October 08, 2003

Actual appreciation, yet

It occurs to me that, what with all the whingeing and white knuckle drama, I'm really not doing justice to the good things that are happening in this hospital. Now, as anyone who knows me will attest, I'm no Mary Tyler Moore/ Sally Field/ perky little happy person. But there are good things happening here, and good care at Jefferson, too. I tend to be negative too often anyway, and fear and stress have made me focus a lot on what's missing, not what's there.

So. Redress time.

Oncology nurses. They are simply the best. The women and men on this unit work indefatigably with people who are dying, people in extreme pain, people having a 24/7 hissy fit, people with intractable wounds, people who are demented and people who have just had a rather unwelcome diagnosis and are tense and scared. They work up to twelve hours a shift, and they work constantly and cheerfully. They consistently notice when treatments aren't doing what they're supposed to do -- I hear them calling the MDs all the time, describing symptoms, suggesting causes, outlining possible ways of addressing problems. The Baby Doctors, as I think of residents and interns, have their little furry asses saved by these nurses about ten times a day each on average. A strong nurse can teach a new MD more in a week than s/he learned in years of medical school clinical training. Even in the two weeks I've been here, I've noticed my oncology resident, whom I call Dr. Puppy, begin to learn to listen to nurses and patients, to be more responsive to requests, to grow up as a doctor. It's an impressive form of training they put him through. (And he has needed it. ) When I first met him, I said there was nothing wrong with him that ten years wouldn't cure. Now, I think it's one or two years -- that's how strong these nurses are in their role as teachers of the arrogant.

This life is undoubtedly hard on interns and residents -- they're tired and they're scared. After all these years of training, they're suddenly called "doctor" and are supposed to be grown ups who know what they're doing. Some have defense mechanisms that allow them to work effectively. Others come onto the floor and start being condescending with oncology nurses who have 25 years experience on the unit. This is not a sensible strategy at any level. I would truly hate to be a neophyte MD who had pissed off the nurses on my unit -- it's no longer sink or swim, it's straight down to the bottom and glub glub glub.

Ward aides and other support staff. Remarkable people. Paid a pittance, I imagine, and work long hours at menial labour. Yet they are cheerful, helpful, prompt and efficient. They sing out their hellos, remember your name, have a joke and a bit of conversation with each patient. Did I say efficient? I managed to push the phone jack into the wall, trying to reconnect the phone. It took less than ten minutes for a maintenance guy to come to the room, and less than ten minutes for him to fix it.

Food. Well, it's a large institution, and it's pretty awful food. Bound to be, really. But the nutritionists come by and offer snacks and special orders and do their best to honour idiosyncratic dietary wishes. Much kinder than they need to be, and solicitous of their patients. Though I still get green jello not red, dammit.

Rooms. Mine is now decorated in what my oncologist calls "British American Princess" style. (She's a sarcastic cow and I adore her). But even the basic room is really comfortable and pleasant. No piped music, thank ghod, Now I've added my various gifts -- towels, pillow cases, sheets, a chenille wrap, a painting or two, photos of friends and my dog, cushions -- the place looks positively like home. I'll miss it tomorrow, which I'm going to spend in the ICU.

My oncologist: Dr Z. Short, bouncy, energetic and funny as hell. No respecter of persons, no nonsense. What she says is what she means -- she's upfront, honest, authentic. And has a wicked dry sense of humour. We make each other laugh a lot and give each other a hard time, which is about the best basis for treatment I can think of. Oh, and she's completely non defensive. When an oncologist friend suggested a slight change in the treatment protocol she's written for me, she welcomed it, asked for references, said she'd be glad to incorporate it if she could see anything in a journal about it. I like her a lot.

Her onco-partner, Dr. R. He of the "nice veggies, nasty weed" story. That really was a momentary aberration on his part. He turns out to be bright, funny, exhausted, thoughtful and very kind. I've no idea where the playschool story came from. Maybe he was worn out and on automatic pilot. He's always been very present and authentic and helpful when I've dealt with him since.

So this place is far from a washout. Snafus happen, and they are usually coordination snafus. Plus screwups that happen on services that are particularly hierarchical, like Neurosurgery -- I think the residents are almost too scared to talk to their Attendings. But an awful lot goes right here, and I feel cared for and cared about in a way I never expected. Big thanks to the staff who've made that happen.

Posted by maddy at October 8, 2003 10:33 AM
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