Wednesday, 07 March 2012
How to Survive a Hospital Stay
Way back in 1977, on the day I was to begin an exciting new job, I instead wound up in a hospital with, among other symptoms, a high fever and unbearable abdominal pain.
Soon after my arrival, I lay on a gurney in a hall with a drip line in each arm as medical personnel scurried about ignoring me now that I was in no danger. Then I noticed that one arm was blowing up like a balloon. I tried to get the attention of one of the white coats but for some reason I couldn't speak above a whisper.
Okay, I thought, I better rip this thing out myself before my arm explodes. But my other arm wouldn't move much - I was weak as a newborn kitten - so that wasn't a solution. As hard as I tried, I couldn't yell but eventually, an orderly noticed that my arm was alarmingly enlarged and ripped out the line. (I'm betting he got it trouble for that, but I'm grateful.)
I don't recall much of the next 10 days – it's a blurry image of people around my bed, needles being stuck in my bottom, a lot of vomiting and horrific abdominal cramping that never let up.
Then I woke one morning with fever gone, a clear head and free of pain – unless you count muscle soreness from 10 days of constant cramps. When I asked, the doctor admitted that he had no idea what had been wrong (where's House when you need him?), but I happened to get well.
After a week-and-a-half in la-la land, the only thing on my mind was food and the doctor prescribed small amounts of strained fruits and vegetables to start off. As hungry as I was, I couldn't disagree given the residual muscle pain that made even sitting up a difficult maneuver.
Hospitals being what they are, it took several hours for a tray to arrive but instead of mashed bananas or peaches or whatever, the plate held slices of overdone roast beef, boiled potatoes and string beans. God, I wanted to dig in, but the absence of pain felt tentative and I wasn't willing to risk setting it off again.
When I tried to explain that I was on a different diet, the delivery person pointed to my name on the tray, Bennett, and refused to believe a mistake had been made as she dashed off to finish her rounds.
My stomach was growling, but I only stared at that gray roast beef - maybe drooling over it. Ten minutes later, the delivery woman came running into my room. “You didn't eat that, did you?” she asked, explaining that she had confused my tray with another Bennett down the hall.
I had mostly forgotten that hospital adventure when, in 1999, I read of the Institute of Medicine's now famous report titled, To Err is Human [pdf] about preventable hospital deaths. The statistics are shocking:
”At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have prevented...” states the report. “Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motorcycle wrecks, breast cancer, and AIDS.”
With numbers like that, it was easy to see that the report was well named, and I had only to recall my own minor hospital errors to know how easily they can happen. People make mistakes; there is no reason to believe doctors and nurses don't make them and in their case, unlike you and me most of the time, it can be a matter of life and death.
I made a mental note to stay as far away from hospitals as possible.
Several years later, surgeon and writer, Atul Gawande, caught my attention in a December 2007 issue of New Yorker with an article titled, “The Checklist,” in which he related the story of a Johns Hopkins critical care specialist and the experimental medical checklist he put into practice at one hospital over a year's time in 2001 for just one kind of hospital procedure:
”The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero.
“So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.”
A few years later, the results of a similar experiment with hospital checklists were even more amazing:
”Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero.
“Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide...The successes have been sustained for almost four years—all because of a stupid little checklist.”
It's an astonishing story that Dr. Gawande expanded into a book, The Checklist Manifesto, but the New Yorker story will give you the essence of it.
As Dr. Gawande explains, it is an uphill battle to get physicians and hospitals to adopt something as “unscientific” as a checklist and, in a recent story at their website, AARP reports that for the 37 million Americans who are hospitalized each year, the problem of medical mistakes has only grown since the 1999 To Err is Human report:
”A report released in January on Medicare patients found that hospital staff did not report a whopping 86 percent of harms done to patients. If most errors that harm patients aren't even reported, they can never be tracked or corrected, the Health and Human Services Department report pointed out.
“This latest study built on an earlier HHS study of Medicare patients that found one in seven suffered serious or long-term injuries, or died, as a result of hospital care. Researchers said about 44 percent of the problems were preventable.
“In another key study published last spring in the journal Health Affairs, researchers examined patient charts at three of America's leading hospitals and found that an astounding one in three admissions included some type of harm to the patient.”
Types of "harm" are not defined and certainly some number are as minor as mine were but it is still shocking and a warning for anyone requiring hospital attention. You can read the AARP story here.
A companion piece has been posted at the AARP website with – wait for it – a checklist of things you can do to help ensure safer medical care when you, a friend or relative is hospitalized.
Print it out for yourself. It is an highly useful list. From it, two items stick out that are of paramount importance:
- Never, ever allow any hospital personnel (or visitor) – that means your physician too – to touch you without first washing their hands. If they approach you without having done so in your presence, politely ask them to please wash before touching you. Also, wash your own hands frequently.
- Have an advocate with you as much as possible. Most of the time, whatever reason you're in the hospital means you are probably not thinking clearly. You need someone to be your eyes, ears and brain when yours are not functioning at full capacity.
When someone cannot be with you, rely on that “stupid little checklist," as Dr. Gawande calls it. It saves lives.
At The Elder Storytelling Place today, Johna Ferguson: Elder Problems in China and the U.S.