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Barrett Dorko
17-03-2008, 02:05 PM
It’s been a quiet week in Cuyahoga Falls…

“What season is it?”

I heard this question asked of a patient while I handled her leg last week. A young nurse stood above her, oblivious to my presence. We were in a large and crowded treatment area and I had commandeered a small portion of an elevated exercise mat upon which to work. The nurse had announced that she was going to ask some questions in order to find out how “oriented” my patient might be and, I guess, these questions couldn’t wait for therapy to end.

I drove through a cloud to see my brother Kevin last Saturday; the fog especially thick on the Ohio Turnpike where it crosses the Cuyahoga River Valley. I’ve made this trip countless times and always consider what the view at this point brings to mind. I’ve driven this way in order to celebrate many holidays, to begin hundreds of trips to distant cities and to witness various members of my immediate family as they grew ill and passed away. I usually see something that leads to something else, perhaps from a book, or my life. If I’m lucky, something I might write comes to mind. On Saturday I could only see the white vapor that enveloped my car and slowed my rush to see my family and my old neighborhood. I couldn’t see a thing, and my patient’s answer came to mind.

On the day the question about the season was put to my patient the sun shown brightly through the large windows that overlook Cleveland from the department’s perch on a hillside above it. A heavy snow fall a few days before had largely disappeared - people were shedding their coats and gloves. But it was early in March and more Winter is surely ahead, perhaps a lot more.

The nurse’s face remained perfectly still when she heard my patient say “It’s Spring,” waving her hand toward the windows and using a tone that indicated the questioner wasn’t too bright. I thought, “Today this isn’t a fair question, but I’m pretty sure this woman will be labeled “confused.” But in light of all that’s occurring at the moment I knew I was the confused one.

I said nothing. Despite the fact that I was in the middle of a treatment with this woman it was clear to me that my presence was irrelevant. This is a feeling I need to get used to if I am going to continue working in these places. Oddly, I feel I can do it without much effort, and I wouldn’t have predicted that.

On Saturday I could see nothing until I reached the other side of the valley, but my patient’s answer came to me and I remember looking into her eyes once the nurse had walked away. She shook her head a little and I raised my eyebrows.

We were both thinking about that question.

Mariette
17-03-2008, 06:41 PM
Thanks Barrett
This is so appropriate in my current situation. It is summer and today was extremely cold and rainy. When considering that I live close to a desert I am confused as to what season it is. In my work too. The irrelevance with which other health professionals regard my presence and that of my patients helps to keep me confused.
You are such a good writer. I'm on the opposite side of the world and I'm sure you sometimes mean something totaly different, but I always get something out of it.
Regards
Mariette

Barrett Dorko
18-03-2008, 01:32 PM
Marriette,

Thank you. You "get me" and that's not always a given when I just allow myself to write as I did yesterday.

smikolic
19-03-2008, 01:16 AM
Mr. Dorko,

Today I thought of your story. I was working with a woman on her exercises and a nurse came into the room to give some medication through her central line. This without a word to either of us.... She was talking to some other healthcare provider on her hospital cell phone while looking something up on the in-room computer and then she scanned the patient's arm band, the medicine bottle and proceded to give the patient her medicine and leave the room without ever regarding me or my patient beyond a computer chart, an arm band, and a central line. As I was taking this all in, a girl from the lab came in, said, "I am going to take your blood" and proceded to do so, all the while the patient is trying to concentrate on her exercises.

I couldn't believe what I was witnessing. It could have been anyone, or anything in the bed. I was so lost as to how the person can get lost behind their hospital gown to so many other healthcare providers, beyond the rudeness of interrupting the patient's exercise session. Confused seems an understatement, but I have no better way to express my feelings. I wanted to scream, or to cry.... No wonder patients become depressed and disempowered in a hospital.:(

nari
19-03-2008, 01:57 AM
One day I gave a response to this problem of non-existent PTs and patients. The nurse came in, said what she was about to do and I said: "Do you mind waiting for a moment?" in a rather irritant tone.
She looked totally surprised, but did wait.
Afterwards she apologised and said that I could have continued with what I was doing, etc, it didn't matter. My response was that it did, and explained why.

She never did it again.

Nari

smikolic
19-03-2008, 07:02 PM
Nari,

Thanks, I really didn't know how to react to the situation. I am the new one there and I realize we all have important jobs to do for the patient. I didn't want to interrupt the nurse's phone call (even though it was taken in the patient's room), and I really didn't know how important the medicine was or anything. I didn't want to be rude, even though they were seeming rude to me.

I will speak up next time, in a nice way, and explain why the patient and I need them to wait, at least until we are done with our set of exercises or whatever. I don't think my CI would mind me speaking up as long as it is in a nice way, and I really doubt the patient would have minded me saying something, she was the one really being interrupted. What really bothered me was their seeming lack of regard for the patient. The didn't say excuse me, or ask if it was ok with her they did their thing. I was surprised and confused at that I guess, as well as feeling offended for the interruptions. Thanks though, I will try to gently be the change I want to see...perhaps open some eyes to a little different perspective in the process.

Steph

Jon Newman
19-03-2008, 07:29 PM
Some medications are scheduled and have to be given within a narrow time frame or it will be considered a medical error so that may be part of what was going on. The lack of communication could be explained in a number of ways. For example, the nurse could have just been in prior to you and already explained to the patient what was going to happen as soon as the meds came. It could also be learned behavior. Our practice environments change us, some more than others and the not always in a desirable direction.

nari
19-03-2008, 10:05 PM
I can certainly appreciate nurses have some tight time schedules; perhaps it is a matter of courtesy. A simple "Do you mind if I do -----, for a few minutes?" would be fine. The assumption that what they do is more important than what anyone else does doesn't go down well; but it only applies to some nurses.

Nari

Jon Newman
19-03-2008, 10:28 PM
Oh I understand. I've had sessions interrupted by far less (according to me) urgent things.

nari
19-03-2008, 10:57 PM
Perception of priority is in the brain of the beholder...;) isn't it. In the acute setting particularly.

Nari