Monday, August 25, 2008
WHEN DO YOU COMPLAIN?
No one particularly likes a sponge bath, but at the hospital where I underwent my first five surgeries, they made it as pleasant as possible. There was a sweet smelling foamy basin, a soothing back rub with baby lotion, and if I wanted it, that ultimate luxury: a shampoo. A the end of the process, I felt pampered and refreshed.
Thus, I was shocked when an unsmiling aide I’ll call S. showed up to administer my “bath” at my new hospital (a first class institution.) The curtain surrounding my bed still open, she tossed me a wet face cloth, and ordered: “Wash!” A request that she pull the curtain clearly annoyed her, and when that asked for still more, it put her over the edge.
“Soap?” she repeated, as if it were a new concept in bathing. She shuffled out of the room, shaking her head.
I tried to engage S. in conversation, to somehow remind her we were both human, that I understood she hated her job. I, in fact, wasn’t thrilled with my role either. Couldn’t we maybe just be kind to one another?
But S. answered my questions with a grunt, and refused eye contact. After I used her profferred towel, she disappeared without a word.
When Ted came in, he noticed how shoddy her care was even before I mentioned it. She emptied the contents of the foley catheter on top of the bed, and neglected to wear gloves as she moved from one patient to another. The simplest request was met with a glower.
Still, S. and I might have survived each other if I didn’t develop a problem with my pain pump on my second day. When it ceased working, the pain level was intolerable. I pressed my call light, but that wasn’t working either, and my roommmate was out of the room. When S. ambled into the room with her usual scowl, I was thrilled at the sight of her.
However, when I told her about my pain and asked her to get my nurse, S. continued to go about her business as if she hadn’t heard me. “Use your call light,” she said at last, turning her back.
I explained that it wasn’t working, and S. gave it a hasty look. “Try again,” she said, and again turned her back.
As S. moved in and out of the room, I continued to plead my case: the call light wasn’t working; and my pain was nearly unbearable. Could she PLEASE go to the desk and alert my nurse?
The woman, however, was resolute. “There’s nothing wrong with your call light,” she said, as she begrudingly shuffled through the tasks tasks she clearly abhorred.
When my roommate and her nurse returned, S. slithered out of the room before the nurse saw my distress, and confirmed that the light and pain pump were not functioning. She quickly volunteered to get my nurse--but first, she stormed after S.
Though I didn’t tell anyone what had happened with my callous aide., no one seemed surprised the next day when I requested another caregiver. S. was never assigned to me again.
However, I did encounter her in the hallway--and this time, she was the one eager to make eye contact. Now I’m usually a pretty forgiving person, but I wasn’t about to let a woman who’d knowingly left me in pain for over an hour off the hook so easily. Now it was my turn to look away, to refuse to relieve her anxiety. Obviously, she was worried that a complaint that might lead to her termination.
A couple of days later, Ted and I ran into her in the solarium. My first thought was that she was dogging work again, probably avoiding another patient who needed her care. Again, I refused to look her in the eye.
But as we sat there, for a while, I watched her furtively, a heavy woman in her late fifties with deep cut dark circles under her eyes and swollen feet. She clearly had no business working in health care, but she probably didn’t have a lot of choices either.When Ted looked in her direction, she seized on the opportunity. “Beautiful day out there, isn’t it?”
Then she turned to me with an almost touching temerity, exhibiting the broken-toothed smile she'd denied me before, “And how are you feeling? Better, I hope.”
Cynically, I suspected she was only being friendly because she feared receiving what was probably not her first complaint. Maybe her job was even on the line.
I intended to ignore her, but then I thought of the quote from Plato, which had never felt more true: “Be kind because everyone you meet is fighting a hard battle. I hesitated only a moment before I smiled back. “Yes, a little better every day. Thank you.”
And yet even in my moment of amity, I hadn’t entirely ruled out filing a complaint. Though I wasn’t personally angry with S. anymore, I felt a certain responsibility the the next occupants of my bed. Should anyone else be subjected to this kind of care? Was remaining quiet a kindness, or just another example of my greatest flaw: excessive passivity.
I thought it over for the next two days while I was in the hospital, but neither road felt particularly clear or right. In the end, however, I couldn’t forget my moment of empathy for S. as I watched her in the solarium. I thought of her stubby fingernails with their peeling polish, and her tired eyes. In my mind, I stared down at her swollen ankles, and the shoes that were clearly in need of replacement. I remembered that wily, but somehow heartbroken smile. What would happen to her if she really lost her job? Perhaps, I thought, she’d really learned something from her failure with me. Perhaps she wouldn’t treat the next patient the same way. Given the weaknesses of nature she’d exhibited, that might be unlikely, but given my own, I had no choice but to hold out hope.
I hope you are home soon, Patry. What a hospital war correspondent you've become for some of us.
I work in a hospital. The lab, but still it is in health care.
All hospitals have incident reports that are supposed to fill out when things are done that are against policy.
The common slang is "writing it up."
I don't know if S. was written up by your roommate's nurse for failing to respond to your needs, but she should have.
I hope she did, because as far as I'm concerned this needs to go in front of the Quality Assurance director. That person has to review all of the incident forms and see if there is a way to reduce or eliminate recurrences of similar incidents in the future.
The problem was that you had a malfunctioning call light, and you were unwilling (or unable) to become what is known as "a screamer" to get the attention you needed.
I know that when I have drawn blood from inpatients that they will occasionally ask me for things I cannot provide. Either they need help going to the bathroom or more pain meds, etc. I will either press their call button or will go to the nurses' station and convey the message. It is common courtesy.
S. did not display the professionalism that is required for her job. If she is not up to the task, then she needs to either change her attitude or change professions.
I would suggest that you mention these incidents to one of your nurses that you respect. It might then obligate that nurse to fill out an incident form, but that is up to her (or him) to decide how to proceed with the knowledge you have provided.
S. might be hanging on to her job by a tattered and frayed thread, but if that is the case then she has only herself to blame.
You and every other patient deserve better care than what you described.
More good thoughts coming your way.
Since I had had a terrible experience with a call light after my daughter was born (needing the bathroom at 3:00 a.m. and being unable to go because it had been a high-risk birth and I was still on a mechanical IV that was plugged into the wall -- and then punching the call light for half an hour and getting no response), my sisters and father and I refused to leave my mother alone in her room. We took turns sleeping on slippery fold out chairs at night, and sat with her during the day. It was the only way to ensure she got good care. Not to say that some nurses weren't compassionate, but just that there were enough who hated their job to put my mother at risk of suffering or worse.
No patient should have to suffer needlessly. I love your compassion, but I suspect that aide has a long history of abuse of patients. As others have said, I hope the nurse wrote her up, even if your kind streak prevented you from lodging a formal complaint.
As always, beautiful writing. :-)
lisa: I felt pretty certain that her actions were noticed. That nurse was furious--and as I noted, S. immediately changed her attitude toward me.
l mccabe: I agree with you. This person's shoddy work practices, as well as her lack of compassion, should not be experienced by another patient. I do have a very strong sense that the other nurse "wrote her up." For her sake, I hope she CAN change; and if not, she needs to find a job where the people who are "bothering her" aren't so vulnerable.
marja-leena: Actually, I'm home now, and it is paradise! At times, however, even in a fine hospital with excellent care overall, I DID feel like a war correspondent. (Colleen always finds the right phrase.)
jzr: It's all a matter of balance. Sometimes making a scene is entirely appropriate! Or as someone recently told me: "The nicest patients die first."
jana: I'll make sure to read your blog post.
kevin: You're so right. Cranky bank tellers or waitresses, or clerks might make life less pleasant, but cranky health care is intolerable. I have never appreciated the kind touches, the warm smiles, or the patience of my caregivers more than I did in the hospital. Nor have I ever admired the nursing profession more. Nurses change lives every day. A "bad egg" on the other hand, does a lot of harm.
As far as having no choice but to hold out hope: it's an interesting word, isn't it? I was recently reading a passage in a book that included a dialogue about just that (Bonds Between Women, China Galland). One woman is telling her friend that hope is the wrong word. She says hope is irrelevant, that it's born of denial. "Hope doesn't walk you through the narrows..... the word is grace--or maybe faith." These words really resonated and I think I agree. We can hope a nurse will treat us with care, or hope that pain goes away, or that someone hears us, or that the world is changing for the better. But does that get us through the narrows? We just have to be open to (have faith that) grace will find us and give us what we need. We have to simply wait.
I think S. heard your words even though you didn't say them out loud. I think she appreciated the way you said them. I think she changed. I think you were both graced.
That's what my heart says. My brain says: have the witch fired.
In a health care setting it is so challenging to balance the high tech with high touch. And yet that is what healing is all about.
My mother had been in the CICU for most of the last 5 months of her life. I will never forget the kindness of the unit secretary who brought clementines because she knew my mom craved them. However, when my mom was moved to a hospice bed in the same hospital (before we moved her to Hospice House), we stayed around the clock to see that she was respectfully cared for. I stopped the aides who bathed her roughly and without dignity and without regard to her pain. Health care with dignity is a right rather than a privilege, in my mind.
I had worked with hospitalized kids and their families and this was much of my job.
I am glad you are home. I wish you warm breezes and sunny days.
I think if you ever see her again you should change her day. I wouldn't complain and cost her her job. But I wouldn't accept her taking her miserable life out on you because you represent a job she doesn't like. Maybe if she stopped and enjoyed the people she might learn to like her job.
debra: "It's good luck to be nice--" what a wonderful philosophy, and one I truly believe in. Thanks for sharing the stories about your mom.
aimeepalooza: It's funny that you related it to waitressing, because I did, too. On the one hand, I understood how it felt to be tired and to be annoyed by one more request for water or ketchup. On the other hand, I, like you, felt when I couldn't respond with the good cheer my customers deserved, I shouldn't be in the job anymore. I'm sure you are a blessing to all those you serve.
Whaaaaaaaaaaa??? This is the sort of thing that *kills people*. Hospital acquired infections are a very serious problem. And yes, leaving patients in pain is very bad, too, albeit not deadly. And no, it shouldn't be up to you to police such people and practices, you have more than enough to worry about in healing and recovering.
Sigh. Glad you're home!
Natalie: It seems to be the kind of moral dilemma, for which there is no clear "right" answer. I share your outrage at S's behavior, and in many ways, she deserved to feel and hear that fury. But I couldn't help but pity her--or to wonder what kind of life would produce such heartlessness.
But... then I think... what if she were providing care to a child. Would I be so tolerant? Do I turn a blind eye to someone neglecting/abusing a child?
Then I've had to think... why do I tolerate sub-quality care/customer service than I would expect for someone else?
Despite her struggles, she has agreed to certain professional standards. To be held to those standards are not unkind.
I'm sorry you had to go through that. Thank goodness you are home...after all... there's no place like home!
Imagine the next suffering patient, who is left for hours in pain, unable to move, having a stroke or heart attack. Be kind to them.
geesh..how embarrassing on a writers thread! ;)
there are very few "non-carers" in the medical profession and my experiences have been 99% positive
and - all too often it it those closest to the bottom of the ladder who have shown the most concern
that said - i think plato was right
(who'd have thought mickey mouse had such a smart dog) :)
keep smiling - even at such very old jokes
i was in the hospital 2 years ago unable to swallow from my cancer. A rude nurse kept telling me "not to drink" every day and I was even charged 24.00 a day for liquids and I could not swallow???Amazing but true ..sandy
But, though it's hard to believe in this day and age, there are people out there who cannot respond with compassion because they're never experienced it.
All in all, I think Patry's response, perhaps followed up with a note on the questionnaire, was the perfect one. I think a lot of truth about S is contained in the details as Patry wrote them originally.
floots: Thanks for the smile. 99% of my caregivers have been wonderful, too. It's good to know that most people who choose to work with the sick do it from the best possible motivations. And as I've said, they change lives every day.
sandie: We all come home from the hospital with stories--most of them good. But people remain flawed, and there's always the one...
robin: I only wish you'd been here. Somehow I think you would have straightened her out!
Mary: Unfortunately, it's true. Some people have no compassion in them, and the greatest harm they can do is to rob us of our own. My response, as I said in the post, reflects my own strengths and weaknesses. And though I see Zhoen's point, I also agree with Leslee. Right now I'm pretty overwhelmed with my own recovery, which has not gone well (I've already been sent back to the hospital for an overnight, and may be need to be readmitted tomorrow).
..or like you, they remind us of our own. Hang in there, Patry.
Best regards, Diana
Diana: Thank you so much for taking the time to visit and to share your thoughts. It's always a thrill to know someone I never met has read and enjoyed the book.
annie: You make me smile--a much needed service.
Your ability to find compassion for this person amazes me, and inspires me. I would still question her functioning in that environment with people at their most vulnerable, and possibly severely damaging someone, and also if she actually came to any realizations herself, other than her job being at risk. Then I read your quote from Plato. This is a hard one. All the best to you Patry. Kia kaha.
Rangimarie,
Robb
But I think it's lovely, being able to reach to compassion in such circumstances. (& far more important, ultimately, than whether you complain).
xoxo
when we meet again, you can give me some pointers on gentle kindness to others, and i will give you some on assertive self defense! you know the phrase "too sweet for her own good?" well...
sometimes the result is exactly what we need but don't know how to get it - if she loses her job it might be the thing she most needs in the bigger scheme of things. apparently she is not in the right profession if she has had multiple complaints, enough that one more would terminate her. it could mean that when pushed she might find a job better suited to her needs and certainly that patients would be in safer hands.
i think an official report is certainly reasonable given the circumstances. the next patient could be someone more vulnerable than you. it appears something may have already been done by your roommate's nurse, but you can always speak to the patient advocate's office and ask for advice about how to proceed given your concerns for the well being of the employee as well as for the well being of other patients. i am sure they will advise you appropriately.
dale: I felt angry with S. initially, but that has long dissipated. Dissipated and replaced by hope that she might behave differently in the future. But reading the comments here, thinking of how difficult it is to change our faults even when we want to, and realizing it wasn't one lapse, but many, I ended up mentioning it on my questionnaire.
sky: I've been trying to learn assertive self-defense all my life. To that end, I even took aikido in college--and I do think it helped for a while. Maybe I'll go back to it once I'm ready for the rolling and tumbling again. In the meantime, I look forward to taking a lesson from you!
I am glad to hear that you mentioned these incidents in your questionnaire and that our feedback helped you make up your mind in documenting this substandard care.
You had mentioned your roommate had Mercer. I do not know what that is and did a quick Google search on the topic and found someone else asking about Mercer disease and the answer on that medical bulletin board suggested that they probably meant MRSA. It is sometimes pronounced as Mersa.
I however, still pronounce all the letters of M-R-S-A which is the abbreviation for Methcillin Resistant Staphylococcus Aureus.
If *that* is what your roommate had, let me tell you, that stuff is nasty. Really nasty.
My family a few years ago had what is referred to as Community Acquired MRSA as opposed to becoming infected in the hospital environment. One of my nephews contracted this nasty pathogen and at first it was thought to be a spider bite. It wasn't, and he was not specifically told afterward of the culture results.
It kept recurring for months and he had repeated visits to emergency rooms.
Later his brother and my mother contracted the same organism.
They all had to seek emergency medical attention to debride their wounds. My other nephew wound up using crutches for a week because of a wound on his thigh.
I was pissed when I found out what they had and it was only because I as a clinical laboratory scientist insisted that they get a copy of their culture reports and tell me what it said.
For laboratories an identification of MRSA is a critical result and we must notify a caregiver immediately. If we do not properly document who we spoke to then we can get in trouble if they fail to follow up on the case. It also is reported to the hospital epidemiologist.
Another nasty pathogen that is epidemic in hospitals is Clostridium difficile better known as C. diff. It causes nasty diarrhea and is very contagious.
It is not an option in this day and age to pick and choose whether or not you follow the standards of changing gloves and washing your hands between patients.
It is mandatory.
Be well and stay strong.
Linda
Still, it sounds like S. may be in the wrong profession, especially if she cannot get your broken call button fixed and insists on being mean.
I have heard other stories like this, sadly enough. When people are sick in hospital, they really need to be taken care of! For those people paid to take care of the ill, this has to be one of their top priorities.
I'm sure you weren't the only one S. has been mean to (unfortunately). I'm glad to hear you're home and on the mend.
Sue: I know you would! I still remember how much I admired you when you fought for our taxi. (I'd probably still be standing on that street, waiting...) As far as the youtube video goes, I'd love to see that one!
Hope all these travails end soon with you in good health.
Grrrrrrrrrrrrr!
I was/am horrified by your experience, angered and frightened by it. I am glad you are home "in paradise" and grateful for your beautiful words.
dawn's comment really struck me:
"why do I tolerate sub-quality care/customer service than I would expect for someone else?"
I, and no doubt you, would fight tooth and nail for a child in pain, but when it comes to ourselves, we think of the other person first.
in your situation, though I would probably have screamed or called out if I could, I would also have empathy for 'S'. in fact, after initial anger, the more awful a person is, the more I feel sorry for him.her (often counter-productively).
but then I get to extrapolating --and this is NOT about you, but an effort to understand human nature which you inspire in me.
the essence of humanity is empathy, yet care for the self can be construed as self pity, which one wants to avoid. but when is that denial of self itself a kind of vanity? is pride more powerful than self love? when does one take a stand for the self and when does one put the welfare of others first?
I think of Ghandi, the Dalai Lama, Christ...and the idea that love for others is love for god, or goodness.
and yet, does that leave advocacy for the self entirely to others? is that childish? martyrdom? what if we do not want to be saints?
I have no answers, but these are such important questions, especially in these times, and I thank you for helping me think about them.
all goodness and bliss to you, dear patry.
Have loved reading about your red shoes and seeing your beautiful granddaughters ... and it has to be said, neither you nor your husband look nearly old enough to be grandparents!!!
r: You would have had her head!
Anon: Thanks for sharing your thoughts and your wisdom. I see your point, but an abuse victim usually has an emotional tie with their abuser that makes them return for more. It's not really forgiveness; it's co-dependence, no? My compassion for S. was much more dispassionate. (Though I forgave her, I also requested another aide for the rest of my stay. The knowing look I got in response led me to believe her co-workers were well aware of her conduct.) For me (a shy type who flunked assertiveness training class) that was pretty good! Ideally, I probably should have filed a complaint immediately on behalf of her next "victims", but I was pretty sick myself. At that point, keeping her away from me was all I could handle. In any case, thank you for your thoughtful message--and I agree with you. S. wasn't just negligent; she was cruel!
deborah: I wish you were there!! Thanks for sharing your fire. As I said before, readers ultimately made a difference in how I handled this situation. Whether anything will be done about S. remains to be seen. Since I will be having another surgery in 3 months, and will probably be on the same floor, I'll report back
maryanne: You raise some important questions--the kind that were very much on my mind when I wrote the post. I really believe that I was seeking the wisdom and counsel of the amazing readers of this blog when I wrote the post--and I got it. I also got a wonderfully expanded, thoughtful discussion.
Anonymous and several other commenters really made me think: If it had been one of my children lying in the bed, I would have screamed at S. and made as much noise to her supervisors as I could--and it's unlikely I would have forgiven her. (I'm still angry at the fifth grade son Josh in front of the class twenty years ago--even though he forgot the incident long ago.In that case, I not only reported the teacher to the principal; I wrote letters to every member of the school board.) But that's a mother's instinct. I've never been quite as good at sticking up for myself...
Kay: Thank you! Not only have the blog readers been a source of wise counsel, the love and support has been incredible. Even when my recovery stalls, I feel like the most blessed of women. Thanks, too, for saying we look too young to be grandparents! I used to FEEL too young, too, but lately, I'm feeling more like their great-grandmother. They keep wondering where their energetic playmate has gone.
Whatever you decide, you did what you needed to do at the time. That was your first duty. And I think that writing the post, thinking about the pros and cons of the situation and asking, perhaps indirectly, for the input of others before reaching a final decision (perhaps via the questionnaire) shows your desire to be fair to yourself, other patients and S herself.
In a case like this, with many serious factors to consider, reflecting and taking the time you need is evidence of common sense and wisdom, even. In my book anyway!
*sigh*
But you are like my grandpa, who always said it was better to be as kind as possible...Maybe she was having a horrible day?
:)
amber: Your grandpa sounds like a wonderful person, but S. probably deserved to be yelled at!
I agree with those who said you should even now report her, and here's why:
She is indeed in the wrong job. Not only is she endangering life and causing misery to others, she is clearly unhappy in the job herself. One way to look at is that if you get her fired, she may well end up somewere better - both better for herself and for others.
I agree with those who said you did what you needed to do at the time. I believe that we are all catalysts, that our actions affect others around us in ways we cannot predict or know. What you did then was the right thing at the time. Doesn't mean you can't follow up with a report on that questionnaire.
Lastly, I believe that something vital has been forgotten in the medical world. Nursing care. That doesn't mean just injections and medication and changing dressings, it means care of the patient, body and soul. It means that tender sponge bath, a listening ear, perhaps brushing a patient's hair or providing other small comforts - like the clementines.
Personally, I believe that nursing care is almost as important in recovery as the drugs and the surgeries, and it's tragic that good nursing care is so rare these days. I know the time and money isn't there, but a smile and kind word cost nothing.
Sorry my first post on your blog is so long.
I think it may happen far too eaily and often in health care, that people can grow jaded - they build a sort of wall between them and the people they're supposed to be serving - and no one is served by it, not even the person who built the wall to protect themselves...
You are such a kind, compassionate and merciful soul, Patry - I pray that at least some of the mercy that you showed her, will penetrate through the walls she's built around her, so she can show mercy to others again...
And most of all - I pray you never have to experience such pain again!
I love your Plato quote. It is so easy to fail when life asks much of us. I think perhaps S recognized her cruelty and wanted to make amends ... and to change. Perhaps you gave her the opportunity to do so. I like to think that is what happened.
beryl: I'm not surprised that you see it that way--and when I think back on her cautious smile in the solarium, I think you might be right.
Hugs to you.
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