Hospital update

So I want to let you know, there aren't going to be fun pictures (or any for that matter) in this post. Sorry.

I just wanted to briefly write an update for how things are going in the hospital. It has been quite some time and I've loaded you up with plenty of non-hospital posts over the last couple of months. 

First off, I will admit the most rewarding (and sometimes only rewarding) aspect of working within the medical ward is the chance to make an individual difference in someone's life. That may seem obvious, but when trying to work at a broader level within the hospital, sometimes one forgets about the "little things," which I've come to learn are the biggest things. 

I'll recount some of the most memorable instances.

L.A. (yes, I will try to uphold HIPPA even in the bush), a young woman in her mid-twenties, was admitted for "psychosis" earlier this month. Sometimes the diagnoses originally stated are frustrating because they overlook some really crucial medical problems. In this case, L.A. was not suffering from psychosis or anything of that sort; rather, she had developed a serious case of meningitis and had an acute onset of confusion and change in personality. With some diagnostic tests and rule-outs, we found out she was afflicted with TBM, or Tuberculosis meningitis. Not common at all back in the States, it has definitely taken some time to adjust my mindset towards these conditions rather than other "common" disease processes. Anyhow, with a little sedation, time, patience and anti-TB medications, L.A. recovered relatively quickly and began "acting herself" per family. She went from being drastically confused to a patient who could hold a conversation, follow commands, and act like a normal twenty-something year old. Aside from it being especially nice to see the marked improvement, it was really rewarding to help her overcome a disease that can become fatal very quickly (and has for many of our patients in the past). L.A. happily went home and I hope to see her in a few weeks for follow up!

D.O. was another inspiring case that occurred just recently. Another mid-twenties patient, D.O. arrived unconscious and very unstable after reportedly being poisoned with some organophosphate substance. With quick action, we were able to begin to reverse his poisoning with atropine, support his respiratory system (which was severely compromised from aspiration), and lavage his stomach to decrease the concentration of poison. Honestly, with severely limited resources (ie he should have been intubated immediately, along with tons of other treatments and medications) and his very critical state, I wasn't very confident in his recovery. However, (and this goes for multiple other cases) solely through the grace of God and the resilience of the human body, D.O. recovered really quickly and progressed from being unconscious and unresponsive to completely normal in 7 days. I watched him go home today. Amazing. 

Sadly, these cases are not the norm. We receive a surprising amount of critical patients and again, with limited resources, these patients don't recover as well. It's a hard transition, coming from a place where every ill patient received every possible treatment to heal them and avoid death. Here, death is much more common place and accepted. Understandably so, however it is still difficult to see stroke patients and cardiac patients arrive and deteriorate without much influential intervention. 

Although one would think that limited resources would serve as the biggest challenge, it honestly has become the secondary difficulty faced each day. I have found, consistently, that the largest and seemingly insurmountable challenge within the medical ward and hospital at large is lack of staff accountability. I can't reasonably explain why and how this happens, but it does...and it's frustrating beyond belief. Now, this actually becomes the biggest hurdle in delivering optimum patient care, even more so than the limited resources and hospital's physical capabilities. It has been mind blowing to watch various staff, seemingly lack a sense of care and responsibility, allow patients to deteriorate right in front of their eyes.

SIDE NOTE: I know this is really controversial and a heated topic, but it's the reality here. Sorry if this makes anyone uncomfortable.

Anyways, it has created a nearly impossible work environment where gaps in patient care become more prevalent (and accepted) than patient care continuity. I'm not naming names or placing blame, since that's honestly irrelevant at this point in discussion. Furthermore, with regard to my last post, the institution of a “nursing model” is truly unrealistic and I honestly spend each shift making sure the patients receive the care they need for optimal outcomes independently from my staff. It has definitely been a transition from a broad focus “me and the hospital” to a very individual “me and each patient.” Frankly, as long as the patients avoid needless suffering, that's all I'm concerned with.

With all of this in mind, I can easily and unashamedly admit that this has been one of the hardest things I have done. It is just the fact. Although having adjusted well to a vastly different culture/lifestyle and being away from family and friends, these transitions have been compounded by this extreme professional challenge (and a dwindling sense of accomplishment). Surprisingly, it has become easier, if not automatic, to admit the aforementioned.

I'm not quite sure what any of this amounts to and am sure I won't for a long time. It has simply become a day-to-day goal to keep focused on making those differences for each patient and praying I can create some sense of purpose and direction.

Please email with any thoughts, concerns, suggestions etc

Rick.cmalo@gmail.com