One of my unforgettable instructors in nursing school said the goal of corporate health care should be to provide personalized, individualized care. A simple-not-so-simple diagnostic procedure reminded me why I label our health care system in need of healing. The dreaded colonoscopy. What could make anyone feel more depersonalized than a test focused on the bunghole? The answer: the entire process. Step 1: Tele-visit with the colon surgeon’s PA to find out why you need another colonoscopy and to get a prescription for the purge. The PA couldn’t or didn’t discuss the need for anti-coagulation due to a blood dyscrasia. For that I had to see my PCP, another drive, time spent in an office with possibly sick people, and a brief conversation with him to get the order. The PA didn’t ask about my cardiac status, which is okay since my pacemaker implantation. I still have lots of irregularity with my heart rhythm. Might someone need to know that? I made a pre-procedure appointment with my electrophysiologist. Another drive and time expenditure. Then there is the “purge.” Liters of disgusting tasting liquid to cleanse the body of waste so the surgeon can see every nook and cranny. No one referenced my MS, which mixed with the purgative fluid and electrolyte shift exacerbates into flaming limbs, hands and legs from the knees down on fire. No one referenced the nausea and imbalance from clear liquids for two days. Has anyone besides me noticed that popsicles have lost some of their tangy flavor. Then, there is the sleeplessness from getting up to address the rumbling bowels.
Of course, on the day of the procedure, we, because I must have a driver, went to the wrong place, the facility I used the last time. The receptionist there quicky sent us to a huge maze, also known as a growing tertiary acute care facility or hospital. It didn’t matter that my driver-husband wears a brace or I have foot drop and walk with a limp. We trudged our way to the admissions area. The QR code I was required to show wasn’t needed. I brought my phone along for nothing. I was taken to a recovery room bay and given a gown and a plastic bag for possessions. Then, I remembered why I loved my hands on job as an ICU nurse. I really got to know my patients.
My first “nurse” was new to her job. I was her first admit that she’d done on her own. She performed data entry and filled in my history, my preferred pharmacy, the existence of an Advance Directive. Paperwork all done, but she never once touched me. Never assessed my neuro status or breath sounds. Good use of a four-year degree. Another nurse started an IV. She was proficient with that task, but acted miffed when I questioned all the air bubbles in the tubing. “They won’t hurt you,” she said, as they bobbled their way down the tubing and into my system. “I’m an old nurse. I don’t like looking at them.” She went and got a new bag and tubing more carefully primed. A colleague had a patient die from an air embolus. It’s a rarity I never forgot. Once finished, the curtain was closed, yanked shut with the force of slamming a door. I did know how to use the call light. Who could I tell how afraid of dying I was? When the nurse put my name on the “white board,” my husband had to correct the spelling.
Then there’s the waiting. Scared. Dehydrated. Tired from lack of sleep. Stomach still staging rigorous protest. And more waiting. There is a move to another room only to be told the procedure won’t be for another hour or so. An anesthesiologist who looked remarkably like one I’d seen on the news did yet another history. At least he got to my clotting disorder, PE, DVT, MS, and dysrhythmias. Too bad I never saw him again except when he yanked the curtain aside looking for someone else. More waiting. Another nurse told me the name of the CRNA who would give my anesthesia. “Do you trust her?” I asked. “Oh yes, I’ve worked with her a few months.” You have heard of fight or flight. During all this, maybe one nurse asked if I was okay.
The CRNA introduced herself. I asked if her ACLS (Advanced Cardiac Life Support) was up to date. She never answered, said “We don’t talk about ACLS, we don’t want to jinx anything.” Fight or flight.
I had texted my son my love the night before. My husband kissed me good-bye. I wondered about the out-of-body stories of those who had near death experiences. I probably was relieved when the propofol hit my brain. Nothing untoward happened during the procedure. If it had, there was no baseline physical assessment to compare my before with my after. Yet, I had interfaced with at least three nurses. The paperwork was complete. A colleague of mine said it correctly. “It will only matter when a lawyer becomes involved.”
A nurse I had seen before provided discharge instructions. My mouth ached for a cup of coffee I could not drink because it was too industrial. Waiting and more waiting. A brief chat with the doctor including rationale for a repeat in three years. In three years, there will be an FDA approved blood test, and it won’t matter that the nurses didn’t know my name. I probably won’t be back.
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