Thursday, September 12, 2013

I will remember you (Musings on realities for nurses and residents)

Updated: 13 Oct. 2013

September's blog was stimulated by recent personal experiences in a local inner city hospital with ~700 beds, treating ~ 450,000 patients/year. I spent much time in the hospital over 5 days and came away impressed with frontline health care staff. 

In contrast, I happened upon a news item about a lawsuit that did not impress: 
  • SmithKline Beecham vs Abbott Laboratories: Abbott removes juror because he's gay in suit over hiking HIV drug price
The blog's title derives from an iconic song by Canada's Sarah McLachlin.

First the good news. Being naturally curious and a people observer, during the recent encounter with our health system, I learned many tidbits about work realities for Drs (surgeons and residents), RNs, LPNs, pharmacists, occupational therapists, respiratory technologists, nursing aides, cleaners, and more.

In brief, I have an enhanced appreciation of colleagues in the front lines of the interdisciplinary health care team. They work under incredible pressure, yet those I observed invariably put the patient first and were caring professionals. 

As background, as a medical laboratory technologist who worked in a transfusion service lab for many years, I've encountered many nurses, those I call 'pitbulls', because they aggressively challenge 'rules' the blood bank has related to identity that are designed to ensure patient safety. That makes my new found appreciation all the more sweet.

Thank you surgeons, residents, RNs, and all staff at Royal Alexandra Hospital (Nursing Station 31), Edmonton, Alberta, Canada.

Some things I observed:

  • RAH entrance: 2 security officers holding what could be a homeless man with a beaten face, him screaming, 'I f*ckin' did nothing, you bastards.'
  • Signs say 'No smoking on RAH property' but 'patio' outside main entrance always full of patients smoking. Not similar at University Hospital. Perhaps a losing battle in inner city?
  • Most memorable image of RAH: Emaciated male exits nursing station 31 with fag in mouth, going for a smoke.  Frankly, despite being one of those ex-smokers who is now fanatically anti-smoking, I don't begrudge him his smoke. 
  • Exiting RAH elevator on 3rd floor: Mother angrily screams at ~12 yr old girl that she needs to say something when asked a question. Mom walks towards the ward area and screams, 'Where the f*ck are we?' Then mutters, 'Wrong floor', and stomps away leaving child to follow. My heart ached for child. Mother obviously stressed but no excuse to abuse child. Miracle if kid survives a mom like that. 
  • Respiratory technologist attaches a BiPap to patient in respiratory distress in ward's special 'observation room' (2 RNs for 4 post-op patients), all the while training a student. As a longtime blood bank clinical instructor, I was impressed by his expertise and patience. Later one of the RNs asked the respiratory tech if respiratory could give an in-service on use of the BiPap. Good stuff. 
  • Patient in observation ward for those who need observing carefully post-surgery, and who are attached to many monitoring instruments (and where every few minutes machines beep loudly  - sleep is impossible in the  hubbub of activity) screams, 'Shut up! I'm trying to sleep.' Another patient comments, 'Stuff him in the closet' and he replies, 'Yes, please.'
  • Elderly gent on observation ward, post-surgery, keeps screaming, 'Let me outta here. They've kidnapped me. I've got to go home' and tries to rip off his monitoring equipment. His elderly wife patiently says, 'No dear. You've got to stay.' 
  • Several times a day a patient leaves the observation room for a regular hospital room and a new patient comes in. This is when two staff members enter and strip the bed, then wipe down (disinfect) every part of the bed, tables, and any surface the patient may have touched. It's a frenzy of cleaning, hard grunge work, but it's got to be done and quickly, to prepare for the new patient. 
You get the idea. Every day is total chaos but residents, nurses and all staff maintain their cool and keep caring for all their patients no matter how difficult they and the environment may be.

Now the bad news. Watching nurses and docs perform under trying situations makes me all the more disturbed to see how industry colleagues continue to put their interests ahead of patients and seemingly use every tactic to maximize profits and win lawsuits.

Indeed, I could recite many cases that definitively show that Big Pharma routinely behaves badly but I'll limit it to a current case.

Smithkline Beecham (SKB) v. Abbott Laboratories (USA)

SKB v Abbott is about whether it is permissible for a lawyer to 'strike' (remove) would-be jurors from a case because of sexual orientation.  In this antitrust lawsuit involving HIV medications, an attorney for one of the companies exercised a so-called peremptory strike, effectively removing a possible juror because he was or appears to be, could be, homosexual.

The case involves Abbott challenging the only known gay juror during voir dire
for a trial in which SKB challenged Abbott's controversial 400% price increase for an HIV medication.

In other words, Abbott wanted to get rid of a gay juror presumably because it believed he would be biased against them for their exorbitant price for HIV meds.

How did Abbott know he was gay?
When the judge asked how they knew he was gay, Abbott pointed to his mannerisms, his residence in West Hollywood and his previous work as a freelance screenwriter.

What to say? Jesus wept? Oh, give me an effing break? Geez, if you're 'straight' what cases does that preclude you from?

Be aware that SKB is no better than Abbott. Name any Big Pharma company and it's easy to discover how they routinely behave badly. For example,

Frontline health professionals work under incredibly stressful conditions and yet put patients first and remain cheerful and helpful. 

As someone who has worked in a transfusion laboratory and taught all my working life, I have new respect for the nurses. They carry the burden of dealing with patients who often are close to impossible to handle and may go into a life-threatening crisis at any time. To say nothing of the many bodily fluids they have to clean up with a smile and kind word.

As to Big Pharma, it seems the bottom line is all that matters. Frankly, drug and diagnostic reps are often fine 
colleagues. But they're at the mercy of their employers. 

For Fun
To all the nurses, residents, and other health professionals at RAH, Nursing Stn 31, in Edmonton, rest assured,
Further Reading
As always the views are mine alone and comments are most welcome.