The fastest discharge in the history of the world
I wasn't too busy, so when my friend Emily called and asked me to come to the ward to check on our friend Lawrence I went right away. It helped to hurry my pace that she said something about "anesthetic" or "pain." Since Lawrence had been admitted after being hit bar a car 10 days ago, he had had plenty of pain--mostly related to significant soft tissue injury to his right arm that had been requiring daily dressing changes. In any first-world hospital he would have had proper pain control in accordance with his weight, his status as a child/teenager, and the severity of his injury. He also would have had proper dressings that wouldn't stick to the wound and rip it open afresh every day.
Instead, because he was in Uganda, in a hospital that didn't even have enough gloves to complete the dressing changes, he got various forms of pain meds depending on what the nurses could find--nothing was usually documented because there is usually one nurse for 20 patients and they are just too darn busy to document--and sometimes without much regard for whatever the doctor had bothered to write. Of course, in the hypothetical first-world hospital, he would also have been sacked with a bill probably over $10,000.00 for a stay of 10 days that included one trip to the theater (OR). Or rather, he wouldn't ahve been treated at all, since he is a street kid.
Over the duration of Lawrence's hospitalization I had bothered the nurses and clinicians quite a bit with questions about medications, dressings, care-plans, protocols, etc etc etc. However, when I came onto the floor on this particular day, a group of men I didn't recognize were gathered a short distance from Lawrence's bed, and Emily was standing protectively next to Lawrence--who looked like he was about to bolt at any time. Emily explained that one of the men had come over and started to remove the dressing as Lawrence slept--no warning, no pain meds. I did not blame Lawrence for looking ready to run.
"Have you brought it?" The leader of the white-coated men asked me. I was confused. What was I supposed to bring? Apparently he didn't know either. I'm guessing it was some sort of pain med, since he didn't seem to have any. My anger that had been building over the last ten days finally spilled over onto this nameless character. I looked him square in the face, and said "WHAT is your PLAN?" "Plan?" He answered, puzzled. "YES, your PLAN? PLEASE don't tell me you were planning to remove this dressing without pain meds." "It isn't about the pain," he retorted.
At this point I had had enough. "IT ISN"T ABOUT THE PAIN FOR YOU, BECAUSE YOU HAVE ALL YOUR SKIN STILL ON YOUR ARM. When was the LAST time he had any medicine?"
"What?" Mr. white coat was not getting me. I repeated the question, my face inches from his (really--i wonder--where do i get the nerve to speak to people like this? I really have no idea) I repeated the question again and again..to all the members of the group, to the nurse on duty. I sounded like a broken record. I was probably stamping my foot. Truly, for someone who took so long to develop documentation skills and who routinely called her workplace after midnight to ask people to document meds that she had forgotten to note...I was being a bit over the top. Maybe. At some point Mr. White coat asked me, "DO you have a medical background? Are you related to this patient?" I straightened up, raised my voice, and said, "I am a NURSE." YES. I don't think he was impressed, but I felt good.
At this auspicious moment my phone rang. My friend Glenda, who has a high-level job and connections in the city, and to whom I had poured out my frustrations with the hospital the previous day, had come up with a connection at IHK (internation hospital of kampala) where Lawrence might be able to get free (and much better) care.
With only the hint of a promise of a solution in my hand, I walked up to the group of doctors. They informed me that they would be taking lawrence to the theater to put him under general anesthesia for his dressing change. (THIS IS A SOLUTION? GENERAL ANESTHESIA?). I calmly informed them that they only place lawrence would be going was out the door, with me, and I kindly (!) asked for his discharge papers. They blinked once, twice, and filled out the paperwork within five minutes. Emily and I ran around collecting cash for the bill (in this blessed country, until you pay your hospital bill you are a prisoner of the hospital, unable to leave the grounds), paid it, and left. At some point in this frenzy of activity I remembered to ask Lawrence if he wanted to leave. His answer was to painfully hobble over to the door and ask for some sunshine. His grin was unstoppable. I knew we were doing the right thing.
We had to round up a taxi (the private kind, not the fifty-people in a fifteenpassenger van kind)and over bumpy roads, with lawrence gritting his teeth the whole way, we made our way to IHK.
Although he still had pain when the dressing was removed at IHK, the fact that he bounced up from the table at the end of the ordeal and began shaking all the nurses' hands and thanking them for helping him...this witnessed to his changed situation. I felt the entire time as though we were in some sort of medical heaven. The nurses had gloves! Saline! Dressings! At no point did they ask me to go look for or buy supplies. At no point did they refer to lawrence as "difficult" or "stubborn."
I want you to know that the medical care at IHK for everyone else who walks through those doors is extraordinarily expensive--more like western medical costs. So it still begs to be asked--is our system really that much better than what I encountered through Lawrence's hospitalization? If we have endless supplies, endless specialists, the very best in pain control...but if these are only available to the wealthy, or well insured, or if a major accident or illness leaves a family bankrupt and destitute as a result of inflated costs..is the system really that much more just? I think not. And as a side note, the problem of arrogant medical professionals does not just exist on this side of the globe. Although I was just a friend to Lawrence, being on this side of the conversation in a hospital is daunting and demeaning. I cannot imagine how dehumanizing it can sometimes be for patients who see themselves at the mercy of the all-powerful white coat.
The end of the story is good (for Lawrence)..he will most likely regain full use of his arm. He is happy to be back in the garage where he lives with 11 other street kids, and when I last saw him yesterday evening he was practicing his trumpet with one good arm and asking intreguing questions about white blood cells and the immune system.
For the rest of this country, I'm not so sure. What does justice in medical care mean? Is there a road between shoddy but affordable (for some people) care, and high-quality but unaffordable care? Do we all deserve compassiate nurses and knowledgable doctors? What would it take to transform the hospital that I work in to a place where adequate care was given and recieved? I don't know...
Food for thought.
Instead, because he was in Uganda, in a hospital that didn't even have enough gloves to complete the dressing changes, he got various forms of pain meds depending on what the nurses could find--nothing was usually documented because there is usually one nurse for 20 patients and they are just too darn busy to document--and sometimes without much regard for whatever the doctor had bothered to write. Of course, in the hypothetical first-world hospital, he would also have been sacked with a bill probably over $10,000.00 for a stay of 10 days that included one trip to the theater (OR). Or rather, he wouldn't ahve been treated at all, since he is a street kid.
Over the duration of Lawrence's hospitalization I had bothered the nurses and clinicians quite a bit with questions about medications, dressings, care-plans, protocols, etc etc etc. However, when I came onto the floor on this particular day, a group of men I didn't recognize were gathered a short distance from Lawrence's bed, and Emily was standing protectively next to Lawrence--who looked like he was about to bolt at any time. Emily explained that one of the men had come over and started to remove the dressing as Lawrence slept--no warning, no pain meds. I did not blame Lawrence for looking ready to run.
"Have you brought it?" The leader of the white-coated men asked me. I was confused. What was I supposed to bring? Apparently he didn't know either. I'm guessing it was some sort of pain med, since he didn't seem to have any. My anger that had been building over the last ten days finally spilled over onto this nameless character. I looked him square in the face, and said "WHAT is your PLAN?" "Plan?" He answered, puzzled. "YES, your PLAN? PLEASE don't tell me you were planning to remove this dressing without pain meds." "It isn't about the pain," he retorted.
At this point I had had enough. "IT ISN"T ABOUT THE PAIN FOR YOU, BECAUSE YOU HAVE ALL YOUR SKIN STILL ON YOUR ARM. When was the LAST time he had any medicine?"
"What?" Mr. white coat was not getting me. I repeated the question, my face inches from his (really--i wonder--where do i get the nerve to speak to people like this? I really have no idea) I repeated the question again and again..to all the members of the group, to the nurse on duty. I sounded like a broken record. I was probably stamping my foot. Truly, for someone who took so long to develop documentation skills and who routinely called her workplace after midnight to ask people to document meds that she had forgotten to note...I was being a bit over the top. Maybe. At some point Mr. White coat asked me, "DO you have a medical background? Are you related to this patient?" I straightened up, raised my voice, and said, "I am a NURSE." YES. I don't think he was impressed, but I felt good.
At this auspicious moment my phone rang. My friend Glenda, who has a high-level job and connections in the city, and to whom I had poured out my frustrations with the hospital the previous day, had come up with a connection at IHK (internation hospital of kampala) where Lawrence might be able to get free (and much better) care.
With only the hint of a promise of a solution in my hand, I walked up to the group of doctors. They informed me that they would be taking lawrence to the theater to put him under general anesthesia for his dressing change. (THIS IS A SOLUTION? GENERAL ANESTHESIA?). I calmly informed them that they only place lawrence would be going was out the door, with me, and I kindly (!) asked for his discharge papers. They blinked once, twice, and filled out the paperwork within five minutes. Emily and I ran around collecting cash for the bill (in this blessed country, until you pay your hospital bill you are a prisoner of the hospital, unable to leave the grounds), paid it, and left. At some point in this frenzy of activity I remembered to ask Lawrence if he wanted to leave. His answer was to painfully hobble over to the door and ask for some sunshine. His grin was unstoppable. I knew we were doing the right thing.
We had to round up a taxi (the private kind, not the fifty-people in a fifteenpassenger van kind)and over bumpy roads, with lawrence gritting his teeth the whole way, we made our way to IHK.
Although he still had pain when the dressing was removed at IHK, the fact that he bounced up from the table at the end of the ordeal and began shaking all the nurses' hands and thanking them for helping him...this witnessed to his changed situation. I felt the entire time as though we were in some sort of medical heaven. The nurses had gloves! Saline! Dressings! At no point did they ask me to go look for or buy supplies. At no point did they refer to lawrence as "difficult" or "stubborn."
I want you to know that the medical care at IHK for everyone else who walks through those doors is extraordinarily expensive--more like western medical costs. So it still begs to be asked--is our system really that much better than what I encountered through Lawrence's hospitalization? If we have endless supplies, endless specialists, the very best in pain control...but if these are only available to the wealthy, or well insured, or if a major accident or illness leaves a family bankrupt and destitute as a result of inflated costs..is the system really that much more just? I think not. And as a side note, the problem of arrogant medical professionals does not just exist on this side of the globe. Although I was just a friend to Lawrence, being on this side of the conversation in a hospital is daunting and demeaning. I cannot imagine how dehumanizing it can sometimes be for patients who see themselves at the mercy of the all-powerful white coat.
The end of the story is good (for Lawrence)..he will most likely regain full use of his arm. He is happy to be back in the garage where he lives with 11 other street kids, and when I last saw him yesterday evening he was practicing his trumpet with one good arm and asking intreguing questions about white blood cells and the immune system.
For the rest of this country, I'm not so sure. What does justice in medical care mean? Is there a road between shoddy but affordable (for some people) care, and high-quality but unaffordable care? Do we all deserve compassiate nurses and knowledgable doctors? What would it take to transform the hospital that I work in to a place where adequate care was given and recieved? I don't know...
Food for thought.
posted by Christi-Lynn at 7:36 PM
1 Comments:
Hey, you go girl!! you get that keen ability --to "help" people see the main point-- from the Sampsons!! Keep seeking justice and advocating for the powerless!!
love you!
your momma!
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