Hospital experience


Friday June 15, 2007

After several days of restless sleep, dehydration, and both physical and emotional stress, I have stepped out with more knowledge than ever of the crazy world of the ER and the County Hospital. It’s like a feeling of deja vu. You see a nurse one day wearing extremely bright pink top and blue scrubs one day and the next morning 12 hours later, it’s the same nurse with a different outfit on. Only this time, she’s working in a different area of the ER with other beds/patients.

Having an ER that have prison wards and psych wards can be extremely overwhelming and exciting. The last thing I remembered was the nurses yelling for people to clear the hallway, when in my mind I am still upset about how visitors cannot sit in a waiting room but have to roam around in the hallway to begin with. Little inefficiencies here and there that could be fixed. Having an incompassionate security guard in an emotionally charged entrance does not help any. Visitors of all races crowded around just to yell at her and she’d yell back, but everyone complied anyhow b/c that was the security’s job. Well, frankly none of the other security officer behaved or reacted that way. They only aggrevate visitors more by behaving the way she did. I think we GET IT, no need to yell at visitors.

Cardiology is an amazing field.  The Indian Dr. who saw us in the ER came again to do two procedures today. She was amazing and I loved how she smiled back at my little comments and when I wave at her when she is going into the elevator. Her teammate’s pulling the patient bed and her pushing the bed from the patient’s feet with her butt sticking out and her feet pushing the ground, was a sight to see. She was a little lady with such bright, intelligent eyes, with inner strength coming from a powerful will to care for her patients. While the residences could not stabilize a HR of 159 that lasted all night, the Cardiology doc came down and slowed it down enough to see atrial flutter with weakened and enlarged ventricles. It was just beautiful the way she knew how much to put in and not overdo it.

Though atrial flutter is not life-threatening and is treatable….

How do you know when this type of atrial flutter is serious?

When it’s a congestive heart failure that leads to kidney damage, shortness of breathing (dyspnea) and orthopnea (lying down difficulty breathing), anxiety, pitted edema (swelling in the leg, scrotum, and stomach; with as much as 20 lbs of water retained inside the body from the waste down, undrained), high blood pressure of near max, and a heart rate that beats 150s and it remains high even after drugs have been administered to slow the heart down.

So much was given: diuretics (lasix), cardezim, esmolol, calcium bicarbonate, and anticoagulants (heparin), and several other things etc etc etc. You know, to lower blood pressure, lower heart, get fluid out, and to prevent stroke due to potential clotting in atrium of heart with no where else to go, sends blood into brain.

Medical ward and ICCU were using different heart meds. One type damages the kidney more than the other. Medical ward was using Cardezim (calcium channel blocker) and ICCU used esmolol (beta-blocker). If ICCU gave him digoxin, that is the one that messes with the kidney. So far, I don’t think he got that one yet. Hypertension and long standing high blood pressure kills the heart and kidney. Foley catheters look so painful for men. Why don’t they just numb it with anesthesia next time instead of trying to put it in? Seriously,….

ICCU holds more men than women.

I’m tired today, but I fought to understand and translate what transesophageal echo (more than 30 mins. setup and do) and cardioversion (2-3 mins.) is. Let’s just say, since it’s elective cardioversion, we are resetting the heart to its normal rhythms under general anesthesia and in emergent cardioversion, you are jumpstarting the heart w/o time for anesthesia. The best way to get a patient to accept it is to explain it, not force it upon them and say: “you have to do this. You have no choice.” Especially for the stubborn ones, I guess. I don’t know, maybe it works differently for different people. Just hoping a radiofrequency catheter ablation procedure will not be required.

At least I know someone’s hospital phobia has decreased as a result. Knowledge assymetries and language barriers can make hospitals a very scary experience. Hospitals should reconsider changing some of its policies if a language barrier arises and the patient is in ICCU requesting for one family member to stay with them. It takes a while to go get an interpreter and sometimes the patient doesn’t even trust the interpreter. [Today, after having become a Medical Translator, I realize the importance of translating everything appropriately to the patient. Family members may not have the vocabulary required to completely translate a form and could even withhold information from the patients. So there are multiple sides to this story.]

I’M BEAT but know I’m ready for this. nite for 5 hours.

Posted 6/15/2007 at 3:37 AM


Tuesday June 12, 2007

I have spent 20+ hrs. in the ER and the last 3 days at the County Hospital in L.A., one of the nation’s largest teaching hospital staffed with 870 residences! (It will be several more days before it is over). Just being in a hospital long enough gives you a little taste of the difference between the public and private hospitals. This post is triggered by innerspark’s post about Pharmacists wanting a little “RESPECT”. Everyone at the county hospital seem to be very friendly to their patients and to one another. Staff appear to be a little bit better trained than the 2 private hospitals + 1 VA hospital that I have been to (either volunteering in or experiencing in some matter).

Nursing staff can sing songs and hum all they like here. And while the hospital is not a hotel, patients obtain so much generous care. I guess without the full limitations of capitated use from managed care, lawsuits from negligence and malpractice, and the idea that patients can’t get what they can’t pay for in private outpatient clinics…. doctors and nurses can just focus on providing their patients with the best care possible and follow the Patient’s Bill of Rights.

I assume there is more I will see in the following days and have horror stories exposed (and explode into my face) one day to change my mind, but I think I know where I would like to be a part of for a while.

And, national health insurance is extremely valuable to this country. It cannot be emphasized more and only ’til you are losing someone dear to you b/c you cannot afford healthcare, will you realize the significance of getting equal treatment options.  Lol, this is why the L.A. County Public Health Dept goes in debt.

Without coverage, those who are uninsured, e.g. in the case and example of illegal immigrants, use the emergency room services. In California, the Department of Public Health in Los Angeles County suffered a deficit of $1.2 billion dollars basically putting public health care in L.A. on life support and leading to closure of clinics, trauma centers, and emergency rooms (Fox News, 2005). In 2004, L.A. County spent $340 million to treat the uninsured, which is roughly $1,000 for every taxpayer. Today, the problems continue.

Reference:

Fox News (2005, March 18). L.A. emergency rooms full of illegal immigrants. Fox News Politics. Retrieved June 7, 2007, from http://www.foxnews.com/story/0,2933,150750,00.html

Posted 6/12/2007 at 2:27 AM

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