Case Study of Confusion


This morning in the hospital around 11:00 a.m. I met with the physician assistant, a rather pleasant, intelligent young woman who was working as a fund raiser for an out-of-state nonprofit, then she changed her focus, came to a New York State school, got educated as a physician assistant (PA) and came home to practice where she grew up.  (I should stipulate that “young woman,” from my age perspective, means “under 45.”  My parents were still calling my sisters and I “the girls” even after we started retiring from gainful employment.)  So this PA—this girl—and I had a useful meeting, discussed what needed to be discussed, and came up with a plan:  insulin shot before lunch, insulin shot before supper, and anti-pneumonia antibiotic after supper.  Then This Girl went down to the nurses’ station to write the orders around 11:30—and, yes, she had spent about half an hour with me.

No insulin came, but lunch did come around noon, so I just minded my P’s and Q’s, which has nothing to do with peas or carrots.  P’s and Q’s were pints and quarts that were chalked up on blackboards in English pubs.  Basically, the barkeep was running a tab for the customers and “minding your P’s and Q’s” meant you needed to pay attention to how much you were drinking.  I just figured that the nurses had not had time to take the PA’s orders off the chart and make them ready, so I ate my lunch and was a patient patient.  Patient, after all, means forbearing, stoic, tolerant, or uncomplaining—or a person under medical care.  It comes from the Latin pati, “to suffer.”  Keep that in mind as we move along here:  historically, a patient is a person who suffers without complaining.

The afternoon passed with getting caught up on emails, visiting with a friend, and taking a few phone calls.  Then I took a nap.  The deepest healing occurs when you are asleep, so I am working the program.  I woke up around 4:30 p.m., pretty groggy and slow on the uptake.  I am being treated for streptococcus pneumonia and diabetes mellitus with a glucose level that hit a high of 414.  It’s supposed to be 110.  The nurse comes for an “accucheck”; at home we call this “a finger stick.”  You poke your finger with a needle, called a lancet, drop blood on the strip in the machine and in five seconds—literally—you get your glucose level.  In the hospital, they start by scanning your name band to make sure you are you, then they do the stick thing, then they wait about two minutes to get the number.  Why the hospital’s equipment is so far behind the home equipment is beyond me.  Maybe because the pharmaceutical companies don’t make a profit.  Pharmaceutical companies basically give away home glucometers for free, then charge about $70 every couple months for lancets and strips.  They probably don’t have that kind of money-making deal with hospitals so hospitals don’t get the classy machines.  Maybe that’s why; maybe I don’t know.

My glucose before supper tonight is 294, which is pretty neat since it’s the lowest it’s been since I was admitted a few days ago.  I was admitted to the Emergency Department, then I was admitted to the Observation Department, then I was admitted to the Medical/Surgical unit.  I was in Emergency for eight hours and got no sleep.  I was in Observation from about 1:00 a.m. till sometime the following afternoon and got three hours sleep.  I have been in Med/Surg since then and have slept off and on.  In short, I no longer have the faintest idea when today is.  But that doesn’t matter because we were talking about the insulin that was supposed to be administered before supper.

The supper tray arrives at 4:50 p.m. and the physician arrives at 4:52 p.m.  The physician is a hospitalist, that is, a guy who is supposed to treat patients who are in hospitals, as opposed to private practices, group practices, clinics, or street corners.  He is the PA’s boss.  I tell him that I did not get the insulin before lunch or supper.  He says insulin comes once a day, either in the morning or the evening.  The PA had told me it could either be once a day or three times a day.  I chose the three-times-a-day version, gave her my rationale, and she agreed with it.  Giving people a choice is a really good thing; it is called freedom. It makes people feel good. The physician has no intention of giving me a choice.  He would rather skate on very thin ice with a person he’s only known for two days and who he could not say for sure didn’t have rabies and a history of biting.  Some things they don’t screen for.

Then the physician goes on to ask if I had any trouble tolerating the antibiotic today.  I tell him I haven’t had any today, only yesterday.  He says I did have it today.  I say no I didn’t.  He points to the bag hanging on the IV pole.  I repeat that it was yesterday’s.  He again insists it was today.  Finally I—being more of a scientist than he is—ask him if there is a date on the bag.  Facts, man; let us resort to hard, cold, verifiable facts.  Yeah, there is a date on the bag.  It’s yesterday.  So the physician trots himself down to the nursing station and comes back with the charge nurse and her computer.  A previous charge nurse told me that they are not allowed to let the computer out of their sight; where Mary goes, the lamb is sure to follow.

This is a new charge nurse; I have never seen her before.  I am very clear and very firm about what the PA and I agreed on, and how the plan is not being carried out.  The nurse is rolling her eyes and clearly treating me with disrespect.  The physician is showing signs of disordered thinking consistent with a diagnosis of schizophrenia.  And I am pissed.  What it comes down to is that hospital policy is that insulin is given after meals, not before.  And never freaking mind that the health care provider and the patient patient had good reasons for developing a different plan.  This is not about what is good for the patient; this is about what is good for the hospital.  In nursing homes they serve supper at 4:30 p.m. so that the kitchen staff can go off the clock by 5:00 p.m.  It’s about serving the employees union, not the patient’s comfort or pleasure.  (To be continued, one hopes.)

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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