To be a patient...

[Eagle5US]

Once again, I have been humbled as a provider by experiencing poor patient care. If I had been my patient, I would have been infuriated once the tale of my care had been relayed.
Wait times of more than 2 hours for nausea meds, the hour of beeping when my morphine pump ran out because the nurse with the narc key and the pump lock code was "off the floor", the correction of a medication that woud not have occurred if I weren't a provider and the simple lack of common courtesy by the staff.
Of course, the staff needs to turn on lights to work in the middle of the night...what they do NOT need to do is hollar back down to the nurses station to "turn their tupperware in the microwave" from the back of the 4 bed semi-private room at 0230. Similiarly, patients needn't be addressed at the back of the room, from the hallway about needing to wakie wakie and take their medicine at 0415 when that one patient is the only one receiveing meds at that time.
The simplest things seem to have been overlooked...there are 4 patients in the room...4 TV's, 4 radios, 4 phones, and 2 chairs???
With the radios and TV's great idea, I don't want to watch or listen to PVT Tentpegs tv show...but since none of the other people brought headphones, turns out I was privy's to listen to all three of their TV's all night long, even while they snored. Which led to the :
"Hey Buddy, how about turning down or off your TV if you aren't going to watch it?"
to which their reply:
Well, I need the noise to sleep...:confused:
WTF?
The nurses were nothing short of deplorable and seemed inconvenienced each time they were remionded that my meds weren't only due...but were OVERdue.
Once again, perspectives have been adjusted, and hopefully, this will make me that much better of a provider.
Any other experiences to share???

Eagle

[Sacamuelas]

Eagle.. No stories about me personally. However, my little twins spent 13 weeks in the neonatal intensive care unit in New Orleans when they were born. This place was supposed to be THE place for the very early premies.

Anyway, I spent every night and every weekend over there during that time being with the little guys. Overall, I think we received excellent care. But I did catch one thing that would have been a fatal error if I had not been vigilant and well read/knowledgeable about things.

My little boy was on the jet ventilator (400 pulse breaths/minute- really cool device) because he had a persistent pneumothorax in his left lung. They had a chest tube and pleurovac hooked up for the pneumo. Well, they decided that they needed another tube placed farther anterior to drain the lower left 1/3. I demanded that the "guru" pediatirc surgeon come do it even though normally the neonatologist performs such a "routine" procedure. This guy gets there and puts it in. When I get back in, the boy is doing much better. I go home about 01:00 with a good feeling.

Well, the next morning I come back @ 07:00. XXXXXXXXX has not had a good night. AS I get in the NICU, the NP and nurse are attempting to irrigate/unblock the chest tubes from serous fluid accumulated in the tubes. As I am watching I notice that both tubes are connected with a 3 way connector before the main suction hose goes down to the pleurovac.. THe nurses tell me that he has been showing signs of decreased breath sounds in the lung. THey tell me they think the tubes are clogged and no suction is present b/c of it.

Well, I watch them attempt to clean the lines. THey remove one connection (actual chest tube to vacuum hose) while carefully clamping off the chest tube to prevent air flowing back into his lung. Then they place a large gauge syringe onto the chest tube and pull with a large amount of manual pressure to break the clot/while irrigating it with sterile saline preiodically. Sounds good right?

Well, one problem. The hose that WAS connected to the chest tube is laying there on the bed unclamped. It is still connected with the 3way to the other chest tube and the pump down below. EVERY time they placed negative pressure with their syringe on one chest tube, they were drawing air INTO his lung through the other chest tube.

I Freaked out, well professionally voiced my concern! LOL... called over the MD, the shift supervisor,etc. I explained the physics to them. After some initial attempts to convince me that I was wrong the light finally went off in their heads. They ALL fell silent, and the MD admitted I was right.. and they started apologizing and kissing ass. I was VERY pissed.. I found out that he had steadily worsened over the night b/c they thought his tubes were blocked so they had been irrigating/manually suctioning them all morning. THis whole time putting more air into his chest causing it to collapse and therefore lower his O2 sats.

This really scared the sh#$ out of me. I never believed that this kind of stuff happened in good hospitals. Moral of the story, if you or a loved one is going to receive medical care then you should be involved and educated. Never feel bad about asking questions or DEMANDING explanations. I made a few more corrections during their stay but that was the most dangerous one. To all nonproviders, I did not sue or press the matter after it was corrected. We are all human. I wish more people would think that way...

The boy... well, he did just fine after that... and now he is a 11lb 14oz recruit for the TS's early intervention soldier training program. As you can tell, he is a fighter at heart. LOL

[NousDefionsDoc]

Nice pic. I like babies.

I can't believe this stuff. What ever happened to taking pride in your work.

IMUA caught me treating people in the waiting room at Womack once because there wasn't any room in the back and I didn't want them to have to wait.

"While I admire your intiative and care for the patients, if the Colonel catches you suturing people in the vitals signs closet, we'll both be in trouble. Make sure you don't get caught. Carry on."

Eagle, what facility are you in?

[Eagle5US]

Originally posted by NousDefionsDoc

"While I admire your intiative and care for the patients, if the Colonel catches you suturing people in the vitals signs closet, we'll both be in trouble. Make sure you don't get caught. Carry on."

Eagle, what facility are you in?
LMAO...I have received many a similiar speech...
I was in Tripler...funny thing about it all...I only saw 4 uniforms the whole time...2 were 2LT nurses, and 2 were PV2...all 4 were squared away and cordial, but none were assigned to me...
All the "problem instigators" were civilians working the ward.

This is another point of contention that I have with the military medical system...
People routinely knock military providers for being less than adequate...when in fact, military providers are by in large some of the best in the country. Where we tend to get a poor label is in regards to all the civilians we hire for generally about 1/2 to 2/3rdwaht the local salaries are. These people are hired on cheap by the USG because they can't get or keep a job on the outside. I have seen this on my last 4 duty assignments. Shoot, when I was working the University Tramua center ED in syracuse, we had a PA get fired mid shift...he was THAT BAD, he had been fired from 2 previous jobs in the area as well...not 2 weeks later there he was, working in our TMC as a new hire...but again, he was hired on at about 46K a year as opposed to the 80K he was making at the University.
We (the military) seem to seek out the 10%'ers in order to save $$$...not a good practice.
Of course, we will see what happens once the administration gets ahold of the "letter of concern" that will be attache to my "would you like to share compliments on your experience" worksheet they gave me with my discharge.

Eagle

BTW...Saca, VERY pleased you had the right words to convince the crowd you were correct...that is a great picture!

[Doc T]

Originally posted by Sacamuelas



Well, one problem. The hose that WAS connected to the chest tube is laying there on the bed unclamped. It is still connected with the 3way to the other chest tube and the pump down below. EVERY time they placed negative pressure with their syringe on one chest tube, they were drawing air INTO his lung through the other chest tube.




I can not picture this in my mind as hard as I try....just cannot see how the set up is connected to cause this but I am sorry for your experience....

As you said, we are all human and people do things, somctimes incorrectly, with the best of intentions. Patients in the ICUs often cannot tolerate anything out of the ordinary and small things can quickly turn into huge things.

Eagle...I am sorry your stay was so awful...glad you have one to one nursing at home:D

[Sacamuelas]

Yes Ma'am. I agree with you completely. It takes special people to work under that kind of stress on a daily basis. Even after the incident, I feel very close to some of those nurses as they were almost family in there to us. We brought the little ones back to visit two weeks ago.... it was great and the staff loved it.

Just to help you picture this... here is a little aid I made. Sorry the original explanation was so confusing. I tried to reword it several times but it really takes a pic.

Below you will see a green chest tube that will be unattached and connected to the syringe for manual suction. As the plunger is withdrawn, it creates negative pressure causing air and fluid to move in the direction of the orange arrows. That is good.

The Red chest tube is the one that is allowing air back into the lung. AS you can see it is still connected to the blue/red hoses which 3 way connect into the pleural vac (PV). These connections have with no valves.

As you can see, the Blue/red hose is open to air from where it was disconnected from the green chest tube to allow for manual suction with the syringe. The PV is only pulling small amounts of air at -30cfm so its pressure to pull air from the hoses is negated by the open to air ending in the blue/red. Therefore, room air will travel in the direction of the orange arrows back into the chest through the red chest tube every time there is suction created by the syringe.

To prove my point, when they suctioned with the syringe they got unlimited CC's of air out of his lung. THey would pull 50cc's out... cap it and reset plunger and then pull another 50cc's out. Even that did not set off a warning sign that something was leaking air into this lung from somewhere other than his pneumo. Anyway, Doc T did that help? Hope so.


Sorry about posting a baby pic. When I talk about how sick the little guy was I get all mushy and crap. I will refrain from posting family/nonSF pics in the future Admins, I swear.

Eagle, I hope the complaint coming from you actually gets some attention. Good luck

PS- not all civilians are incompetent. I finished third in my class with special honors and applied/got accepted/ and I turned down specialty school due to family obligations. I work for the DoD because it is a honor and it is also 4 minutes from where I live. I get to treat guys for no cost so I get to do what is best for them, not what can be afforded.
I know you weren't shooting at me. But please remember, some of those civies may just be the real deal! LOL :D I thought I worked a pretty good deal with all the specialty pay incentives and retention bonuses. Damn, I think I am going to go feel sorry for myself now!! LOL

[Sacamuelas]

diagram...

[Eagle5US]

Originally posted by Sacamuelas
Sorry about posting a baby pic. When I talk about how sick the little guy was I get all mushy and crap. I will refrain from posting family/nonSF pics in the future TS, I swear.

Eagle, I hope the complaint coming from you actually gets some attention. Good luck

PS- not all civilians are incompetent. I finished third in my class with special honors and applied/got accepted/ and I turned down specialty school due to family obligations. I work for the DoD because it is a honor and it is also 4 minutes from where I live. I get to treat guys for no cost so I get to do what is best for them, not what can be afforded.
I know you weren't shooting at me. But please remember, some of those civies may just be the real deal! LOL I thought I worked a pretty good deal with all the specialty pay incentives and retention bonuses. Damn, I think I am going to go feel sorry for myself now!! LOL
1. Baby pics are cool as hell
2. He is already in training, so it counts as an action shot, (he is giving the camera that "you talking to me???" look)
3. Generalizations on hiring practices are just that, generalizations...we had an AD guy at Drum who retired as a PA, and came back to work at the TMC as a Civ...why? cause he didn't want to drive 80 miles each way to Syracuse like I did...he was a damn good PA too! He was satisfied with the salary he was getting, his hours, retirement check, and fed vacations...wasn't that he COULDN'T get hired anywhere else, there just wasn't anyplace else within his driving comfort range to hire him :D

Eagle

[Solid]

That's a beautiful baby. My nephew Kaylum enjoyed posing in the exact same way!
"Eyy... whatayouse, a coupla tuff guys, eh?"
:p

Solid