Monday, February 19, 2007

How to Survive Hospitalization

From Dr. Kildare and Marcus Welby to ER and even House, we have been indoctrinated to believe being admitted to a hospital is the equivalent of a spa vacation. It is a place of miracles and the unwavering attention of an unending staff of doctors, nurses and orderlies who eagerly put their own lives on hold to cater to our every need, medical and personal.

In TV hospitals, every room is a bright, airy private suite. Nurses' stations, hallways, elevators and labs are clean and perfect. The staff never yells in the halls (especially at night) or bang carts or gurneys into walls, beds or doors. And, of course, every nurse and doctor has memorized every patient chart and never make mistakes.

TV patients smile bravely or complain incessantly, treat the staff with friendly respect or rude dismissiveness – it doesn't matter, they have no active role in their own care. Instead, everything is in the hands of a perfect staff, each of whom speaks the native language perfectly.

In the real world, anyone believing this TV fantasy is reality is in for a rude shock; which is not to say there are not excellent hospitals and dedicated, skilled medical professionals working in them, but neither can come close to the Hollywood image. It is the responsibility of every patient to take common sense steps to assist those caregivers, ensure a personal understanding of what is happening and deal with certain situations – at least initially – on their own.

The first step is to create a journal, entering the date, time, individuals involved and details of everything that happens during your stay, from trips to X-ray to the nurse bringing you a pill. Before going to the hospital, if possible, pack a "Sanity Survival Kit":
* A good sleep mask (the lights never really go out)
* A good set of ear plugs (the old days of quiet hospitals are long gone)
* Two sets of pajamas (light robe optional)
* One pair of slippers
* A notebook computer, with DVD drive, loaded with your favorite games, work you will obsess about if it's not done, projects you've been putting off, even some movies you've been planning to watch * A DVD player (if you don't have a computer)
* An MP3 player loaded with your favorite songs (one that doubles as a radio is even better)
* A comfortable headset that will plug into everything, including the hospital TV or bedside controller
* A cell phone with headset
* An ink pen and notebook
* Magazines and paperbacks
* Packets of instant tea or coffee
* A spice bag (salt or salt-free substitute, pepper, sugar or substitute, packets of ketchup/mustard/mayo, Tabasco/soy/pepper sauce)
* Plastic toothpicks, the kind with built-in floss.
The above can, of course, be provided or replenished as needed if you have someone who can bring things to you. If not, take enough to last a full week. Entering a hospital room as a patient is not unlike climbing into an unfamiliar rental car.

Just as the wise driver checks and adjusts the mirrors and locates light switches, the incoming patient should run through a hospital room checklist:
* Find the nurse call button, make certain it works and secure it (most have clips) where you can quickly find and use it in the dark
* Do the same with the bed controller
* Locate all electrical outlets and ask a nurse which you can use and for what
* Make sure your room phone is easy to reach – sitting or reclining – give a friend or relative the hospital phone number and your room number, find out if you have a private line or share it, what you will be charged for calls and how to dial out
* Check TV/radio controls and whether you have a private set or share it; if the latter, come to an agreement first thing on how you are going to share control – and deal with volume issues, whether you share a TV or each have your own
* Check out the bathroom, make sure you can get in and out (especially if you are dragging around an IV pole), locate the light switch, door lock and emergency call chain and check for a second door – in some facilities, two rooms share a single toilet; if there is no shower, have someone show you where to find one
* If your room opens onto a balcony or patio, ask a nurse about access, how to lock it for security, how to open and close any drapes or blinds and what the use regulations are (especially for smokers)
* If you are using any medical equipment (IV, oxygen, etc.), find out if and how you can disconnect or turn them on and off when walking to the restroom
* The hospital should take an inventory of your belongings and offer to lock up valuables; if they do not, ask about it and provide your own list
* Never leave anything of value in plain site (especially computers, cameras, watches, etc.) – neither you nor the staff has any control over other patients or visitors
* Make sure you have a box of tissues close by
* Request fresh water at least twice a day
* Ask to have your tray table disinfected and cleaned in your presence; if you leave your room, have this procedure repeated – you have no way of knowing what, if anything, may have happened to that table while you were gone (visitors and even orderlies have been known to place soiled bed sheets on a tray table, then forget to clean it afterwards)
* Always use the paper toilet seat cover and always wash your hands afterward with sanitizing soap; remember, it isn't just you, but every other patient and visitor
* Check that all tables, drawers, chairs, etc., are in good shape and ask for replacements if not; some hospitals allow furniture that has fallen apart to remain in "service"
* Always check everything you want on your future meals menu, even if it says you will receive some items automatically; also check your selections against you actually get, especially if you have informed the dietary rep (who should have interviewed you on admission) of what you cannot eat or drink; it is not uncommon for foods clearly marked as forbidden due to allergies or medical restrictions to nonetheless be placed on your tray
* Write down the names and shifts of every nurse, orderly and other staff with whom you have contact
* Get the business card of any new doctor you see, then note what he or she said or did and the date and time of the encounter
* If not offered, insist your bedding be changed at least every two days and that you be allowed to take a shower or sponge bath every day (it is not unheard of for patients to spend up to a week in a hospital and never be offered an opportunity to bathe)
* Always tell a nurse or doctor about any unusual bleeding, bruising, itches or pains, both at the time you are admitted as well as any that develop while you are hospitalized
* If a doctor recommends or orders any invasive procedure, ask for a full explanation of why it is needed, what is involved, how long it will take to recover, what restrictions will be imposed during recuperation, what the risks are, if it is fully covered by your insurance – and then request a second opinion from a doctor of your choosing. Your insurance company should both insist on and support you in this (if not, find a new insurer). If a doctor balks or implies you should rely entirely on him or her, you definitely need a second opinion
* Before being released, pack or oversee the packing of your belongings, check everything against the list you made when admitted and immediately report any discrepancies
* Make certain your regular doctors get a full copy of your hospital record
* When the bills come – probably separately from the hospital, each doctor and every lab involved in your care – check them carefully against your journal and the cards you collected; billing errors are common (most of them honest mistakes) and should be reported immediately to your insurance carrier.

This may seem like a lot of work, especially when all you want is to forget everything and have someone take care of you. Unfortunately, the best protection may be what you provide for yourself. But even if the actual need is rare, one or more of these steps may be the difference between a safe and secure hospitalization/recovery and something less. But in all cases, common sense actions, such as locating your call button, are vital to making the best of an otherwise bad situation.

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