Notes from the oncology floor

February 23, 2015
lone flower stirling

It’s all about what we notice.

Spend any time on a hospital oncology floor and you notice things.

I’m not sick, but a friend is, and I’m there a lot.  Every day. For hours.

Waiting.

Watching.

Oh yes, I’m watching. I’m no stranger to hospitals or medicine.  I know how things work.

Or don’t work.

That “don’t work” thing? I see a lot of it.

Two_Doctors_Consulting_a_Patients_Chart_Royalty_Free_Clipart_Picture_090504-141400-639009Do doctors get that two heads are better than one?

Doctors seem to operate in silos. They have their specialty and that’s all they will address.  Ask about something not in their wheelhouse and they back away.

The infectious disease doc says “Ask your oncologist, I don’t know.”

The oncologist says “That’s the responsibility of your infectious disease doctor.”

They leave it at “I don’t have an answer.”

It doesn’t seem like they put their heads together in anything resembling a “team” to solve the problem. Collaboratively.

What happened to two heads are better than one?

140724_pp_hipaa_illustration_300x200What exactly does avoiding infection mean?

Sterile precautions are a big deal when a white count is nonexistent. But is it more form than substance?

There’s a small sign on the patient door to check in at the nurse’s station before going in.  It also lists required sterile precaution measures. It’s barely noticeable. No one reads it.

Well-meaning friends walk past the sign to visit and in an abundance of (potentially deadly) compassion touch patient’s hands and face with their ungloved hands.

A nurse comes in and dons gloves.

Or doesn’t, even though a sign on the door  says she should.

She adjusts, the bed, the commode and pushes buttons on monitors. The same bed, commode and buttons others have touched. And then, she touches the patient.  And touches a possible site of infection. After that she goes out and types on the computer at a mobile station. We know how germy keyboards are.

Doctors use the same stethoscope on multiple patients, even those who have no white count. Studies have shown those things harbor bacteria but I never see a doctor sanitizing a scope before or after he uses it.

Just wondering.

stock-illustration-48943564-hospital-bedWhen two beds are better than one

Patient lays in a broken bed for 10 days, one that is extremely uncomfortable, especially when the patient has spent 24 hours straight in it for a week.  Patient complains, family asks about it but no new bed ever appears.

Family asks again and are told “We’re full; we have to wait for a room to empty so we can use that empty bed.”  Family has seen rooms empty and refill for 10 days.

Finally, friend is there early one morning and sees empty bed in room next to patient. She alerts nurse and asks to have that bed for patient.  Nurse is one of the few that won’t act put upon when a request is made and immediately asks nursing assistant to move empty bed out of room before a patient is admitted.

Which is good, as friend was going to get in the bed herself to be sure no one else did.

Within 20 minutes patient has replacement bed. It works fine.

Now, was that so hard? Why didn’t it happen earlier? And without half a dozen requests?

Nursing-Staff-to-get-two-additional-incrementsContinuity is a no-brainer

Every day on every shift there seems to be a new nurse.  On the same shift. Never the same one two consecutive days.  Without nursing continuity day to day,  “report” at shift change can take an hour as the nurse going off duty reports to the nurse coming in. Most patient care comes to a standstill at “report.” Since the nurse coming in is new to the patient, getting a full briefing from scratch eats up time.

Time nurses could be answering call buttons.

Wouldn’t it make sense to assign a shift nurse to a patient for the consecutive days she is on duty? I see the same nurses there every day, they’re just not always assigned to my friend. Why not?

It seems like such a no-brainer.

5845621219_8e4230ecbd_zHelp me Rhonda, help, help me Rhonda

Sign says the hospital encourages families to visit and “help.”

“Help.”  Do we really want to “help?”  Is that our role? Is it even wise? Do we even know what we’re doing?

But signals from call buttons go unanswered for 20 minutes or more.

Friend has a 12-hour private caregiver and it’s a good thing, because families are just not equipped to “help.”

Nurse hands friend an ice pack and says, “Here, put this on her hand.”  Her hand which has a swelling that could be a site of infection.

Friend is not a nurse. Friend is not paid by the hospital.  Friend is not wearing gloves.

Seriously??

“Help” from families is necessary because there are too few nurses and nursing assistants.  The floor is obviously understaffed.

♥      ♥     ♥     ♥

These are just a few of my questions, based on what I’ve noticed.

I have more.

But I thought I’d ask these today.

Thanks for listening.

35 comments on “Notes from the oncology floor
  1. PatU says:

    Medicine is very different from when your father practiced, or when Rich started out. Sad, indeed. For me, the negative changes began with the dawn of “Managed Care,” or Damaged Care, as I prefer to call it.

  2. ryder ziebarth says:

    Sounds like a crappy hospital. I had to do a lot of diligence during Dad’s many visits before he died–and believe me, the front desk nurses hide when they see me striding toward them…but I got things done. Yes, you have to have two people in with the patient at all times, and Danbury has a coordinating doctor assigned to each patient for their “team” with computer notes at the ready. Very helpful. What I found enormously frustrating was the wait to see each specialist–sometimes 8 hours past appointed time. I couldn’t leave the room until they came–they would other wise try to ask my totally incoherent father questions ( ridiculous!). As for C-diff. we were gowned, gloved and masked every time we were in his room, and so were all the staff. Danbury was diligent.Hospice was not around when he died and I wish they had been, all but one nurse was sympathetic and even cried with–only knowing him for 20 minutes before he arrived on the hospice floor. The rest were matter of fact. The attending–a 24 year old– walked in the room and said I am so sorry about “your mother.” The key is staying around, staying on them, and never going without a pen and paper.

  3. Laura says:

    The next time you notice someone coming in and violating the isolation someone not washing/sanitizing appropriately: speak up. It’s possible they are rubbing down the work station outside the door of the room. (that’s what we did because of the strong odor of the wipes we used) The subspecialists do not want to tread on one another’s toes and most medicine and nursing–for that matter–is practiced in a veil of disclaimers. Defensive medicine. I’m not sure why there is a lapse of continuity when it comes to having the same nurse again and again. That’s a basic tenant of patient safety.

    Thank you for watching.

    I’ve found that when people are catastrophically ill the help of the family helps everyone. Family take better care of my patient than I ever could. Often the patient responds best to family. It’s not just another set of hands or pair of eyes because the nurse is too busy and too overworked; it brings a sense of control to the family member watching their loved one waste away from hideous disease; it allows intimacy between the patient and their loved one.

  4. pia says:

    Usually the more obvious family and friends are the better the service. They’re not playing to the patients but the ones who have the most and loudest visitors.

    There’s so much a loving family and friends can’t do–patient doesn’t allow it, beyond the scope or the hospital doesn’t allow it (potential liability)

    If not then a social worker is supposed to be the bridge between the patient, family & friends and hospital staff. Most social workers hate their jobs for several reasons–go to grad school and get licensed to fill out paperwork. Families don’t consider them to be “professionals” and order them around as though they don’t even have a GED

  5. From someone who spends and an inordinate amount of time in hospitals because my white count is also non-existent I have also seen stuff like this many, many times. Because of my blood count when I am in the hospital will not allow anyone to clean the room but him. He did this every single day I was in the hospital for weeks. I’m not allowed to have flowers or pets. It surprises me that close friends or family members that know my situation think the rules don’t apply to them. They would do the same thing march right past the big signs telling them what to do.

  6. You sound like such a wonderful, loving friend Carol,
    I can totally relate to all of your frustrations. I’ve seen them all. But the last time my husband was in the hospital, we actually had a great experience.

  7. Hospitals vary so much in quality of care – maybe your friend is in the wrong place? My father got amazing care at City of Hope, where it’s only about cancer.

  8. Robin says:

    Just spent some time in Boston’s Beth Israel Hospital. Phenomenal nursing care, scrupulous attention to patient safety, nurses assigned to consecutive shift days w same patient, super responsive to calls via a “dispatcher” system. Great staff attitude and I believe certainly led to quicker recovery and shorter stays for both my roommate and me. 5 stars.

  9. My client (I work as a caregiver) was moved to a nursing facility last week. If my company wasn’t here she would be dead. I have spent the entire week biting my tongue, hard.
    This place is the most expensive in our area. I looks nice but the care is non-existent. There seems to be an abundance of Chiefs and a shortage of Indians.
    I could go on and on but…
    It is one year tomorrow that my dear bff passed away. My heart goes out to you Carol, I know how hard it is. #cancersucks!

  10. Diane says:

    I have been so lucky with the care I’ve seen. I stayed with my daughter when she had surgery for a badly-broken back. Fortunately, we didn’t have the restrictions of a low-white cell count to worry about and I was able to be of real help.
    Both of my parents received and receive excellent care. Kind, attentive personnel. I’m beginning to wonder if we live in a bubble . . .

  11. It really is amazing. So many protocols seem like a ‘no-brainer’. On the flip side- have you heard/seen some of the narcissistic requests that come from patients/family/friends? New wall coverings, fresh flowers, candy to not be shared, certain ‘words’ to not be spoken, specific ways to ‘address’ the patients. My sister went ballistic over the color of nail polish on my mother’s nails. Jesus. I think the level of ‘tolerance’ is tough on both sides of the aisle.

  12. we always know when my husband is getting better when he is in the hospital….he starts to tell them how to organize better, and how to be more efficient.

  13. Andi says:

    I am virtually knocking on wood as I have yet to have an extended hospital stay or had any family or friends who have either. I can only imagine the horrors of what it is like.

  14. Carolann says:

    Hospitals scare me. Your post was riveting! I felt like I was standing there with you. I guess it depends on the hospital too. I’ve been in some very good ones.

  15. Lana says:

    I think there are good hospitals out there – but they seem to be in the minority. When my mother had breast cancer, I was so frustrated by the lack of coordinated care and sub par nursing help. But when my grandmother was in the cardiac ICU, it was a completely different scenario. You are a good friend for asking these questions.

  16. Michelle says:

    I’m sorry your friend is sick. 🙁

  17. We saw so many things that shocked us when my dad was in the hospital. Patients need advocates, and everyone needs to speak up when they see something wrong. Healthcare has to improve or we’re going to be in big trouble as the baby boomers age.

  18. Ramya says:

    Carol,
    I havae gone through similar expereince when my dad was fighting with cancer in the hospital. The onco ward gets overwhelming at times.
    Cancer is a tough fight.
    -Ramya

  19. Carol,
    Sorry to hear about your friend’s illness… The medical field has changed so drastically, even during our few short generations…some changes for the good, some not so good… I think this is a universal issue related to so many areas outside of the medical profession…education screams at me… We are currently a culture stretched so thin, making major gains and strides in some areas while letting some of these simpler, yet no less significant tasks fall by the wayside… Something has to give… but for now, I am always grateful for those patients who have the support of friends or family who are there and will “help” out by assisting the patient in whatever capacity they can give…

    Your friend is so lucky to have you…Godspeed…
    Yours in hope, healing, and happiness…
    ~AE

  20. Donna says:

    I will never be convinced I am wrong about the fact that we will all have health insurance but none of us will have health care.

  21. sdf says:

    I pay a visit everyday some sites and sites to read content, but this blog presents feature based
    posts.

  22. Shelly says:

    Just came aross this post and my general feeling is that as more hospitals are beeing built, so many more continue to be unhospitable. Which is really sad, a hospital should be like a home. Where you feel somuch love and hope.

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