The View is Very Different When You Are In The Bed

August 18th, 2011

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By , BSN, RN

I am an Operating Room Nurse–the only kind of nurse I have ever been. The man in my life is a former Emergency Room Nurse who decided to go back to school and become a physician. He has never been in the hospital as a patient and I haven't had any hospital admissions since I became a nurse. Last week that all changed.

It started around 3:30 a.m. when S.O. (his name from here on out) awakened me rolling around on the bed moaning, saying he didn't feel well. Barely out of REM sleep I told him to leave me alone. He grabbed my hand, pressed it to his head and I felt pouring sweat. He then said he felt like he was going to be sick. I responded as many women would, I said, "so go throw up." It was on.

He half heaved, half fell out of bed and the vomiting began. By the time I got the light and my glasses on and ran around the bed we were well into what would become a three-day journey through the health care system. There was blood everywhere.

I grabbed my cell phone and dialed 9-1-1. S.O. collapsed and rolled onto his back. As the operator answered and I said I needed an ambulance and gave my address I was also yelling at him, "roll on your side, roll on your side." Somewhere in the back of my brain I knew aspiration of blood was a possibility and dangerous. The first lesson of this adventure was about to hit me.

I was on a cell phone. The operator couldn't pinpoint exactly where I was, despite the address. She asked for a cross street and I didn't, in that moment, have any idea what they were. I should have called from our landline. In an emergency, landlines are not yet obsolete.

With EMS on their way, I flew into action. There was so much blood I couldn't get a grip on S.O. I knew I needed to get some clothes on both of us before the EMTs arrived, and that would help keep him from rolling onto his back again. In a clear part of my brain I was also assessing the symptoms. Later, I was amazed I was able to do this and figure out what was happening. "Coffee ground emesis, dark blood, and then redder—GI (gastrointestinal) bleed! Wow, just like they described in nursing school." You have to keep in mind, I am an OR nurse, I had never seen a GI bleed happening. Talking later, it seems S.O. was having the same thoughts except he was recalling his ER days. "Damn, a GI Bleed…the thing I never wanted to experience myself."

The EMTs arrived, and between further bouts of vomiting, S.O. RN, MD couldn't help helping. Health care providers are the worst patients. He was telling the paramedics where to put an IV, then he had a little seizure, then he was telling them to skip getting a blood pressure, then he threw up some more. They loaded him on the stretcher and left, suggesting I follow in my own car. I grabbed our phones, his wallet, a change of clothes for him, a sweater for me and ran out the door. Being a nurse kept me on track in this moment. I know the admissions process, I know hospitals are always cold, I know discharge planning starts at admission…what I didn't know was how long we would be there.

At the Hospital

We were in the emergency room about two hours. While admission to the Medical Intensive Care Unit (MICU) was arranged I did what I knew how to do. I told our ER nurse that we were both in health care; it does change how you are spoken to. I fetched warm blankets, found washcloths and tried to clean him up a bit and when we left for the MICU I helped wheel the stretcher.

We arrived on the unit at 6:50 a.m.—shift change. It was so loud. Nurses, doctors, medical students, nursing assistants: all giving or getting patient report. We felt a little lost in the process even though we understood what was going on and why we were waiting. This was our world. We met our nurse for the day, talked with the ICU physician, were told the GI doctors would be there shortly and S.O. would be having a bedside EGD (Esophagogastroduodenoscopy).

Throughout the day, we both repeatedly told people he was doctor and I was a nurse. It seems obnoxious but it does change how you are treated. Again, I fetched blankets. I nursed in every way I could: I got ice chips, had his nurse teach me how to arm/disarm his IV pumps, requested supplies and gave him a bed bath, fetched the nurse and the physician when he wanted to talk to them and stayed and watched his EGD. I was spoken to collegially and respectfully during his procedure and after his gastric ulcer was repaired all my questions and concerns were addressed. Despite all this, we both felt lost, fairly powerless and for lack of a better description, alone in a very strange world.

Late that evening we were moved to a regular hospital floor. The next day S.O. had another EGD to confirm he was healing and the GI doctors said he could go home after one more blood transfusion. Because S.O. had lost so much blood vomiting, he had been given one unit of red blood cells and required one more to get him back to a healthy volume. This should have been simple and he should have been discharged that afternoon. It didn’t happen.

This is not a forum for complaints; however, even though we both understand how the hospital works, we understand hospital efficiency or lack thereof, and were willing to do what was necessary to move processes along, he was not discharged until very late the afternoon of his third day in-house. Achieving that discharge time only came after I went and spoke directly to the floor's nursing manager and had a call put into customer service.

Lessons Learned

During his stay and since we have returned home, S.O. keeps talking about how strange it was to be staring up, not down. What he means is it is a different perspective when you are the patient looking up at everyone from your hospital bed. Quite literally, everyone talks down to you. And we were lucky. We understood the process, knew how to work the system, and to an extent felt at home in it. What do regular patients, non-health care people do? How do they navigate a system they are unfamiliar with during a time of high stress when even those of us who know it feel lost?

Besides the 9-1-1 cell phone lesson, what did we learn?

  • Hospitals are no place to rest and get better. Doctors, nurses, nursing assistants, equipment techs, food services, and housekeeping: they are all in and out of the patient's room multiple times, 24-7. It's exhausting and unless you know someone with power, there is no stopping them, even in the middle of the night. They are just doing their jobs.
  • Hospital staffs are intimidating. Your care is their priority but you may not understand what they do or why. They often don't have time to answer your questions or they are off caring for one of their many other patients when you want their attention too. I wasn't afraid to go and take a physician or nurse by the arm and bring them to our room, but I'm one of them. Most people won't or can't do that. And, even then, it was only if I could find them.
  • Patients without family or friends at the bedside are more alone than can be imagined. There is no one extra to help them get out of bed, move their IV poles and pumps and just get them to the bathroom. There is no one to fetch another blanket or pour some water or retrieve the TV remote when it falls on the floor. Nurses and nursing assistants try but they can't be everywhere at once.
  • Who is your advocate when you are alone? The nurse is the patient advocate but I know of no hospitals which offer round-the-clock private nurses as standard operating procedure. To drive the point home, nurses are busy, hospitals understaffed and there are too many patients. What's a regular person to do?

A week later, S.O. is back at work, the ulcer is healed, the carpets are cleaned and life returns to normal; however, I don't think either of us will see hospitals the same way again. I have always thought of myself as sympathetic to what my patients are experiencing. Now, I empathize and when I am at work at the hospital I will do everything in my power to be a better advocate.

6 Responses to “The View is Very Different When You Are In The Bed”

  1. Sally Meggs Says:

    How terrifying! Made worse or better by your combined knowledge and experience? It is a whole different kettle of fish to see someone you love go through this. I am glad he is doing better. Your experience reminds me of the William Hurt movie, The Doctor. It is about a successful doctor’s experience with the healthcare system when he becomes a patient. It is probably somewhat out of date, but the concept probably still holds true.

  2. Lisa Says:

    Very good information on using a land-line phone to call 911. I’ve been in ER’s with parents of late and it is so important to have someone else there with you – especially if someone is so sick to hear or cannot hear well. And as you pointed out to fetch water, blankets, etc.

  3. George Says:

    Great post, Jennifer. I’m sure a terrifying event for both of you. Fortunately you both knew the landscape, so to speak, which must have been somewhat of a comfort. Very insightful and interesting to see your perspective — and very glad that S.O. is OK. Best, George

  4. admin Says:

    I remember that movie from 1991 and the concept does still hold true. We tried very hard to be compliant, helpful and not too demanding but the flip side of that is no one cares about your loved ones more than you do. Being vigilant and advocating for care is a full time job during a hospital stay.

  5. admin Says:

    I can’t imagine going through something traumatic without support and I know people do it all the time. It’s great you have been there for others. Thanks for taking part in the process.

  6. admin Says:

    Thank you, George, for stopping by. I wouldn’t wish this kind of excitement on anyone but being familiar probably did make a difference in the experience. I definitely learned from it and would tell everyone to have some kind of plan in place for emergencies just like this.

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