Monday, July 17, 2017

When the Nurse Becomes the Patient

While nurses have a great deal of experience treating and caring for patients, unforeseen circumstances will occasionally cause the tables to turn, giving the nurse the chance to be a patient. This became my personal reality just last week. 


Friday, Bloody Friday

On a recent Friday afternoon, I was doing my usual workout at a local gym where I can be found pretty much every other day most weeks of the year. Cardio, weightlifting, various machines, balance exercises, and resistance training all figure in my personalized routine. 

Early in my workout, I was using thick rubber tubes for resistance training. These bungee-like tubes have handles at one end and are anchored into a sheet metal base on the wall. I use three in each hand in order to maximize resistance, and I was deep into my usual process when I heard a sound and then instantaneously felt a searing pain in my left ankle as I fell to the floor. 

Apparently, the metal anchor for the bungee cords had torn from the wall as I did my usual exercise, and this 18-inch piece of molded sheet metal flew at me with all of the pent up force of those six tensed rubber tubes. It guillotined the lateral aspect of my left lower leg just above the lateral malleolous.

Blood was spurting everywhere, and although I couldn't fully visualize the gaping 7-inch long wound, I could see bone and knew I was in trouble. No one else was in the large exdercise room with me, but my screams brought another gym rat to my rescue, and he valiantly applied massive pressure to the wound with blood-soaked towels for the 15 minutes it took the ambulance to arrive.

Through the pain, I had the wherewithal to tell the gym owner where to find my keys and wallet, and gave her instructions to call my wife and ask her to fish my laptop out of the trunk of the car. I also noted that several gym members chose to do their usual routine on the rowing machines not six feet from my head, even though I was writhing in pain, yelling, and pounding the floor with my fists. N
ot even human suffering could get in the way of their fitness (they obviously weren't nurses). 


Frying Pan and Fire

The blunt force trauma of my own personal fitness guillotine delivered a shattered fibula, a fractured but non-displaced tibia, two severed tendons, a severed peroneal nerve, and massive soft tissue damage. A three-hour emergency surgery resulted in reconstruction of the fibula with a stainless steel plate, screws, and antibiotic-impregnated glue, and an outward appearance dubbed "Frankenfoot" by my son. 

While the nurses and other staff at Christus St. Vincent Medical Center here in Santa Fe were exceedingly kind, there were significant deficiencies in my care that will lead me to pursue my potential follow up surgeries (tendon repair and bone graft) elsewhere. My deficiencies of care included: 
  1. Being offered an incentive spirometer on the day of discharge rather than the day of admission
  2. Not receiving an assessment of my lungs and respiratory status until 48 hours into my stay
  3. The complete ignoring of my bowel status, with no one listening to my bowel sounds or offering stool softeners or other interventions until I came to my senses and requested such on day two
  4. Not a single nurse assessing the pedal pulses in my operative foot for the first 48 hours
  5. Never being offered a basin, warm water, and soap until I begged for it
  6. My room never being disinfected, mopped, or otherwise cared for (with the exception of the trash being emptied)
  7. The surgeon attempting to force me to be discharged on a Sunday at 5pm, despite ongoing pain, dizziness, nausea, and a home completely unprepared for a disabled patient (our bedroom is on the second floor up a spiral staircase)
  8. The case manager not knowing what a transfer bench was

Now, you nurses are likely reading this with mouths agape and an incredulous look on your faces, and such a reaction is appropriate to such egregious omissions of care. Now, imagine if I wasn't an educated, astute, and assertive healthcare professional -- what would have become of me? If I was a non-assertive patient with little knowledge of healthcare, I would have doubtless gone straight from the frying pan into the fire. Nonetheless, I was obtunded by narcotics and wasn't able to adequately advocate for myself the first two days, thus some deficiencies went unnoticed until I came to my senses. 

In the end, I demanded a respiratory assessment, a stool softener (which, by the way, was ordered but never offered), an extra night in the hospital, a case manager to coordinate my discharge, and time to talk with the unit manager. I filed a complaint with my insurance company, and will seek follow up surgical opinions and care at a teaching facility in Albuquerque. I will also fire my surgeon; he did a great job on my leg, but his bedside manner bordered on sociopathic when he insisted I go home to an ill-prepared and unsafe environment. 

Self-Advocacy and Compassion

We nurses are indeed patient advocates, and self-advocacy can be our rallying cry when we ourselves become patients. Nonetheless, who will advocate for patients when other nurses and staff fall down on the job? 

The majority of the nurses caring for me during my stay were very kind and compassionate, yet all but one forgot to perform basic nursing care, including respiratory assessments on a patient taking narcotics who was recovering from general anesthesia, pedal pulse checks on my operative leg, and bowel assessments and interventions. What could have resultantly gone wrong? Everything! 

I'm very grateful that this aberrant piece of runaway sheet metal didn't hit my knee, neck, or vital organs, or I may very well have been partially decapitated or my life otherwise extinguished through massive blood loss. I could also have ended up with a massive brain injury and permanent disability. Yes, Nurse Keith came within striking distance of being rendered a vegetable. 

On a personal level, I'm surrounded by love, compassion, caring, empathy, and amazing friends and family. My wife Mary is my amazingly kind and capable nurse extraordinaire, and my cat George is my feline healer. Friends and family are just wonderful, and I can't express enough gratitude for all we're receiving. 


What I wish for other patients are the fortune of community and loving support, as well as the wherewithal to assertively advocate for their own needs both in and out of the acute care setting. I also wish for nurses and healthcare professionals who pay close attention to detail, not overlook basic nursing care, and otherwise care for patients in a manner that optimizes outcomes. 



All too often, patients are forced out of the hospital all too quickly by surgeons who are feeling the heat from insurance companies and hospital executives. My surgeon chose to attempt to force me to go home against my better judgment, even as he acknowledged the "social" issues I had brought up in conversation. I pushed back hard, recruited the help of the nurse and physician assistant, and had an extra night approved. Had I not done so, I would have gone home even less prepared for what was to come. 

Be the Champion

Nurses, be your patients' #1 advocate and champion. Leave no stone unturned, and push back against those who take the easy way out and ignore basic standards of patient care. 

We nurses are champions, and I'll continue to speak out for those who may be less able to assert themselves in the face of substandard care and less than compassionate medical professionals. No one else is going to do it, so we have to. 

My story will end well, and I want that sort of ending for every patient out there. Join me in making that vision a reality. 

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of "Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century," and has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.
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