when he came in, but I'll check again.... 75%. That can't be right...." But that's another story, maybe for another day.) The point was that while we were awaiting the arrival of his physician, some attending came in leading an audience of admirers, consisting of a resident, an intern, and a student. Never acknowledging my mother, who was sitting by my dad with her fear and concern as obvious as if she were on fire, the attending told my dad he was going to listen to his lungs, and did so. No introduction, no preamble. Without another word to my dad, he asked his charges to do the same, which they did, wordlessly, after which he began to talk to them about it as they exited the room. The student turned and (uncomfortable, I'd like to think, at the absence of humanity) said "thank you" as he left. "I'll be right back," I said to my folks, launching from my chair with the fury of righteous indignation thrusting me like a bottle rocket.
"Excuse me, I'm Dr Schwab, and those were my parents," I intruded into the gaggle outside the room, ignoring entirely the attending and looking only at the student. "I've been in practice over twenty-five years, and I've never seen a worse example of how to behave in front of patients and family. I hope you took notes, because it's really important, more important than whatever you heard in my dad's chest. No one introduced himself, no one explained why they were there, what was going on. If you couldn't tell my mother was scared to death, you're all blind. Yet no one acknowledged her at all. No one even turned her way. She didn't exist to those people. That was the most egregious behavior I've ever seen.... and I'm a damn SURGEON!! Maybe you can learn from this -- (still looking at the student and paying no attention to the doctors) -- I'm guessing the rest couldn't care less." As I walked back into the room, I noticed the eyes of a couple of nearby docs aimed in my direction. I don't know what they were thinking.
Docs, nurses, students: when someone you know is in a hospital where you aren't known, make it a point to visit. Watch and listen. It'll be better for you than a dozen sensitivity classes. Way better. Acknowledgment, explanations. Listening. In that first case, about twenty extra words from the docs, and twenty fewer from those nurses would have made all the difference. For all of 'em: empathy. It's all about empathy. The absence is about 90% of what's wrong with medical care. And you know what? I'll say it. I'll take a chance on sounding like a pain in the ass: I know I was never perfect. I don't have the fastest hands nor the deepest knowledge on the planet; I've made mistakes in technique and in judgment. But I always had empathy. I treated my patients as I'd have wanted my parents to have been treated. I never acted like any of those idiots. (Not to patients, anyway.) And I'm still pissed.