Thursday, June 17, 2010

Hospital Experience #13: Donna Glee - Perspective

This is the thirteenth in a series of posts on a recent experience at Ochsner Hospital - having a cardiac catheter ablation procedure to correct a heart arrhythmia. These posts describe and reflect on various aspects of the hospital experience. This thirteenth post will examine the differences in perspective between patients and medical professionals.

The thoughts expressed here draw on conversations with Donna Glee, a life-long friend and a registered nurse who lives in North Carolina. Donna Glee supported me generously throughout my hospital experience. Specifically, she offered to come all the way to New Orleans to accompany me throughout hospital day, she listened deeply to me, and she provided extremely helpful and reassuring information as well as useful tips that made the experience more comfortable. One aspect of the experience that I reflected on with Donna Glee is the difference between the patient's perspective and the medical professional's perspective.

First of all, as Donna Glee explained to me, what is normal and routine to the medical professional is not the least bit normal to the patient. For the patient, a "routine" procedure may be alienating, bizarre, painful, uncomfortable, frightening, embarrassing, or humiliating. The medical professional is functioning in hospital reality, while the patient is still functioning in non-hospital reality.

We can see the clash of these two realities in my post-procedure bleeding incident. This occurred the first time I attempted to get up after the cardiac catheter ablation procedure. I had been required to remain lying down without bending at the hip or raising my head (beyond a slight elevation provided by the hospital bed) for several hours after the procedure, after which time I was allowed to get up. I needed to urinate, so I went into the bathroom and locked the door. As soon as I started to urinate, one of the groin insertion points started to bleed - a lot. Blood was flowing down my leg and onto the floor, and I was trying to mop it up with toilet paper. I kept bleeding.

Finally, I called out, "Merry, I think I'm having a problem." Merry asked, "What's wrong?" I answered, "I'm bleeding." The doctor, accompanied by a nurse, had just come into my hospital room to see me, so Merry, the doctor, and the nurse all approached the bathroom and called out, "Open the door."

Unbelievably, I answered, "No. I'm bleeding and I'm trying to clean it up." I then heard, "OPEN THE DOOR!" I thought I'd better open the door, whereupon the doctor and nurse helped me to the bed and instructed, "Lie down."

Again, unbelievably, I said, "No, I'll get blood on the bed." I heard, "LIE DOWN! WE'LL FIX IT AFTER." So I thought I'd better lie down. Then the doctor and nurse put pressure on my groin, stopped the bleeding, talked encouragingly to me (I was upset), and instructed me to stay in bed for another hour - after which I was fine.

Donna Glee says that this often happens in the hospital. The medical professionals find it normal to come into the bathroom to help a bleeding patient and to clean beds with blood. The patient doesn't find this normal at all. The patient finds it normal to clean up a bathroom before letting others in and to avoid getting blood on a bed.

Donna Glee also told me about accompanying a relative during a hospital stay and seeing that the relative felt embarrassed at spilling some urine on the bathroom floor - I think the relative had been required to urinate into a container. Donna Glee's nursing self saw nothing to be embarrassed about - that's why you put tile floors in hospital bathrooms and hire a housekeeping staff to deal with such normal things as urine spills. At the same time, Donna Glee recognized that her relative was not operating in hospital reality, but in non-hospital reality, where spilling one's urine is an embarrassing event.

Before hospital day, Donna Glee had explained to me the importance of being well hydrated. I had said that I planned to stop drinking water early on the afternoon before the procedure. Donna Glee advised against this. I explained that I was worried about the long period of time when I would be unable to use the bathroom - all during the procedure and for several hours afterwards. Donna Glee explained that I could use a bedpan if I needed one. I replied, "I don't want to do those embarrassing things." Donna Glee explained that I felt that way now because I was fully clothed, sitting at a table in my apartment, talking with her on the telephone - but that then I would be in a different reality and would view things with a different perspective - and it wouldn't seem so embarrassing within hospital reality.

Besides the things that are done in hospitals, an additional problem can be the topics that patients are asked to talk about. Although this is not so much a problem for me, I know that some patients feel embarrassed to be asked questions about their bodily functions. In hospital reality, it is normal to talk about bowel, bladder, menstrual, and sexual functions. In non-hospital reality, these topics are avoided.

I think it is important for medical professionals to recognize the difference in perspective between themselves and their patients. The patient is functioning in non-hospital reality and will not find "routine" hospital procedures to be routine at all. What is a logical way of proceeding in the hospital is not logical at all to the patient. It is good for medical professionals to be sensitive to the fact that, for the patient, "normal" hospital occurrences may be uncomfortable, embarrassing, or humiliating.

Actually, I find that most medical professionals are sensitive to these matters. It happened that I did need to use the bedpan during the post-procedure lying down period, and the nurse who assisted me made the process as emotionally comfortable as she could.

I will end this post with a big thank-you to Donna Glee for many conversations before and after hospital day and for extremely helpful and reassuring information. Donna Glee gave me information about heart arrhythmia, cardiac catheter ablation, medications, sedation, blood pressure, healthy practices, hospital policies. Knowing all this helped immeasurably to calm me.

Donna Glee absolutely loves to be helpful. It gives her great joy to know that she has provided tangible help for someone. This hospital experience is just one of many times throughout my life that Donna Glee has provided valuable help for me - and has let me know that she enjoyed doing so.

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