Hospital and Heresy

[pullquote align=”left”]My first hospital memory is of an open-air clinic in Africa.[/pullquote]  My mother, herself a nurse, took over the needle and thread the young doctor was attempting to use on a screaming four-old year’s nose.  A burly nurse wrapped me in her arms and sang a village lullaby as my mother finished the stitching.  Since then, I, or those dear to me, have experienced hospitals in many countries around the world.  With one  exception, the nursing care was outstanding.

When it came time for me to face a full spinal fusion due to idiopathic scoliosis, I was relieved I happened to be living in Houston, home to the Texas Medical Center, and some of the world’s finest hospitals.  Dr. Paul Harrington first developed the procedure there in the 1960s.  I had every confidence in my chosen surgeon.

Naturally, I remember nothing of the surgery, which I am told took about ten hours, but I do remember most of the following week. I remember crying as I saw my husband, looking so much older than when he’d kissed me goodbye that morning.  I remember lying on an air mattress to reduce the pressure on my back, tubes snaking out of my arms, a catheter trailing from between my legs, and pain that I have no words to describe. I remember when my thumb, curled around the morphine pump, loosened its grip, and then I dropped it.  I finally managed to reach the call button lying at my side; any movement sent pain messages screaming through my nerves.

“What do you want?” a nurse asked when she finally came.  I cried out as she banged into the bed.  “What?” she repeated.

My mouth was glued dry.

“Have a drink,” she said from the other side of the bed, pointing to the glass on the table.  She leant across me when I muttered I could not reach it.

“Here.”  She angled the straw for me. “You must lift your head,” she said as I gagged on the water.  “Where is your pump?  You must use it.”  She put the precious pain pump back in my hand.  “Do not drop it,”  and with that, she left.

A while later, I called her back.

“I need to move,” I muttered.

“You will have to wait.  I need four people.  We are busy.”

I cried as I waited.

“Hold the sheet.  Lift and roll at the same time.  Her back must not bend,” she instructed the two young girls and the man standing on either side.  They lifted and rolled.

“No, no, back please,” I cried.

“Make your mind up,” she said,  “We are busy.”

As dawn was sneaking through the blinds, I must have dozed because I woke to a new nurse.

“You didn’t tell me you are diabetic,” she shouted.

“I’m not,” I croaked through lips again dry.

“Your blood work says you are,” she said and stormed out.

Without the advocacy of my husband, it would have been infinitely worse, but he could not be with me the whole time.  There was no kindness, no empathy, and no compassion from the nursing staff with the exception of one shy aide who washed me.

[heading style=”2″]My surgeon was appalled.[/heading]

Articles are written and papers published discussing the need to reduce variance in nursing practices.  In the United States, this has a direct correlation to HACs (Hospital-Acquired Conditions) and the willingness of The Centers for Medicare and Medicaid to reimburse medical facilities.  In a paper by Kathleen D. Sanford, support is called for from finance leaders in the medical world in three specific areas: investment in best practice procedure products, in effect to find, publish and update nursing policies and procedures to reflect evidence of best practices; to recognise in this era of budget cuts the importance of retaining education dollars for nursing staff; and finally, to encourage a culture of accountability while recognising “that medicine and science are not exact sciences.”

I would argue there might not be the same book-learning opportunities for nurses in less developed countries, but compassion and a desire to care is inherent. Maybe what is needed is an exchange of skills, and not just a reduction of variance.  Those entering the nursing profession can surely learn the necessary technical skills without losing their empathy.

Ludwick and Silva in their paper, “Ethics: Nursing Around the World: Cultural Values and Ethical Conflicts,” discuss the value of recognising that different cultural mores may often require different nursing practices, taking into account the possible difference in cultural value, ethics, and ethical conflicts.  They state, “Lack of communication is more likely to occur when nurses care for international and culturally diverse person.”

The irony in both the statement on medicine not being an exact science, and that lack of communication can cause problems are, to me, key in the discussion on nursing care wherever in the world one is.  Those nurses who are in my ‘happy’ memory bank were all from countries outside the United States.

The second week after my surgery was spent one floor lower in the medical tower in a rehabilitation ward.  I could have been on another planet. The difference was the leadership given by the head of the department who expected both professionalism and compassion from the nurses on his ward.  Interestingly, the majority of the nurses in the rehabilitation ward came from the Philippines and Malaysia.  The care that had been lacking upstairs was made abundant, and I learnt to walk and laugh again.

Whilst I will forever be grateful to my surgeon’s skill and the modern facilities afforded my surgery in a developed country, I do wonder if perhaps too much emphasis is placed on book learning for nurses, and not enough on humanity.  Their lack of it is a heresy not disclosed on the hospital brochures.

As I lay in bed that first week, I longed for the kindness of an African bush hospital nurse. 

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