I’ve been debating doing this blog post, because it is more negative than the last.
This post and the last post started as one blog post, titled things I want ICU doctor’s to know, but eventually I cut all the negative out of the last blog post and titled it “10 Things that can make an ICU stay easier”. If you haven’t read it, it’s still here. Just go to Home, and then scroll down one post.
I know that working in the ICU must be stressful. I’ve been reading tweets of ICU staff for 2 years now, but…
Well here goes.
If you are still reading this, thank you.
Almost 10 Things not to do to make an ICU stay easier +1.
1.) Don’t ask your patients to describe the day before they went to the ICU. They will not remember.
I went to the ICU during the coldest time of that year. Oddly enough the day before I went into the ICU, it was a nice warm winter day, that ranged between -10 and -15 Celsius.
By the time I woke up from sedation, the temperature plummeted into the -40’s Celsius. Cars wouldn’t start, nurses wore warmed blankets around their shoulders, and the ICU staff conversations revolved around proper winter clothing, cars starting, and scrapping snow and ice off windshields.
My parents couldn’t start either of their cars and therefore couldn’t visit for 2 days.
During those 2 days I was awake enough to be asked questions.
The ICU doctor asked me to describe the day before I went into the ICU.
I said it was a normal day.
He questioned further “anything unusual happen”.
“Were you feeling sick?”
“Any nausea or diareaha?”
The questions continued like this, until he left.
What he didn’t know was although I was telling the truth, from my perspective, it was extremely inaccurate.
Because I had no memory of the day before I went into the ICU, I thought it was a normal day with no memorable events. I also thought but did not say, that there was a severed human foot at the base of my bed where he stood.
It neither shocked or scared me. I just thought “so that’s where they keep amputated limbs”.
I didn’t know I vomited violently the night before, and was so week I couldn’t walk to my bed without assistance after vomiting.
This was all written out in detail in my diary, and my mother told me about it afterwards, but the doctor never found that out. I didn’t remember, I didn’t have any visitors to tell him any differently, and I was too sick to think of telling my parents to correct what I had said when they could visit.
A diagnosis was made with wrong information.
I used to think, that it didn’t matter what the story was, because doctor’s diagnosed using diagnostic tests. I thought doctor’s were just being snoopy when they asked questions like that. It wasn’t until I started reading the tweets of those of you I follow on twitter that I realized the patient history is used in making a diagnosis.
2.) Do not assume your patient doesn’t have delirium.
I may have been thinking amputated feet were kept at the bedside, but I didn’t mention it. I didn’t think there was anything out of the ordinary, about it. Why would I interrupt the doctor’s questions to ask whose foot that was?
I didn’t say anything when the coffin rolled by either. I assumed that a patient had died, and that’s how they took dead bodies out of the hospital.
3.) Be aware that delirium is a thing, and tell the ward the patient is going to afterwards that it is a possibility.
I wasn’t actually diagnosed with delirium or ICU psychosis. I was diagnosed with hallucinations after, asking a nurse if there were fire works on the ceiling or was I developing schizophrenia?
She explained that neither was the case. “Sometimes when a person swells up because of a allergic reaction like you did, their brain swells up too, causing hallucinations. Do you want me to ask a doctor for medication to make it go away?”
“No”, I said “I’ll just enjoy the light show and go to sleep”.
I didn’t sleep that night. Instead I had entire conversations with people who weren’t there, and saw babies crawling in the snow outside.
In the morning I was moved to a private room because I kept the other people in my first room awake all night by talking.
After being in the hospital for a few weeks the speech pathologist, very nicely leaned over to me, and said “I think you have ICU psychosis, but nobody in the ICU realized it because you are so smart and hid it so well. I just thought you should know that’s a thing.”
4.) Do not assume that delirium means your patients are completely wrong about everything?
I may have had delirium, but I knew the names of the medications I was taking, and I knew why I was taking them.
Has delirium ever caused anybody to know things they didn’t know before?
I was getting the proper medications in the ICU, but once I was transferred to the ward, the med student changed them.
When I asked for one particular drug that I can not live without, he told me nobody took that for anything.
Would I really be able to come up with the accurate name of a real drug, that I was taking just a few days before, because of hallucinations? (The delirium I wasn’t even officially diagnosed with).
5.) Do not lie to your patients. They won’t believe anything you say afterwards.
When I was in the ward after the ICU, a med student told me “I know everything there is to know about kidneys”, and then refused to contact my nephrologist or the community pharmacist who helped decide what medication I should take.
I knew that was a lie. If he knew everything there was to know about kidney’s he’d be a nephrologist, not a med student (who knows even less than a resident).
He lost all my respect and trust, with one lie. What he said didn’t matter to me at all after that.
6.) Do not let med students and residents work on patients who are critically ill.
After that the med student came in and told me what “the team” decided, and asked me questions “the team” wanted to know. He was always by himself.
He wasn’t educated enough to work with the critically ill. Having to talk to the doctor through an intermediary is the most garbled kind of communication ever. I didn’t have any trust in him after he lied, and I’m sure he didn’t translate my concerns or questions properly.
I should have been able to talk to the doctor myself, not use this intermediary that worked as well as a wonky walkie talkie.
7.) Do not insist that you know more about your patient’s long term health problems than your patient does.
I have been living with a variety of health problems since I was born. My first diagnosis was “failure to thrive” and imminent death.
Obviously I didn’t die, and as I grew older, my parents were given different and better diagnosises.
I may not know everything about every health problem, but I know about mine, my body, the medications I take, why I take them, and what tests need to be done when I am not feeling good.
Because this med student assumed I didn’t know any of that, he refused me medication I knew had to take, and he verbally bullied me, which leads me to #8.
8.) Do not bully your patients.
During one argument with him, I realized he could do anything. He could rape me right there in my private room if he wanted and I would not be believed, because he had all the power.
He had the power to say anything that would make him look good and me look bad. I was the one who just got out of the ICU a few days before and had documented “hallucinations”. I was the one who was “crazy”, and he was the supposedly sane, educated one.
It’s a terrible feeling to know you don’t have any power over your own health or body. I knew he was making mistakes, but he wouldn’t believe me that my kidney function could not be measured by a blood test, or that I was on some rare medication to keep my kidney function as high as possible.
I knew that if I didn’t get that medication soon, I would never get better and would just die there in the hospital from kidney failure.
9.) Do not consider your patients to be learning tools.
I am a person. I have my own life, my own thoughts, and my own emotions.
I have a family who loves me, and an important role of caregiver and at times care receiver in that family.
I have my own likes and dislikes.
My body might not work 100%, but I am 100% human.
I am not a stethoscope, MRI machine, or textbook. Unlike those things, when I break, I either die or suffer irreparable harm.
I am not a learning tool.
And as such, I should never have been treated like one when I was in the ward after the ICU.
I realize this is in the ward after the ICU and the ICU staff have no control over what happens after a patient is discharged from their ward, but I also realize I have control of this blog, and this is what I want to say.
I am a person. I am not a learning tool.
My experience after the ICU should never have disintegrated into arguments, a feeling of powerlessness, or the threat to sue that med student for everything he had, just so I could get the proper medication.
If he had seen me as a person, and not some talking learning tool, it might not have become that.
Please teach your students, that patients are people? It seems so obvious, and shouldn’t have to be said, but obviously some students don’t understand that.
I wish that a prerequisite to meds school was to actually have a chronic or long term health problem. That would make students empathetic and less likely to see their patients as living text books.
10.) Do not tell your patients to “Just Walk”.
I was so often told “just walk, you’ll leave the hospital faster if you walk”, but I wasn’t given any assistance in walking.
My balance problems and fear of falling were not addressed until 18 months later, when I finally saw a physiotherapist (one I asked to see).
Telling somebody to do something, they are afraid to do will cause even more harm because it makes the patient feel hopeless, helpless, judged, and hated.
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