Writers' Corner ~ When Did Healthcare Get Terminally Ill?

I am an old nurse. Not quite ancient, but old. I have memories of how it used to be and I watched as we became more “High Tech”. Some of these changes looked marvelous at the time. They looked as though they would save valuable time that we could give to the patients who needed it. I was younger and dumber then.

I became a Licensed Practical Nurse because it didn’t take as long as the course for a Registered Nurse. It put me about mid-way up the ladder. There were some things that I wasn’t supposed to do, according to either hospital policy or the state board guidelines. That was fine with me! I didn’t want to start IV’s or give meds through an IV line. I also couldn’t take a verbal order from a doctor. That was OK too. I gave direct care. I could help the RN by doing things like giving enemas, (Now that I wouldn’t have minded skipping.) doing dressing changes, assisting a patient to a chair or help them walk. The person who I could count on for help was the Nurse’s Aide. We did the direct patient care and did all we could to keep them comfortable. There were things that the NA wasn’t allowed to do, but we were. Trust me when I tell you it wasn’t because they didn’t know how to do them, they weren’t supposed to. If they had given a dollar bonus to every Aide who taught a nurse how to do something, they would run the world!

I remember taking vital signs with equipment that would now be considered antiques. The temperature was taken with the old glass thermometers. We would go along, room by room , plugging in the glass thermometers into the willing mouths. They were supposed to stay in, under the tongue, for about 3-5 minutes. When you had about 16 patients, (This was the 3PM-11PM shift, where you had less nurses to patients because nothing ever happened after 3PM, HAH!) And not all of your patients were able to keep a thermometer in their mouths for any time at all… It could take a good while. I used to love going into a patient’s room and finding them on the phone while they held the thermometer in the air. I always nicely suggested I take a rectal temp on them so they could continue the conversation. They would hang up. 4PM vitals could take until 6PM. If you were lucky, (rarely) you got the temps done before the dinner trays came. There were times when your patient drank the hot cup of tea and then replaced the thermometer in their mouth. This usually resulted in the doctor being called to let them know the patient was running a high temp and might need a chest x-ray or blood cultures or antibiotics or God knows what else! It was check and double check and triple check. And then they invented the Electronic Thermometer! And it was good! It took only 30 seconds under the tongue to register and you stayed right there while it worked. BINGO!! A lot less needless tests, pissed off doctors and puzzled patients. Another good feature was that there were individual plastic covers that fit over the probe that were discarded after each use. During the era of glass ones, I remember finding that there were no rectal ones available,(They had a short, rounded end.) but someone on day shift had managed to record all the temps! There were 5 or 6 patients that had to have a rectal temp done and I didn’t want to even guess! We managed to get more rectal thermometers for our shift so the night shift wouldn’t bring this to anyone’s attention. We didn’t blow the whistle on the day shift because there were no big issues with any of the patients. Besides, the day shift had the head nurse and would always make it look like it was something we could be blamed for. If you think that cops stick together when it’s a problem with one of ‘their own’? They must have learned it from nurses.

Blood Pressure Follies

The hospital I worked in had a blood pressure cuff mounted on the wall between the two beds in each room. It looked so, so,--- MEDICAL! Most of them didn’t work but they were really decorative. We had a sphygmomanometer, (blood pressure machine) that was on wheels and you rolled it from room to room. Stethoscopes were not easy to find so the first thing you learned was to buy your own and guard it like it was your virginity, (Bad analogy). You wore it around your neck at all times. If one of the doctors needed it, he would lift it from your neck and unless you followed him around and grabbed it back, it would disappear. If I had added up how much I spent over the years on replacing ‘borrowed’ stethoscopes, I would find it was cheaper to go to medical school and then never have to buy my own equipment again! When they started to make them in colors almost all of us bought pink ones. Not that it even slowed them down, but you would know it wasn’t theirs they were sporting. And then came the advent of the Electronic BP machine,,,, Progress!
When they first came out, it was with the idea that a patient , at home, who had to keep a close eye on their pressure could put this one on and press the right buttons,,, VOILA! It would give you the reading and even your pulse rate. You didn’t need a stethoscope and it was small enough to be portable without fuss. The first time I saw one, I was working as a Paramedical Examiner. That sounds very important doesn’t it? If people applied for Life insurance, the company wanted to make sure they lived long enough to pay a few premiums. I would fill out a form after asking many questions about a medical history and I would take a BP and a pulse. I had my own BP cuff which had an analog dial and was easy to use. I had a stethoscope and there were no doctors to steal, ooopppsss! I mean Borrow it. I took this magic machine and read the instructions. I read them many times to make sure I had it figured out. What I did was take a BP the ‘old’ way and then put the magic machine on to see what it would get. The instructions did say that for the time the cuff was operating, the arm had to be held completely still. Stone still. Don’t even twitch a finger, still. It took about one minute to do the job and if they even thought about twitching, the reading you would get would not match the one taken the ‘old’ way. I did this for about a month or six weeks. I knew inside of a week that this was not the medical marvel it purported to be. There were some machines in drug stores that did the same thing. My friend Jackie and I had tried them out once. We both knew where our blood pressures ranged so we could tell how close to accurate it was. When that cuff inflates it feels like a Boa Constrictor with an anger management problem. When you do it the ‘old’ way, you can hear when the blood flow is stopped, you might go a few marks up and then release the pressure to listen for the beats that indicate what the pressure is. This thing grabbed your upper arm with gusto and you would watch your hand and lower arm turn purple before it would deflate. Pain can and does increase blood pressure. The drugstore machine showed us that we should just go and call an ambulance. I wondered, at the time, if a doctor had invented it, one who specialized in treating hypertension.
They are now using them in hospitals. I can only hope that they have improved the thing. If you are comatose and not even twitching, it should be working fine!
Hello? Is anybody out there?
Before ‘electronics’ invaded the space of the human nurse and others, the most important sensors were your eyes, ears, fingers, and nose. A lot of medical people develop a “Sixth Sense”. You can walk by a patient’s room fifty times and everything is just peachy. As you approach for the fifty-first time, that sense goes off. You go in and look ……….OH NO! If things go as they do, you will find something that will require a lot of time and attention. I think that medical people were descended from a tribe of Gypsy Fortune Tellers. You don’t know why, you just know.
In the course of a normal shift you had to keep a close eye on things like IV bags. They were timed to run at a specific rate and you needed to ‘eyeball’ them….A LOT! They run by gravity and sometimes they run by whimsy. A patient could have a bag of IV fluid due to run in for exactly, (Well, CLOSE to) ten hours. It has been going like a clock for the past eight hours and you are congratulating yourself on your skill. When you go in to take that last look so you can record how much went in and how much is left for the next shift, Get Ready now,,, BONE DRY! It should have run until 1 AM and here it is only 10:30 PM and it’s gone! When it was regulated in the beginning, the patient was sitting up and wide awake. The drip rate was timed with him in that position. He remained in the same position until about 9:50PM and then he laid down and moved his arms while he went to sleep. As soon as his position changed, so did the drip rate. The minute you left the room after checking it, it started running like a faucet, leading you to this!
Depending on his condition and what the IV was running for, you had to make a choice. If it was a nothing special IV, just running to have someplace to be… OK. All you had to do was hang a new bag and re-time it so he would get the proper amount in the course of 24 hours. If your luck was holding, it hadn’t plugged and wouldn’t need to be restarted. I won’t even go into some of the other scenarios. Most nurses and other medical people can see in the dark better than owls and bats. Let’s invent something to stop having this sort of thing happen! Lo and Behold, The Electronic IV pump! This machine is going to be a miracle! No more off-time IV’s! The bag now hangs above this magic box-like structure and the tubing is threaded into some sort of maze in the box. There are so many different types I won’t even try to name them. There is a sensor that counts the drops and you set the rate for whatever is needed. If it is set for 20 drops a minute, that’s what it runs at! UNLESS…… Some times stuff happens. The patient shifted in the bed and doesn’t know that he is now laying on his IV line. He’s watching Judge Judy and has no clue. The supernatural IV pump now sees that something is keeping the required number of drops from going through the line? An Alarm goes off. Sometimes a gentle chiming, sometimes it sounds like an air raid. When they first started using the pump, it was used for special IV solutions that had to be run in at an exact rate. Heparin is the one I remember. It was a medication used to prevent blood clots. Too quick, you had a problem with bleeding. Too slow and you had a problem with clotting. Either way, you had a problem! When you heard that “Bing-Bong” noise, you hopped to it and fixed the problem as fast as you could. Nowadays, every IV is on a pump and there are so many “Beeps” and “Bongs” and “Bings” from every patient room it sounds like Mardi Gras. A lot of the pumps are so sensitive they will alarm if the patient passed gas. A slight movement is enough to get them going. Sometimes it is a BIG problem, other times it’s the patient changing the TV channel. You know about the boy who cried wolf? All the time with the ‘Bings’ and the ‘Bongs’ and the ‘Beeps’? There should be a squad of nurses on skateboards just to respond. As far as I know? There isn’t. They may be in the process of cloning them but the research has been compromised. They’re trying to use humans.

The Great American Novel, The Chart

The patient chart used to be where anything that was done , shouldn’t be done, will be done, and what the patient was doing while all this was or wasn’t being done, was recorded. It used to be that the nurse would write, in longhand, the time, date and what the patient was doing when they were observed. With any luck at all, the patient would not be too sick or too active. You were expected to write your observations at least every two hours. Like this:

6/11/76 3PM Pt. received in bed, watching TV. Vs present. No C/O pain or discomfort. IV of d5w infusing@20cc/hr. VSS.
5PM Pt. sitting in chair, appetite for dinner good, voiding in BR,
Comfortable. IV intact and on schedule.
7PM Resting in bed, C/O constipation, Passing Flatus Ad Lib. Mom given. Made comfortable. IV infusing well.
9PM Watching TV, Continues to pass flatus Ad Lib, No C/O. 11PM Pt. appears to be sleeping. Resp steady and regular. IV on schedule.

Uneventful evening.
In translation, He has good Vital signs VSS = vital signs stable, he’s watching TV and his IV is running. No C/O no complaints offered, Vs present. He has a visitor. Voiding=peeing, Passing Flatus=Farting. Ad Lib= Freely, any time he wants to. Mom= Milk of Magnesia. At 11PM he APPEARS to be sleeping. He could be comatose and the only way I can tell is if I wake him up.
Resp= respirations, he’s breathing, which is always a GOOD thing.

Uneventful Evening.

Pretty much, the only thing he did was pee, fart, and watch TV. He did complain that he was constipated and we took care of that.

There are other patients who did different things and some of them were scary. The charts for them would not be as simple. Anytime something “Eventful” happened, you had to record it in detail. It would not be unusual to spend more time charting than taking care of the patient. You were not encouraged to put in for overtime, no matter what. Many a time, I would punch out and sit down to start my charting. Getting out 2 hours later was no big deal. If you had the ultimate NERVE to ask for overtime, you could be told that you “Weren’t prioritizing your time correctly.” Like it was your fault that 10 people went bad at almost the same time. No way were you going to get paid for that! Is that why Nurses and other medical people seem to burn out quickly?

Let’s take a look at the chart. Instead of charting all the same stuff all the time, let’s use a checklist! That way you only need to put an ‘X’ in the appropriate box. What A Wizard Idea!!!

Well, almost. You see if the patient does do something that there is no check box for, you have got to write it in. Things like; “Pt c/o Nausea after he ate dinner. He also had eaten a large bucket of KFC extra crispy fried chicken given to him by visitors. Dr. Notified of nausea and possible cause. Ordered medication to be given. Pt. refused to take medication and said he felt better now. Also requested a snack.” It didn’t take long before you were not only spending a lot of time with the “X boxes” but just as much time writing as you did before the ‘check list’.

This is the age of the computer and the notes are being done more and more that way. It’s just a sort of merger of the anecdotal with the checklist, and your typing speed will become fantastic! Unless, for some strange reason the computer system goes down. NAAHH! That will never happen!

Hello. I’m your Doctor. And who are you?

I remember when you had the same doctor for whatever ailed you. If someone said they were going to a ‘Specialist’, you got ready for the funeral. We now have a doctor for whatever body system you mention. And then there are the sub-divisions of those systems, and the sub-sub-divisions. If you are in the type of insurance plan that will only cover certain doctors or even certain hospitals, you know what I mean. Say you wind up in the Emergency Room because you tripped over your dog. You don’t know if you are in the hospital that your plan covers but because it’s an emergency and the ambulance took you there, Let’s hope they cover at least part of it. You are not unconscious and can give information. They tell you, you have a small broken bone in your foot and will need to have an Orthopedic Doctor look at it. You have no idea about who the doctor is that your plan covers. If you are really lucky, someone in the E.R. might have a phone number to call your plan and ask. As you lay there, watching cobwebs form on the ceiling, waiting for the doctor, you wonder when you will be able to go home and see how the dog is. About twelve hours go by until someone approaches you. A total stranger grabs your leg and introduces himself. “Hi dere. I dink I am bing jour doctor. You got insturants? I dake your legge and I fix it up nike and bedda.” Seems like a nice guy but you don’t recognize what language he is speaking in. You have to ask him about ten times before you figure it out. You are in good hands, you hope. Even if your brother is an Orthopedic specialist and he ain’t on your insurance plan? He can send you a card. If any of you readers have gone through this, you know I am not exaggerating.

Your Privacy is SOOOO protected, no information is available.

There is something new these days. The Government has decided that your privacy is the most important thing that they can interfere with. They have come up with something called HIPPA.

Stands for Health Information Privacy and Portability Act. That means that any information that your doctor has about you can’t be shared with anyone else without your signed consent. OK, you can sign the form and have the doctor fax it over to the emergency room where you are waiting for your bones to knit. It seems that you are taking some medication that he had put you on but you don’t remember what it was for. They need to know what you are being treated for so they don’t give you something that might mess you up. Guess what? You can’t fax the information anymore! They have decided that the wrong person could walk by the fax machine when your records come through. They might read this and find out that you were treated for crabs in 1966 and then blackmail you. And then you can sue the hospital for putting your business on the street. Of course it’s happened. And those lawsuits cost someone a lot of bucks. After making about two million on the lawsuit, you don’t care if they put your crab attack on the cover of the Rolling Stone! This is one of those things that will be either over-interpreted or under-interpreted. I’m willing to bet that at some point in the near future, it will be totally ignored. Especially if the law suits start rolling in about information being with-held that may have made a life or death situation happen. This is one of those damned if you do and damned if you don’t situations.

Robotic Enema, anyone? Anyone?

Will the time come when the care you get in the hospital will be rendered by robots? Maybe. There are surgeons who are using robotic devices to do certain surgeries now. They still have to be able to know where to put the little robot fingers to do the slice and dice. I wonder if there is a function on the machine that goes; “No! No! Stupid Ninny Doc! Wrong Side! Go to Left, on Other side!” You could sell tickets for that! Imagine if you created a robot that could do all the things that nurses do. They would have a Die-Hard battery and tires that rolled soundlessly. They would never need a bathroom break or a coffee and no dinner time off. They could take your vital signs without touching you. If you started to cry because you are afraid, it would roll over to you and play a tape of soothing sounds until you calmed down. Wouldn’t that be wonderful? The nurses today don’t have the time to do those things, even if they want to. You might have to settle for a fast pat on the back and a quick hug. The nurse may even take a minute or two to whisper comforting words in your ear. But they have to run because there are a lot of alarms going off on the IV pumps. The robot would play the tape until you fell asleep. Definitely, the Robot! By the way, Robots don’t unionize either. There are more female physicians now than ever. I think it would be a grand idea if there were more male nurses to balance the scales. But if they do go to robots, why would it matter?

If sex took as long as war, no one would have time to fight.

June 9, 2003