The Decomposition of Healthcare…

Today is Canada’s Thanksgiving which is a little different from the American equivalent, still six weeks away.  It’s a time for families to get together, enjoy each others company for maybe that one time a year, stuff themselves with turkey and other good foods while giving thanks for various aspects of their lives.  One big difference between Canada and the US is that every turkey is under threat here since we don’t have a President to “pardon” any given turkey.  Regardless what country you are in being thankful is the major part of this holiday.

For the last number of years I have had a difficult time recognizing aspects of my life I should be thankful for.  I know, deep down, that I have many things to be thankful (grateful) for however as access dries up social isolation tears you down.  With decreasing access, even among people who know you well, it’s hard to feel thankful when social isolation makes you just wish you were dead at times.  This year was a little different and it took a health emergency to wake me up.

I recently became involved with the Island Health Patient Voices Network as a way to be active with health delivery in this area.  I’ve spend the better part of my life involved with health-care so why stop now.  With a new federal health agreement somewhere on the horizon, the changing community demographics and the technological changes that require a different approach to health-care this activity caught my attention.  All the hype about “engaging citizens” and encouraging patients to be “active” members of the treatment team made me think this would be a good volunteer involvement for me.

Plus it would provide me with some community activity and not worry about physical access.  A lot of it is done through conference calls or online.  Another side of me (the jaded side) was busily hoping this would be substance based and not just optics for the community.  I think I found my answer…

I unexpectedly wound up in the Nanaimo hospital for the nine days leading up to Thanksgiving.  It was unexpected and the first dealings I have had with this hospital as an in-patient.  Let me start by saying so much for the patient being part of the treatment plan unless I was prepared to shake my head in agreement with whatever hospital “administrators” (very different from the bedside care-givers) were saying.

So over the next few posts I will be discussing “health-care” from the perspective of a non-traditional patient.  So much of health-care is based on traditional health and body function.  It requires some thinking outside the norm when dealing with a life time of adaptive behaviours.  Anyone who has grown up with some form of life long disability have usually found adaptive techniques that work for them but it’s a very individual process.  Put five polio survivors around a table and you will probably find five different approaches to problem solving a physical condition.  What I discovered in the hospital was that health administrators are failing on this concept.  I was very much left with the impression that administration was running a production line service rather than an individualized treatment approach.  So let me begin…

I’ve reached a point where after 8 to 10 hours in my wheelchair I need to get out of to relax.  On September 26 around 7pm I was feeling fine but it was time to settled into my recliner to catch a bit of evening TV.  My leg was very itchy and starting to swell but I didn’t give it much thought.  Over the years I have developed a bit of a Edema in my feet but I have been told it’s part of circulatory issues related to the polio.  The blood flow is a little weaker and it’s only by using momentum that it maintains some form of control.

I must have dozed off watching the National news but when I woke up at 3:30am my leg was the size of a small tree trunk.  It felt like my leg was on fire and was the colour of a big red apple.  Between a lot of lip biting and grimacing I managed to get back in my wheelchair, get to my phone (which was charging) and called an ambulance.  I also had the good sense to grab my electronics (iPhone and iPad plus chargers) waiting for the ambulance.

Thirty minutes later I was in Emergency at the Nanaimo Regional District Hospital (NRGH).  NRGH has recently built a new emergency unit to replace the very outdated one that had been there.  In their wisdom (a very rare trait in hospital “administration”) they had included twelve separate little rooms as holding areas pending admission.  Long and short of it I was admitted five hours later with a severe case of Cellulitis.

I spend my first three days in one of those temporary beds (all were full awaiting transfer upstairs).  I can’t really complain about the bedside care while in emergency.  The nursing staff were very attentive when I needed them otherwise emergency kept them very busy.  I can understand that because in the 80’s I worked an inner city hospital (Calgary’s Holy Cross Hospital) so I have a good understanding of how emergency staff work.

For the eleven years I worked at the Holy five of those were spend with the Emergency Psychiatric Assessment team.  My office was in emerg and I was more connected to emergency staff than psychiatry staff (completely different area of the hospital).  Over a six year period I took a lot of NLP courses as well as personal metacognition training so I think I have a good idea of the mentality of emergency staff.

Emergency unit nursing is crisis oriented.  That’s the nature of emergency so nursing attention is very limited in those twelve rooms.  The care was certainly there but their focus was on emergency care.  Not to take away from the staff (they were all very good) but if they wanted to work bedside nursing on a medical unit they would be applying for those jobs.  Emergency unit nursing is not easy and requires a very unique skill set so I just sort of laid back, let the IV antibiotics run while waiting for a room upstairs.

With that said I did have to call on staff to adjust my leg regularly since any momentum was extremely painful.  Even having a blanket on the leg was painful but what I missed most was the ability to create momentum.  Many years ago I realized that my ability to turn over in bed was dependent on my momentum, almost a flailing movement to get me started.

However I also knew that something as simple as a small pet sleeping on my bed or even bedding that was too heavy and my ability to create enough momentum to turn over was screwed.  I know this because I use to have a wife who (justifiably) could get quite upset with my elbows hitting her in the face at night.  Getting momentum going did involve using my arms in a flailing motion to roll over.  I thought buying a king size bed would address the issue, it didn’t.  I didn’t realize that my adaptive techniques went unnoticed but then I have always just done it and not many people recognized this.

So whenever I needed to move in bed I did need to call a nurse, it was just too painful to try flailing and swinging in order to roll over.  This went on for three days while I awaited a permanent bed upstairs.  Three days by the Emergency unit allows you to see a lot of activity so I was never bored.  I’m pretty sure if it wasn’t for the wheelchair they would have probably send me home to have me come back on a daily out-patient basis for the IV antibiotic treatment.  Three days later I obtained a bed on a surgical unit but more about that part in my next missive.

In closing today I was introduced to the new computer system in the NRGH, iHealth.  Now there is a tragedy waiting to happen.  The whole system is based on scanning your arm band and retrieving the patient information needed, for me that was the medication I was on and when I took it.  Fortunately for me I was alert enough to question twice why a certain pill was in my med regime when I knew I had never been on it before.  The mistake was corrected each time after I raised it but I do have concerns about patients that can’t speak up for themselves.  I was also told staff weren’t allowed to comment on this system.

I need to point out to Island Health that you are not the Save-On grocery lane.  When the scanner fails there I can look at my receipt and point it out to the sales clerk for a correction.  An unconscious patient or someone with dementia awaiting community placement wouldn’t have that luxury…

Next my time on the surgical unit…next time.  For now I am very thankful to be home and responsible for my own care.  Happy Thanksgiving all!

Just one mans opinion…