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COLUMN: A fall from grace gives an inside look at our health care system

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With the combination of a just-mopped floor and bare feet, I managed to land myself in a world of pain, headed for the universe of Healthcare, USA. When my feet went out from under me, I somehow managed to have a four-point landing, breaking my elbow, bruising my tailbone, wrenching my knee, and pulling a muscle under my ribs. At 4:00 the next morning, I was headed to Duluth for a 9:00 surgery with a dear friend chauffeuring me.
Accidents or illness can give you the luxury of time to reflect. Am I being forced to slow down and reflect on what’s going on in my life, to assess my choices, and to consider alternatives? Is some kind of message trying to get through that I’m not getting? It’s not that I can’t think of anything I could or should change in my life. Rather, it’s that there are so many possibilities for change, but which one is knocking me off my feet?
What was very clear to me is that our healthcare system is full of amazing technology, talented and caring people, and procedures to serve a lot of people quite efficiently. However, that same system is riddled with regulations and limitations that make no sense, whatsoever, at least in light of what might be in the best interest of the patients. One glaring example of this is the increasing categorization of surgery as “outpatient” which is what happened in my case. After surgery and post-op recovery, I was taken to the outpatient area where I had started the day. A very kind, competent nurse was in attendance. The surgeon came in for a brief follow-up, and I was given discharge information, while quite fuzzy-minded from anesthesia, pain, and pain medications. I was not pressured to leave quickly, but once that ball is rolling, it seemed like the best thing to do was to get out of there even though I was feeling miserable and off-balance.
The whole process felt brutal compared to the last time I was in the hospital when I did stay overnight. It was less than 24 hours but it made the whole process much easier. After post-op recovery, I had been wheeled to my room, able to sleep, have some dinner, and get a warm blanket when I wanted it. It gave my body and mind some time to adjust to the trauma of the accident and the surgery, both insults to the body, before having to deal with the stimulation of conversations, noise and distractions in the outside world. I later said that my bruised body felt like it had been tied to a car and dragged down the road. The outpatient surgery experience was like being in some kind of hospital cart race with someone else pushing the cart, which then hit a wall, dumping me out into a day I wasn’t ready to navigate and had no way to soften.
I later learned from a nurse who called to follow up that patients can ask to stay overnight, but that was never mentioned as an option. I do understand that the risk of infection in hospitals is very high, so it’s considered a benefit not to have to stay in that environment very long. I do wonder about the deleterious effects of pushing patients out the door, not giving their minds and bodies time to recover at a more humane pace, nor giving their condition professional monitoring for a longer time
 Hip and knee replacements along with many other types of surgeries have become so common that I think we’ve fallen into thinking of surgical intervention as routine, an inconvenience we should recover from quickly, treating our bodies like automobiles with parts that can be replaced easily.
Another jarring aspect of this experience was that many people seemed to be operating on automatic pilot. The nurses in post-op recovery seemed to be quite oblivious to those of us coming out of anesthesia. They were talking loudly across our carts, even across the room, about personal issues like problems with teenagers, shopping, and joking around. None of that is a problem except they seemed to be unaware that their voices are going to seem a lot louder to those of us in recovery. It felt to me like they were shouting. My nurse mentioned they were understaffed. Perhaps that was one way of dealing with the stress of handling more patients, but she was certainly buzzing around on autopilot. At one point she asked the oft-repeated question, “So how’s your pain level?” and then walked away before I answered. At least that made me laugh. I was parched and kept asking for ice chips, which she would bring but never offered or asked if I needed more. The phrase comes to mind, “You only had one job…” Then another nurse was loudly teasing her because I had asked for ice chips from someone who wasn’t “my nurse.”
I do honor and appreciate people who work in the medical field. It’s hard work, which I’m sure is often tedious and boring, and they have to sometimes interact with difficult people, both patients and co-workers. Most of the people I’ve met have been very caring, competent, patient, and present, making those who are not stand out rather glaringly. When someone speaks in a disconnected manner, it is harder to comprehend, absorb, and retain what they’re saying. Those who are truly present with their patients are giving an amazing gift. They are able to listen, to really hear their patients and understand their concerns or areas where there is confusion, and able to give information in an understandable form, resisting the tendency to go on autopilot. Who can calculate the value of that in the healing process? Who can calculate the value of that gift of being truly present in our daily lives with the people around us? I am deeply grateful for the friends who have given me that gift in many forms and helped my healing process.

Comments

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Bill Hansen

So sorry to hear about your accident. I hope you heal quickly.

Wednesday, August 14
Steve Jacobson

Betty, if you want to be coddled then you need to be in ICU otherwise it's a sign of the times. You wanted full attention to you and that's not the way healthcare is run today. The only way is to have more people paying their fare share and less getting "free" healthcare. You think it's bad now just think what it would be like if Bernie got his way.

Thursday, August 15
John Bassing

Betty, I agree with your article and have experienced very similar treatment in a couple of my surgeries over the last twenty years or so. In other surgeries I experienced care that was replete with professionalism and the highest level of technical care. The two are not mutually exclusive and are not tied to any political party. Professionalism includes communicating clearly, being self reflective and consistently modeling responsibility,respect,and advocacy for the patient. It has always meant healing the sick, nurturing the injured and placing others before self. It should exist at all stages of health care wether at an initial exam on through the recovery of the most difficult of surgeries. My mother was taught it in nurses training over 80 years ago as I was taught it 40 years ago and as has my daughter ten years ago. To simple say doing otherwise is a sign of the times is no accurate and diminishes the effort of most people involved in healthcare today.

Wednesday, August 21
Scott Atwater

Betty's experience isn't that difficult to understand. "My nurse mentioned they were understaffed."

Thursday, August 22
John bassing

Understaffed is no excuse for unprofessionalism. The recovery room is a place where untoward events can and do happen. It is a place where conversation should solely concern the comfort, care and condition of the patients period.

Friday, August 23
Scott Atwater

Understaffing is a reason, not an excuse. I'd venture to say that "medicare for all" will only make this problem worse rather than better, as healthcare facilities will be forced to initiate further cost saving (staffing and pay reduction) measures.

Friday, August 23
John bassing

There is no reason or excuse for physicians or nurses to be talking about their families or shopping or anything else in the recovery room. The condition of the patient is the focus. It doesn’t have to do with politics or healthcare systems just one on one professionalism. This is taught from day one in nursing school, medical school and dental school.

Friday, August 23
Scott Atwater

The reality is that when understaffed, this behavior is tolerated. What is the alternative, remove people for unprofessional behavior and burden the remaining staff further?

Friday, August 23
John bassing

If the recovery room nursing staff has the time to discuss shopping, teenagers and joking around they are not directing their attention to the patient. Most hospitals have training on professionalism because they know it yields better outcomes and is important to maintain the public trust. Professionalism is never a burden.

Sunday, August 25