My patients. . .

Things here are kind of slow to move initially in the morning.  I slept on a cot without a pillow and no a/c.  I slept like a baby but woke up sweating my bleep off.  I rather enjoy the cold shower, though.  We are on our own for breakfast, I realize that someone stole all of my Larabars!  I love my Larabars and someone took them.  I still have all my cash, but will be begging for breakfast for the next week.  Nice.  I hope that it was someone who was really hungry and truly benefited from my very yummy Larabars.  If you've never had one, you should try 'em, Delicious.

The day begins with a group meeting and then rounds.  Rounding is absolute chaos.  There are too many chiefs if you know what I mean.  There is an entourage of 20 of us, doctors, nurses, PA's, PT's, techs, yada yada going around to each patient and everyone has their 2 cents to add and it's just overwhelming, but it at least gives me a good picture of all the patients until I get bored and wander off to do something else.  But I keep in mind this one particular patient.  He is post-op Day 1.  He has a leg fracture and rib fractures from falling out of a tree.  He is laying on a cot with a bright purple cast on his right leg that goes up to his hip.  They decide that he is to be discharged today and needs to be trained to use crutches.  They don't want to keep people too long because alot of these people learn to work the system because they want to stay here forever because it's cleaner and it's a free meal.  When they decided that he was going to go home today, I knew we may have a problem.  One of the techs is to treat and instruct this patient, so I go on with my day.

After lunch I ask one of the girls in my group how the guy with the long leg purple cast did with therapy this am.  I asked if he was ready to go home.  She said he did terrible, it took two people to get him off the cot and he could barely stand on the crutches.  I decided to check on him.  He is sitting in a wheelchair in his room, waiting to leave.  One of the doctors gave him 10 bucks for a ride home.  There are no crutches even in the room for him to leave with.  I try him out on various crutches then a walker.  He is able to maneuver a bit with the walker but is limited due to his back pain from fractured ribs.  I decide that I don't feel like he is ready to go home today so I talk to one of the docs and she says he can stay for an extra day.  I'm working with another patient when I am told that purple cast is leaving.  There is all kinds of commotion going on as there are all these people trying to load purple cast onto a tap-tap.  A tap-tap is essentially an old pick-up truck with 2 benches along the inside of the bed of the truck to seat passengers.  It's like their taxi, they are everywhere.  Purple cast looks clearly uncomfortable sitting on the floor of the bed of the truck.  I ask his father, how far away is home.  He tells me it may take 2 to 6 hours to get home.  I can't imagine having a broken leg and ribs, and riding home 2-6 hours in the bed of the truck through rubble!!!  Well, I don't feel good about this so I unload him from the truck and try to keep him from being discharged.  More Chaos.  Well, I lost this battle because they had no idea if they would ever be able to get him another ride home,  and as I helped him back into the truck, it became more apparent to me that he was not in as much pain as he was before.  I think he wanted to stay in the hospital as long as he could. But the whole scene was chaos and confusion and the patient almost went home without anything to walk with when he can't even put weight on his right leg.  And then he was even expected to make that ridiculous trip back to the hospital on Monday, less than 5 days from now simply for an X-ray.  So, even though he did not stay, things were straightened out.  I hope. .

I have one more story that I would like to share with you.  This story belongs to Joan, the nurse practitioner with my group who gave me permission to publish this.  Let me set this up.  This is primarily an orthopedic hospital, most of the patients have injuries and surgeries to their bones and muscles.  There are some patients that are not orthopedic who just end up here somehow, I guess nowhere else to go.  These patients subsequently get overlooked when the doctors do their rounds and such.  I noticed one patient whose cot is set up in the hallway, oh yeah, some of the patients sleep on cots as well.  She seemed kind of out of it, and I figured she was mentally ill.  Well she is and she is also very medically ill, but has not been followed by a doctor for a while and nursing doesn't take vital signs or anything.  It's crazy!  So apparently this women crashed tonight, she became extremely short of breath.  So guess what the nurses did?  You will not believe this.  They pulled her out on her cot to the balcony area, they stripped off all over her clothes, and proceeded to pour buckets of water on her!  Then Haitians stood around her and sang. What?!?  Does this really happen in a hospital?  Apparently so.  This is when someone came to the volunteer break room and asked for help.  It was evening so we were all just hanging out.  This is when Joan sprang into action to assist.  Apparently this woman has cardiomyopathy that is untreated, basically she is having heart failure due to fluid retention.  And the initial reaction of the Haitian nursing staff was to throw water on her and stand around her and sing.  Think about this next time you want to complain about our healthcare!