Hospitals Are Cool

I think hospitals are cool.  When I was a kid and went to visit someone, I was impressed by the big, maze-like structures, mysterious things going on inside.  The halls were full of strange smells, odd noises, futuristic equipment.  When I got older and entered the profession myself, they became my work home, magnificent buildings dedicated to researching and combating illness and death.

Many have the opposite feeling- they hate hospitals.  When I meet friends occasionally at work, I’ll see them twitch and glance about.  ”What’s wrong?” I’ll ask. “Hospitals give me the willies,” they’ll say, looking as if they expect the mummy or Frankenstein monster to pop out of, say, the Radiology suite.

I see their point.  Hospitals are places where people go when they’re suffering. You hear moans of pain from rooms, overhead calls for “Code Trauma” and “Code Blue,” and staff talking gravely in hushed tones.  Hospitals are also easy places to get lost in. They grow organically.  Is there a new specialty and technology? Throw up a new wing over here. Need more beds?  Stick an annex there.  They’re maze-like not to purposely confuse outsiders; that’s just how they evolve.

Hospitals are certainly safer than in the past.  They’re no longer places where people regularly catch infections, or get the wrong limb sawn off. Initiatives in the last decades have made medicine as safety-conscious as aviation. Checklists, safety-training, and protocols have erased much of the haphazardness of medicine.  Patient safety is now as much of staff education as drawing blood or using the computer.

You can help make your kid’s hospital stay safer too.  First, choose a hospital that’s appropriate for kids.  Some hospitals take care of lots of kids, some don’t.  Second, choose an academic hospital- one that’s affiliated with a medical school and trains medical students and residents.  Statistically, patients at teaching hospitals do better- have more accurate diagnoses, go home sooner, and generally get better care.  There is something about that environment, where multiple doctors at various levels of training put their heads together, discuss cases, teach each other, that helps them figure out what’s wrong.

In the Emergency Department at Lafayette General, I occasionally interact with one bunch of those doctor teams, the surgeons.  Surgery teams are an odd bunch.  Busy, harassed by nurses and non-surgeons like me, they bustle around in packs of five or six. They come in all sizes, levels of training, and stages of grooming; tall, short, medical students, residents, some with hair and scrubs rumpled like they’re just out of bed, some coiffed and wearing clean, starched lab coats.  Their boss is the Attending, the surgery professor who breezes into patient rooms with authority and bon vivant, reassuring all that they’ve got it managed, their minions scribbling down orders in their wake.  Not the pretty picture seen on Grey’s Anatomy.

LIke we discussed above, being a patient in “academic” institutions like Lafayette General or University Hospital and Clinics has advantages.  Patients get better quicker when they have more than one doctor puzzling over their cases, discussing it with each other, researching together.  However, keeping all those doctors straight can be tough for patients, and parents.  Which doctor is which specialist, responsible for which issue?

It’s always a good idea for a patient to have an “advocate.”  Best if this person has some medical knowledge, and can keep everything straight.  Usually pediatric patients come with an advocate already- their parents.  However, parents are also emotionally involved with their child’s case, worried sick.  Already overwhelmed, often the parent needs a cool-headed advocate themselves.

There’s a lot for a patient, parent, and advocate to keep straight, besides which doctor is responsible for what.  There are multiple medications and tests.  Where are we with the diagnosis, what’s the treatment plan?  And did you wash your hands before touching my child?

These are important things to monitor.  Even with computer-controlled drug dispensing, you still want to ensure that your child is getting the right medication and the right dose. The radiology tech comes to pick up your child for xrays- ask why this test, what will we learn from it?

So after you and your pediatrician pick your hospital, and your child must stay, have an advocate to help you navigate the complexities of medical care.  And to keep all those characters in scrubs straight.

Can Hospitals Make You Sick?

It’s tough to care for friends.  My friend Jennifer had delivered her third baby.  My patient was baby Julia, who had a rough start, needing oxygen for the first days of life.  Jennifer was exhausted from labor, delivery, and worry.  But the fourth day I had good news: “Julia can go home today!,” I said.

Jennifer burst into tears.  Puzzled and a little freaked out, I asked  “What’s wrong, Jennifer, what did I say?”

“How come Julia can’t come home?” she sobbed.  I then understood that Jennifer had simply mis-heard me.

“Sorry if I wasn’t clear, but Julia CAN go home,” I explained, and Jennifer recovered.  Whew!

Parents and children often feel vulnerable in hospitals.  A recent article in the BBC News Magazine discussed how hospitals sometimes make you sicker, instead of being places of recovery.  The article stated that of patients in the US admitted to hospitals, 20% have to be re-admitted within a month.  For some reason those patients weren’t healed in the first try.

Hospitalization can be stressful, rather than purely healing.  The most obvious stressor is that your child is sick enough to be admitted in the first place.  You’re worried, your kid’s scared, and she’s tired and hurting.

Hospitals also cause sleep deprivation, just when you need your sleep the most! Patients are awakened all night for vital signs and medications.  When the patient tries to nap in daytime, interruptions continue: morning blood draws, doctors’ rounds, staff and families chattering away in halls, food carts rumbling back and forth.  It’s hard to get even three to four hours of uninterrupted sleep.

There’s also pain, which of course kids hate- needles for blood draws, IVs, and procedures.  Finally, the food: it’s hard to serve hundreds of meals on several floors, hot and delicious, and few hospitals have mastered this. Then they take away your food if you have a procedure- must have an empty stomach for anesthesia!

So how can you make your child’s hospital stay safer and more restful?  First, hospitals have been doing their part.  Since a 1990 government report on hospital-acquired infections, Lafayette General and others are policing doctors, nurses,and techs on hand washing.  Hand sanitizer stations are now all over.  Programs to reduce IV and other catheter infections have made infection rates plummet.

Surgeries have new rules for safety.  The news used to carry stories of surgeons amputating the wrong leg.  Comedian Dana Carvey (who played Garth in the Wayne’s World movies) was also in the news after his heart surgery. In 1997 he had bypass surgery for a blocked heart vessel.  Unfortunately, after cracking his chest, the surgeon bypassed the wrong vessel.  So Carvey had to undergo a second open heart surgery. Hospitals now have protocols to ensure that we operate on the right patient, on the right part, at the right time.

There’s lots you can do to make your child’s hospitalization safer too.  First is to have a patient advocate.  For kids, this is usually the parent.  However, some parents are overwhelmed by their children’s illness and care- tests, medications, therapies, when can we go home, when will my child get better?  Then parents need their own advocate to help sort it all out.

The most important thing an advocate can do is remind staff to wash their hands. And their stethoscopes.  Second is to make sure everyone introduces themselves, and keep straight all the players.  Who is the nurse, the doctor in charge, the specialist?  Third, be sure the right therapy is happening to the patient.  What’s this medication you’re giving, what’s it for?  Why this test or procedure, how necessary is it?  Lastly, an advocate can prevent sleep interruptions, like making a sign for the door requesting minimal wake-ups. And the sign should say “please keep quiet in the hall!”

Hospital care is complicated, and not without risk.  Hospitals like Lafayette General are doing their part.  But patients and parents need to do their part too, like Dr. Kate Granger. Though Dr. Granger was a doctor, when she became a cancer patient she was treated impersonally, until she started a twitter campaign to get doctors to simply introduce themselves.  You shouldn’t have to go that far, but making a sign for your child’s door is a great start.