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Tuesday, October 14, 2008

Meta: Light Blogging

Milagrito and his hoomin, Sirenita Lake, have not blogged lately, and want us all to know why:
I've just had a total left hip replacement. The hip hadda go. It was all gnarly and knobby and cartilage-free. No question, its day was past. Plus, I am the greatest candidate for surgery. High threshold of pain. Lots of extra muscles for getting around using one less limb. Unfailing appetite. A squirrel-like compulsion to store food on me and in the fridge. I had a world-class surgeon, a big noise down at Stanford and apparently on other continents as well. Everything looked auspicious so I went for it. Except for a bout of anemia from blood loss, I breezed through the surgery. The hospital was another story.

I spent three days in the Girls' Reformatory known as Stanford Hospital and was paroled on Thursday. Stanford is weirdly dysfunctional, but there were some bright lights. Here are a couple of my favorite nurses.

The girl on the left was the smartest on the floor, knew fucking everything. The girl on the right was my favorite of all. She was new and inexperienced, but she did her tasks like someone who had read the manual the night before. We supported each other. They came together to start a new IV on me, the experienced nurse there to supervise the new nurse. I'm a great medical dummy — it's almost impossible to hurt me with a needle. It was a stress-free moment for everyone. I shot the picture after success was achieved.

The other picture shows a strange man indicating the array of amenities and decorating touches that brightened up the room, especially since I was cut off from the window by a drawn curtain between my bed and my roommate's.

The woman in the next bed and I communicated through the curtain. She was a crime victim, which I suppose explained why I was confined to a narrow tunnel of curtains the whole time. Nevertheless, we spoke. She told me how she had been hit in her car by a reckless driver, and her little boy killed. She had numerous broken bones and a head injury.

Cops came to see her, and relays of doctors, and about 30 discharge planners. (Which is how I know they have them, since none ever came near me.) We became allies, to the limited extent possible in the environment. We sneered at the nurses who scolded her for not being able to pee. "You didn't pee! The patient didn't pee!" The cry would be taken up by others — "The patient didn't pee? No, she didn't pee!" — and then nothing would be done about it. Hollering and getting excited seemed to be the protocol for handling most problems.

My roommate and I checked on each other and pushed the call button when the other needed something. The third time my defective oxygenation meter alarm went off, I angrily called the station and informed them that I was disconnecting it because my roommate was not getting any sleep. When I was ready to leave, dressed and up on my feet, I finally went around the curtain and held her hand for a moment and wished her well.

As a patient, you are at the mercy of the nursing staff. What I found amazing was how much individual personalities determined the standard of care. Not just how careful or smart someone was, but whether they needed you to be passive, dependent and submissive, or whether they could actually look at you as an individual who had achieved a certain level of recovery and was entitled to a bit of autonomy and privacy, and who could call out her own issues.

I argued for hours that I could no longer stand the Foley catheter, that it was a size too large and positioned in an irritating way. I was told, in different ways, that the world would end and I'd never pee again if I had the Foley out. I finally threatened to get a bladder infection on the spot if they didn't take it out immediately. So they did and washed their hands of me. Spouse and I got me to pee in two seconds with a glass of warm water. The nurses in the picture are among the good ones, not only because they don't need you to be a pitiful, dependent recipient of their charity, but because they don't fear that the universe will tip over if you change a procedure a smidgen.

The other thing, besides the primacy of personality on the floor, that made my life miserable was the lack of charting of changes and progress and the assessments that supported them. One shift would determine that I could stand up and walk, the next shift thought I had run amok when they saw me on my feet. One shift decided to take off the compression stockings, the next shift asked accusingly, "Where are your stockings?" as though I had absconded with them. The PT girl checked me out on toilet use and determined that I did not need a seat elevator as I was very short, and that I was able to lower myself safely onto the seat.

The next day, the OT girl burst in on me on the toilet, throwing open the door to the crowd in the room, because I might be in terrible danger. God forbid I should take a piss on my own and in privacy. She said brightly, "I've come to help you!" and I growled, "I don't need help, I know how to pee. Go away!" I must remember next time to bring stakes to drive into the hearts of the cheerful, intrusive ones. Doesn't anybody chart things? "Patient passed all tests and is now qualified to pee on her own. Signed, dated." Every bit of progress I made I had to defend against the incoming shift.

We sneer at American culture, if any, but when you're in the hospital you really notice that American notions of privacy and independence are lacking and that your nurses often come from cultures where a woman in the hospital has no voice, where the more fussing a nurse does, the better her performance.

The last night in the hospital, I got a horrible pain from an irritated nerve. After a couple of hours of trying to convince Judy, my Filipina nurse, that I needed something other than a Vicodin, I finally fell asleep in spite of the pain, only to dream that I was at a loud party where everyone spoke Tagalog.

I woke up and thought groggily that the noise must be coming from a TV. The third time I had the dream and woke up, I noticed the clock — 11:00 p.m. — shift change. I jolted awake with anger — the incoming shift was hollering their greetings and raising the dead, such as me. I thought, screw Judy, I'm chewing those girls out. I pulled myself out of bed and stumbled to my walker, which Judy had placed out of reach so I could not stand up without calling for help. I was arranging my tubes and lines and ready to undock the mothership (it's not your mother's IV stand) when Judy herself came in.

"You're up!" She was shocked, but I beat her to the scolding. "I'm going to tell those nurses to pipe down. This is a hospital, not a party!" Judy saw the justice of this and said she would go herself. She even forgot that I had been practically AWOL. The noise level dropped and my pain level climbed, until it felt like every muscle in my left leg was spastic, though it might have been an artifact of a nerve irritation. I couldn't lie still. They had my legs spread apart by a thing like an enormous cheese wedge, no relieving elevation, no room to move.

I was imagining a long night of gritting my teeth when in walks Catherine — baggy pants, t-shirt, long graying hair. An old hippie! I'm saved! The first thing she did was unhook me from the IV, which was only pumping fluid that I did not need. I told her the problem and she went to try to get an order from the doctor. He didn't answer.

At a certain point, I could no longer lie in the bed, and my walker and I went to the nurses' station. I had realized finally what I needed was something specific for nerve pain, and I told her exactly what and how much. I leaned on my walker by the nurses' station looking like the Ghost of Christmas Past, waiting for a response from the doctor. I watched Catherine struggle with the computer system with only grudging help from the younger clique and gathered she was a registry nurse.

Finally, I stumbled back to my room and Catherine followed soon after. She had been unable to order the required drugs in the required dosages using the computer, so rather than make me wait, she went to the cupboard to see what they had and was able to make up the right dose by cutting one pill in half and getting two of the other. A nurse that used her head! A nurse that told the computer to get fucked when it wasn't helpful. An independent-minded American nurse!

The best thing about being in the hospital is that you get to leave — on your feet or in a pine box. By the time I left, I didn't much care how. I'm home now. My leg is fine. Tends to swell, but I can walk up a storm and the weird pain never came back. I bought a couple of decent years of walking around making trouble, and if some of the nurses thought I was a problem and a mystery, a couple thought I was a model of guts and strength. I hope someone fixes our hospitals, particularly by reintroducing the good old Western values of privacy, independence and autonomy for patients, to the extent that it's clinically feasible, before I go in for the next surgery.

Sirenita Lake

Well, darling, great to hear you're still able to live up to your reputation as a TroubleMaker. Hopefully Milagrito has all he needs by way of cat treats so that he will soon be inspired to write a rantish sort of post. La Casa de Los Gatos appears to be suffering a bout of sleeping sickness brought on by gimpy limbs and autumnish weather and pain meds. At last count, stretched out sleeping around the foot of the bed, Zingiber, Madu, Gustav, Gojira. Bandicoot's probably outside gathering baby slugs to use as belly decor. He's SO not into piercings. Maybe we'll make him blog.

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At 2:03 PM, Blogger nunya said...

I will never forget how fucking irritated I was with the Filipina nurse when I had my kid, who is 19 now. I was irritated with the constant "do you need something for pain, do you want the epidural, bla blah blah?" anyway, yeesh, it took 4 freaking hours, how bad could it be? So, every time she brings the kid in she says "Ju need to peed de baby." and hands me a bottle of formula, and I explain that I'm going to nurse. The fifth time the bitch came in and said "Ju need peed de baby," I grabbed the formula and shoved it in the kid's face and yelled, "See? I'm PEEding DE baby." The nurse bailed and the formula went clunk in the trash can.

Sometimes they're just control freaks and ya gotta humor 'em.

Godspeed love :)

At 5:29 PM, Blogger One Fly said...

It must have been so good to get home. My best.

At 6:16 PM, Blogger sgtg said...

wow - what a great story. makes me start reliving my c-section experience - which was fucking dreadful. it was 18+ years ago but i never really got it all off my chest and it still just pisses me off. and yes, you are the surgery queen.

At 9:18 AM, Anonymous Anonymous said...

So glad you are free of the hospital! A few years ago, I helped a friend and mentor as he went thru this process...being his home helper (he lived alone) so he COULD go home after three days. Yay, home! Yay, PT NOT in hospital!


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