Last Monday I was discharged from St. Joseph’s Hospital to home. Medical transportation was scheduled to pick me up at 11:30 a.m. The admitting nurse from the Visiting Nurse Association was to see me at home at noon. My home health aide, who has been providing care for about two hours a day since November, was to arrive at 1:30.
So the nurse who was discharging me came to my bedside. We had never before laid eyes
on one another; he was discharging a complete stranger. That’s stupid. A nurse who is familiar with the care rendered
to the patient should be the one doing the discharge to ensure that the right
things get written down. This guy keeps
handing me pieces of paper that I sign without understanding them. Who understands all the stuff they hand you
to sign in a hospital? They cover their
asses and we go blindly. Staff
repeatedly tell us, “Sign here; just sign here.” They get various levels of irritated if we take time to read and understand what we’re signing. Besides, I’m pretty foggy and wouldn’t understand it if I did read it. That
should be a red flag that the patient needs to be discharged with a responsible
party, but nobody cares. They want me
out of their bed, and the nurse wants signatures. I have been institutionalized long enough that I’ve broken down and don’t argue. I sign.
I did not see or sign the Clinical Services
Discharge Notes that the nurse filled out.
They were put in the file that was sent home with me, but I didn’t see
them until after I was at home. The nurse—James
D-something—wrote that I was being discharged to Rosewood Heights nursing
home. In fact, I was discharged
home. The nurse got it wrong. My mental status is listed as “Alert &
Oriented.” I was not. What I was was obedient. They should put that on their checklist and get honest about what the hospital wants and the patient provides. Further, according to what Jim has checked on
the Self Care section of the form, I do self-bathing. Fact:
I haven’t been able to do that at home in about year, and never did it
in the hospital. Well, who cares? The form is meaningless, right? So why are we bothering to fill it out?
The date the Foley catheter was last changed is
supposed to be given. Jim the nurse
didn’t. With a Foley catheter, you have
an increased risk of infection therefore, it has to be changed on a regular
basis. Instead of entering the baseline
date, the nurse writes in the margin that the catheter is “indwelling.” Is Jim really so ignorant that he doesn’t
know catheters have to be changed? He
doesn’t give anybody a clue as to when—and the patient is too confused to
remember when it was started. The Blood
Pressure and Pulse blanks have been filled in and then crossed out. Apparently I am being discharged without a
beating heart, but that’s okay, too.
Now, here’s the one that really gets me: the Discharge Notes are dated 8/15/11 and Jim the nurse has written in Date of Last Bowel Movement 8/2/11. If you are going to say I’m full of shit,
then have the courage to say it to my face.
If that is not the message, then what’s going on here? This man, this nurse Jim, is stating that he
is knowingly discharging a patient who has not had a bowel movement in two
weeks. Okay, Jim boy, when I’m rushed
back to the hospital for emergency surgery for a blocked bowel, I will for damn
sure sue your ass off. Fact: On 8/15, the date of my last bowel movement
was 8/15. So let’s have a little chat,
shall we, about the difference between a human mistake and gross
incompetence. Where is that line
drawn? When people make mistakes they
like to shrug it off with something like “I’m only human.” Alexander Pope wrote “To err is human; to
forgive, divine.” Anonymous wrote “To
err is human; to try to cover it up is, too.”
Some years ago, I kept track of various errors being
made by the American medical industry in its treatment of me. I found the error rate to be about 25%. If you were in manufacturing and had a product
error rate of twenty-five percent, you’d be out of business. Do it in medicine and it’s okay. You want to try it in the flight
industry? Destination: Chicago.
Ah, no, destination: Las Vegas. Oops, sorry. Last engine overhaul was on the 23rd. Well, no, actually, it was a month earlier. Fuel tanks were full prior to take-off. Um, no, actually, they hadn’t been topped off
since Cincinnati. Human beings are as
error-free as you require them to be.
St. Joe’s doesn’t give a damn how careless its nurses are.
The reason paper work was created was to transmit
information from the person who knows to the person who needs to know. St. Joseph’s hospital nurses knew when the
catheter was inserted; the home health care agency nurse will need to know when
to change it. St. Joe’s has not provided
the information. It is an unsafe discharge.
At home, the Visiting Nurse Association’s intake
nurse is perplexed and troubled by not having the information. He contacts his agency go-to person. She calls St. Joe’s but they don’t return her
call. When the regular nurse who will be
following me and changing the catheter comes a week later, St. Joe’s still has
not coughed up the date when the Foley was inserted. Gosh, somebody would actually have to read the chart and what fun is that?
Nine days after discharge, the visiting nurse tells
me that St. Joseph’s Hospital has informed them that the catheter was inserted
at 6:30 a.m. on July 29. I know for a
fact that is not true. Shift change is
at 7:00 a.m. At 6:30 a.m., nurses are
going around finishing up their night’s work, writing notes on patients, and
answering call bells as necessary. They
are not inserting catheters on a non-emergent basis.
Now I am remembering: The catheter was inserted by Brandiss, with
Teresa assisting, on a Thursday evening.
Brandiss had gotten her R.N. on Tuesday.
Thursday was July 28, and it might possibly have been around 6:30 p.m.