Saturday, October 29, 2011

A Safe Place

Patient safety.  What does that mean?   Simply put, keeping the patient safe... duh.  Not killing him.  Not making him worse.  You would think that this would be simple.  It's not.

There is an article in the Washington Post addressing recent deaths linked to platelet transfusions from blood donated right here from Bethesda.  Someone didn't properly scan the blood before it was sent out.  You would think that something so simple and avoidable would never happen.  But it does.

Mistakes like that happen everyday, in almost every hospital.  Does that excuse it?  Hell to the no!  People's lives hang in the balance so extra care needs to be taken to ensure that mistakes like that are NOT made.

In the PACU today, after the dressing and wound vac change, when Derek was getting ready to be transferred to the ward, the nurse removed Derek's nasal canula for his oxygen.  Krystina asked him what he doing, and he said getting him ready to transport.  The nurse did not know that Derek was on oxygen 24/7.  Why?  If Krystina was not there, what could have happened?  Derek might have been fine since he was fine the one time when the oxygen was not hooked up properly after he returned from a jaunt in the wheelchair, but he might have desatted like he did when we tried to wean him off oxygen a couple of days ago.  This would have occurred while he was enroute, and no one would have noticed until he was on the ward, set up and vitals taken.  The patient transport people are not the brightest bulbs in the box since they cannot even steer the bed and take out doctors and unsuspecting walls along the way, so would have have noticed the patient in distress?  It could have been disastrous.  Would Derek have said something?  Probably not.  Was he asleep?  Bottom never should have happened.  The nurse should have known the patients needs.

The fact that this happened while I was meeting to discuss patient safety is ironic.

It felt good to actually be out of the room today, but my mind was with Derek, wondering whether there was something happening.  But I did get out, twice.

The first time was for the aforementioned meeting on patient safety.  A friend and I simply talked about what we see from a patient's perspective and where we see improvement is needed.

What did we say?  First of all, we made sure to point out that the primary doctors are wonderful.  The medical staff is top notch.  When I have brought my concerns directly to Derek's primary doctors, Dr. Perdue especially, action was swiftly taken to correct the problem.  I have no issue with how it was handled once it was brought to someone's attention.

Most of the issues I have had is with communication, and my compatriot had similar experiences.  Covering doctors do not always know the patient, and they enter orders when things should be left for the primary team.  My problem with one team in particular is that the interns, residents and staff doctor are all on different pages when it comes to Derek's care, and no one seems to know what is going to happen in the OR next week, or even on what day, since one of Derek's doctors showed up today and told me a day that is different than what I was last told!

We have growing pains because of the Army and Navy coming together.  They are each wonderful, and they are each top level care providers, but they have two different and distinct ways of doing things.  I see it in something as simple as setting up the supplies.  The two need to stop bickering like children over a box of toys and learn that there are enough toys in the box to share.

We also brought up mechanical issues, such as heavy doors that are not wheelchair friendly and do not have wheelchair accessible buttons, elevators that are always out of order limiting a patient's ability to get to PACU and other areas of the hospital, sidewalks with large spaces that cause wheelchairs to topple, the grade on the slope between McDonald's and Building 10 (the main hospital) being so steep that I watched a man in a wheelchair slide back down three times before he gave up and went a convoluted way all around the country, etc.

It felt so good to be out there, doing something, and feeling like I was actually making a difference for these guys.

I returned to the room to find Derek in good spirits and Krystina under the weather.  Derek is getting better, so it is okay for me to escape for a few hours.  It felt good to be away from the hospital, and I even attended the Aleethia dinner tonight.  Every Friday night, the Aleethia organization ( provides dinner for the wounded warriors and their families.  Krystina and I have not been attending, because we have not wanted to leave Derek alone.  Team Allen was present, who amaze me to no end, and it was wonderful.  I cannot wait until Derek is well enough to come with!

On the note of yesterday, I was told today that the blog issue is dead....for now.  The powers that be have decided that I have a right to do this.  Your point?  I knew that.  If they had decided otherwise, there would have been a fight.

When the issue was raised to begin with, what were they afraid of?  If I took my story to the front page of the NY Times, should it matter?  They should be providing stellar care to ALL of our wounded warriors, as well as the other patients, whether or not the patient is there alone, whether or not there is an advocate like me with a big mouth standing there yelling, whether or not there is a blog reporting what they do, and whether or not a camera crew is following them around!  They should ALWAYS act like it is an episide of Real Life Bethesda and a camera crew is looking over their shoulder.

So, at least for now, I can put aside the fight over the blog.

Krystina made me fall in love with her all over again.  Derek was playing around with her and pulled off his sheet, danced and sang, "Wiggle it, just a little bit."  Remember, his left leg is gone from the hip, his right leg is gone from high about the knee, and he has pins in his hips.  Krystina laughed and told him to put the sheet back.  He looked down and remarked that the right leg was higher than he realized, and he asked her if it was hard for her to look at.  She told him she has been looking at it for 13 weeks (14 weeks since his injury, 13 weeks tonight in Bethesda), and she doesn't care.  He apologized to her and said he was sorry if her life was different.  Krystina, this wonderful, strong young woman told him that he was lucky to have his little stump because it could have been as high as his left leg and then it would have been harder for him to walk.  At least with what he has, it will be easier on him.  She didn't care about the impact on her.  She was worried about him.  This girl is truly amazing,

End of a long, busy, exhausting day.  Tomorrow should be a day to rest, visit with some people who have said they are coming to call on us, and just concentrate on healing both mind and body.

Climb to glory.  God bless you.

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