Wednesday, June 13, 2007

Awareness and Boundaries

No matter which hospital you go to or which doctor you see, the potential for mistakes to be made is simply a reality that can not be ignored. In 2006, USA Today reported that “Experts estimate that medical errors claim about 98,000 lives a year — more than 250 lives a day — across the USA.” I can’t help but wonder how many of those mistakes could have been avoided if patients were more pro-active in their care. With Knowledge being the first key in protecting yourself in a medical setting, Awareness and Boundaries are close behind.

Example 1:

I wish I could be more technical about this example. I feel confident that the fact that I can’t remember the exact name of the medication will make people doubt the validity of this occurrence. But I promise it’s true.

When I was in the hospital after lung transplant number one, I was receiving injections. I can’t remember why, or, again, what the name of the medication was. What I do remember is that I was told by my nurse that I should only get this injection once a day. As she administered it, she stressed this to me and I remembered.

One evening, right after shift change, another nurse came in with a syringe. She told me it was time for the injection. I immediately protested that I had already received that dose for the day. This nurse absolutely did not believe me. After all, I was the one taking high powered narcotics, right? At my insistence, she rechecked the chart and reported that it had not been noted and therefore it had not been done. I was adamant that it had and insisted she call the previous nurse at home. I was walking a thin line and she was getting irritated. Nonetheless, she followed through and left my room to make the call.

Minutes later, she came back in with her face quite flushed. She apologized profusely and acknowledged that I had indeed had the injection earlier that day. The previous nurse had confirmed this and was mortified that she had not marked it in the chart. With her hands a little shaky, the evening nurse put her hand on my knee and whispered “It could have killed you”. I smiled and was very glad that I had been paying attention.

Example 2:

Of all the procedures I have ever had done, blood draws have been the most frequent and numerous. Unfortunately, because of all of the IVs and needle pokes I’ve had in my life, I only have 2 veins left that can be used to take blood. They are both in my right hand. These veins are extremely valuable to me and I guard them like a vicious watch dog. When I walk into the lab or wake up to a phlebotomist in the hospital, I know that they don’t understand my history or how precious those veins are. It’s my job to set boundaries to ensure they don’t get blown or otherwise badly scarred.

I establish immediately with the phlebotomist that they get two tries. If they are unsuccessful and do a lot of “digging” they must stop and find someone else to do the job. Preferably, someone with more skill or experience. Strike two, you’re out.

Occasionally, I will notice that when I tell them they must draw from my hand, their eyes fill with fear. They stumble around and can’t figure out which tube goes with which test. These are the “newbies”. As rude as it sounds, I don’t let newbies draw blood. I am very unpopular when I announce that I would like them to go get their superior and have them do the draw. Some argue but most sheepishly walk away and get their boss. The boss most often does a wonderful blood draw, even with the scowl on her face. I realize that just because someone is new doesn’t automatically mean they won’t be good at what they are doing. Nonetheless, I have enough experience to know that it often does mean just that. I go with the odds.

Often, I leave the lab or hear the door of my hospital room slamming shut knowing that I haven’t made any friends. I’m sure all kinds of nasty things are said behind my back. When I look down at my hand, however, and see that my veins are still in one piece, I really don’t care.

The Verdict:

Remaining aware of what is being given to you and on what schedule can be taxing. Establishing boundaries with those caring for you can be very uncomfortable. Nonetheless, this is what must be done in order to ensure you are getting the best care. This means being aware of what medications interact with the medications you are currently taking, or at least never forgetting to ask. This means knowing your body and what could be detrimental to you, despite that it may even be “routine”. This means educating yourself and then finding the skills that will allow that knowledge to protect you. Don’t lay back and relax. Keep an eye on what is being done to you and learn how to ask people to step back and change their approach. Trust me, you’ll be happy you did.


d.ellis said...

When I was ten, the ward phlebotomist was unavailable and my pediatric nephrologist decided to draw blood himself. After numerous veins collapsed, he opted to draw blood from my external jugular vein. At the time it was exhilarating and exciting and I was very proud to leave the hospital with a puncture mark on my neck that oozed blood for an hour. In retrospect, it was remembering that moment that made me realize that medicine isn't perfect and that knowledge, awareness and personal boundaries is a necessity rather than a luxury. Very well stated Tiffany.

Laurie said...

Great post!! I couldn't agree more--being educated and proactive as patients is so important. Some people may call us difficult or may resent our questioning or demands, but in my writing I argue that often, "difficult patients are actually empowered ones--we know our boundaries and we preserve them.

Joanna said...
This comment has been removed by the author.
Joanna said...

Hi Tiffany, I came across your blog from one of my fellow chronic daily headache sufferer's blogs... 1st, I just want to say I admire your spirit and strength... I was an inpatient with my headache docs last year, and I was woken up so often for random meds and whatnot, and while my memory was so zonked from everything (and still is), I luckily was able to remember that I had (like you) had already received a specific medication earlier in the day... being weak and having my bad memory, I was somehow able to convince the nurse to track down the previous nurse and check it out, and sure enough, I had been right.
We're not trying to be pests, we're just trying to get the care we need and deserve! I'm thinking of you.
<3 joanna
"Her Life In A Nutshell"