Archive for February 18th, 2010

ER (not the TV show)

So I was all geared to write about Nurse Ratched from my last inpatient experience at the hospital, but I’ve lost my fire for the topic.  Probably for the best, because well, I should probably learn to simply be more appreciative of the good things in life, rather than critical of the negative things.  But hey, before I get all holier-than-thou with gratitude for my many blessings and whatnot, let’s cut the crap and get to the real reason that I’ve lost my fire for writing about Nurse Ratched:  I have something far more annoying to write about instead.  Come on, you didn’t actually believe me about focusing on the positive, did you?  That’s Crazy Talk!

So earlier in the week, I had to go to the Emergency Room because there was Yet Another Issue With My PICC Line (YAIWMPL).  When I had the new line placed in the hospital, it was not sutured down (as my second line had been), but the nurse used a statlock to anchor the line.  I knew then that this was a recipe for disaster, as my reaction to the statlock adhesive was severe enough with my first line that it compromised the site and the whole line had to be replaced.  But the nurse at the hospital was not permitted to use sutures, and if I hadn’t been so stupid, I would have requested that she find a doctor or PA to do so in lieu of the statlock, but I’m a moron.

Shockingly (not), when my home health nurse came a week later to change the dressing, I had a severe, infected, skin reaction to the statlock adhesive.  And so I got sent to the ER.  Normally, I would go to the ER near my house, but my OB doesn’t have privileges there, so I wanted to make sure I was in the hospital where my OB has privileges in case any orders needed to be obtained.    It turns out, I hate the ER at SG where my OB delivers – the ER at my local hospital is MUCH BETTER.  Nevertheless, I got what I needed – my line was sutured down, and the statlock was thrown away for good (I hope).  However, I had a very bad experience because of the unprofessional conduct of the nurse supposedly “caring” for me.

I wrote a letter to the hospital administration, and I have been assured a timely response to my concerns.    The letter not only addresses the ER visit, but also summarizes some of my chief complaints from my inpatient stay as well.  I hadn’t been planning to write about the inpatient experience, but since I was writing again anyway, I figure it can’t hurt.  The letter follows (beware, it’s really long!):

To Whom it May Concern;

I am writing today because I have recently had two disturbing experiences at SGAH – both as an inpatient in the Antepartum unit, and as a patient in the Emergency Department – that I would like to draw your attention to.

I was admitted to the Antepartum Unit on February 3, 2010 due to preterm labor.  I also have severe hyperemesis, and am unable to keep any substantive quantity of food or drink down.  I was a patient for six days.  While overall I had a good experience with the nursing staff, many issues came to light while I was a patient.  It became clear that most nurses do not read medical records, but rather depend on “report” between shifts to understand patient needs and orders.  Unfortunately, this can result in a rather elaborate game of “telephone” where medications are missed, or incorrect, and orders are not clear.  I had several nurses who did not administer proper medications on time unless I asked directly for them.

Many nurses did not clean IV/PICC ports with alcohol before accessing them, there were days when I did not receive multivitamins in my IV Fluids because nurses assumed (even after I corrected them) that the previous shift had administered them.  I had an existing PICC line when I was admitted to the hospital, which required heparin flushes at least once per day.  However, nurses repeatedly told me that I was incorrect and that the line did not need to be flushed at all (with either saline or heparin).  I simply got told “we don’t do that.”  As a result, my PICC line became occluded and a peripheral IV had to be placed until a new PICC line could be placed.  When the IV Therapist came, she agreed that the line should have been flushed regularly – both with saline and with heparin.

The peripheral IV was placed in my right hand.  I experienced a significant amount of pain at the site, but nurses continually told me “IVs always hurt when they’re in your hand.”  While it is true that IVs in the hand are typically more painful, I have a lot of experience with IVs and this pain was not typical.  I was having routine infusions of both Phenergan and Ampicillin, which are both very caustic when running through a peripheral IV (they cause no discomfort running through a PICC line).  One of my nurses ran one of my Phenergan doses  (25mg diluted in 100ml of D5W) through the IV at a rate of 999mls/hour – five times the rate it should have been run! When the Phenergan dose was finished, the IV fluids continued at the same rate until I called the nurse and asked her to turn it down.  I was in tears from the pain – and the answer I received was “yeah, Phenergan always hurts going in.”    Later, when she ran Ampicillin through the line, I was again in tears from the pain.  Fortunately, the IV Therapist arrived around that time to place my new PICC line.  She stopped the infusion and pulled the peripheral line before placing the new PICC line.  Once the line had been pulled, I looked down at my hand and realized that it was swollen to about  4 times the size it should be; it took about 8 hours for the fluid that had collected to dissipate and for the swelling to go down.  That evening, the nurse that came on shift gave me my Phenergan, but not the dose that was ordered – she gave 12.5mg q6h.  When I questioned it, she said that hospital policy is that no more than 12.5 mg can be given.  Although I did not get relief with the smaller dose, I respect that she was following hospital policy.  What I want to know is why the nurses I’d had the five days’ previous did not follow hospital policy.

On my last day in the hospital, I spoke with the charge nurse, Marilyn, who responded appropriately and with great kindness and sensitivity to the issues that I had encountered during my stay.  She encouraged me to speak up, should I have another hospital stay with additional issues.  I appreciated her help and advice, but most of all, I appreciated that she didn’t make any excuses for the issues I had encountered, but simply offered her apologies and a sympathetic ear.    Marilyn’s wonderful approach left me feeling confident that the issues would be addressed and at the time, I felt no need to further address the issues.

Had that been my last negative experience at SGAH, I would not be writing this letter.  However, on February 15th, I spent the afternoon in the Emergency Department due to a reaction that I had to the stat-lock anchoring my PICC line.  My previous PICC line had been sutured in place to avoid the skin reaction I had to the stat-lock adhesive, but the IV Therapist who placed the new line wasn’t permitted to use sutures, so I had a stat-lock to anchor the line instead.  I went to the Emergency Department because my skin reaction was so severe that it was a potential risk to the line.  The medical care I received in the Emergency Department was excellent.  My line was sutured in place to avoid further issues, and dressed in gauze to allow the skin to heal before my next dressing change.  Despite the excellent medical care I received, my experience overall was very poor due to the unprofessional conduct of the nurse attending to me.

First, I do not know her name, because her name badge was not visible (and I can’t help but wonder if this is intentional) and she never introduced herself to me.  She came to my bedside to determine what my needs were.  She asked if this is my first baby and I told her that I have a six year old foster son and two year old triplets.  She became visibly shocked and when I said I expected this would be our last, she said, “Well, I would hope so! After all these kids I would hope you’d be done already!”    While I recognize that few people in today’s society choose to have families of this size in this day and age, it certainly does no good to mock me for having chosen to do so.

She went on to ask whether my triplets are “natural” and I stated emphatically to her that this question is not only medically inaccurate (the correct medical term is “spontaneous”), but it is rude and hurtful to ask a mother such a question.  I further pointed out that asking me about the conception of my children is tantamount to asking about my sex life – this may seem a stretch, but imagine how unseemly it would be to ask a woman who had no fertility struggles about the specifics of her child’s conception – this would certainly seem intrusive and out of line, would it not?  Why should it be any different when a doctor and/or embryologist are involved?    She said, “Oh, it’s just that I find multiple births so amazing!  I don’t care whether they are natural or not!”  Yes, my children are amazing.  My triplets are a miracle.  Their conception has nothing to do with it, and I can’t reiterate enough that “natural” does not apply – ALL babies are natural, and certainly the embryologist who assisted us in our conception did not substitute a space age polymer for the usual requisite ingredients for making a baby.

Had this been the extent of my nurse’s unprofessional behavior, I could have overlooked it and attributed it to ignorance and insensitivity.  However, what followed was so egregious that I couldn’t possibly ignore it.   I was in a room with four patients, each of us separated by a simple curtain, so it was fairly easy to overhear the conversations of patients, visitors, and medical personnel.  The patient in the bed to my left was vomiting uncontrollably.  She was clearly uncomfortable and in a fair bit of pain.  While I do not know the cause of her hyperemesis, I do know that no matter the cause, persistent, intractable vomiting is never pleasant.   At one point, the patient began a new cycle of vomiting uncontrollably.  The nurse was in the process of placing an IV in the patient to my right.  When the vomiting started, the nurse started to giggle and then she said, “I’m sorry, I know it’s not funny it’s just…  I think somebody is being a wee bit melodramatic, don’t you?”

No matter what this nurse’s personal issues were with the patient, there is no excuse, under any circumstances, to make a disparaging remark about a patient within their earshot, and particularly not to another patient.  If she wants to wait until she’s off shift and gossip with her colleagues in the break room, by all means, don’t let me get in the way.  But to do so in front of several patients, feet from the patient who was suffering at that moment is inexcusable.

I appreciate your willingness to hear about my experiences at your hospital.  I am planning to deliver my baby at SG and I can only hope that I will never again encounter issues similar to the ones I recently experienced.


Ms. Perky

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