I had an interesting time this past week in clinicals. I have always said that each week, a theme or lesson seems to prevail and that is what I usually end up talking about in post-conference. I kind of let the day’s experiences dictate our discussions. Those lived experiences are usually the most powerful, so I try to capitalize on them. Often times they are the more “soft subjects” that are not always easily learned from a book. This week was no exception and the lesson clearly was about the patient’s perspective.
I had a few very unique experiences as I walked the halls checking on my students. This quarter, my group is in their last group clinical rotation and are spread out through all the ICUs and the ER. It is like the culmination of all their hard work. As I was going from one unit to the other, I was walking down the hall of one of the med/surg units. As I passed a room, I could hear and briefly see out of the corner of my eye a patient banging on their bedside table. I knocked and entered the room to find a frantic, elderly lady pointing at her call light. Her distress was apparent and panic was in her eyes. I quickly realized that her light wasn’t working – it been pulled out from the wall. When I took a closer look at her, she clearly had a some type of radical neck surgery with a red rubber catheter draining from her trach stoma site. After fixing her call light, I made sure it worked and she was thanking me profusely. Essentially, she had been cut off from all assistance. No way to reach out to the staff for help. Left helpless. Such a simple task, but it was her life line to the outside world and I was beginning to feel a bit sorry for her. As I was leaving, she pointed to the white board where I read out loud, “Don’t worry, be happy!” She smiled so bright as I smiled back and I told her I couldn’t agree more! Such a simple encounter, with such a big lesson. Every action, big or small is important.
Later that afternoon, I was in the ICU waiting room essentially killing time right before post-conference. When I first sat down, there was no one in there, so I started to make my notes for this weeks clinicals. I was soon joined by an elderly couple. It became clear that their loved one had just come out of surgery and they were anxious to them. The charge nurse came out to talk with them briefly, letting them know the patient had just arrived and the nurse was settling her in. As I inadvertently eaves dropped in this room, it was clear the surgery was done emergently and the family was very concerned. Eventually, the family was allowed to go back to see the patient, however, when they returned they were clearly upset. I offered them some tissues, but they graciously declined. Shortly after, a code blue was called in that unit. I feared for the worse, but the family appeared to be oblivious. The surgeon came in and sat down with the family and explained that the patient was in full arrest. Although I have been involved in hundreds of codes, it still was sad to see the distress and sadness in this families face. It was obvious the surgeon was upset, but trying to be professional. He left them to return to get more information. When he returned to the crying family, he was happy to report they were able to revive the patient, however the condition would be fragile. As he was leaving, she thanked him for being so kind to them. It was such a touching moment. After he left the family, they were just left in their sadness. I knew in the unit, the nurses were doing all they could, frantically and efficiently running around. However, in the presence of their sadness, I couldn’t help but being overly sensitive to the people laughing in the hallway, the small talk around us and the sounds of business as usual. It all felt so insensitive to this family in such need.
When I arrived for post-conference, I was able to hear the other side of the story – the business side of saving lives. I was able to hear all that the student learned from the experience and answer her questions. However, I was also able to share the sadness of the family in the waiting room. The opposite of the rush and excitement of the code. Just the lived experience of the families perspective of almost losing a loved one.
Another one of the students proceeded to tell of his unique experience. His patient had been an elderly lady on BiPAP who had been a bit confused, but was now becoming clearer minded, yet still very anxious as most are who struggle to breath. The surgeon arrived to place a central line in the patient. As most busy surgeons, he came in like the wind and began the task. Although the student was very interested in watching the procedure, he was quickly aware of the patient’s distress as the sterile sheet was placed over her and her gown was raised to place the femoral line. It was the student who pointed out how terrifying this women must have felt. You see, the student was a male, African-American nurse, as well as the nurse assigned to the patient and the surgeon was a tall dark skinned male also. Humorously, the student pointed out how scared this “poor little white lady must have been with all these strange men in the room, pulling her clothes off and covering her with a sheet”. But, as funny as it sounded, he was right – she must have been very scared and I was so proud of him for recognizing her need. As much as he wanted to watch the procedure, he knew his job was to just calm her and talk with her during the uncomfortable situation.
So, as I left clinicals this week, I couldn’t help but to keep thinking about all these patients and families. I kept having this nagging thought that we can’t forget their perspective. From the voiceless patient who lost her call light, to the family receiving bad news as their loved one clings to life, to the frightened patient having procedures done – they all needed one thing, a caring person to help them. My student put it perfectly, “This patient advocate thing is REAL!” So as you go about your day, your career, your life, remember, we all have our own perspective, but the patient’s perspective is the one that really matters.
Make a difference, show you care and remember the patient’s perspective. Thanks for letting me share my musings.
Take care & be safe.