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Recent Newspaper & Online Columns by Kate Scannell MD

Ingratiating yourself in the hospital, hoping for good medical care

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/17/2011

I WAS able to arrive at the hospital an hour after my frail, elderly aunt had been delivered by ambulance to her local emergency department last month. I found her lying motionless in bed, moaning softly, covered only by an impossibly thin hospital gown, her eyes shut protectively against glaring overhead lights.

Without her hearing aides and distracted by pain, she had trouble communicating. I saw by the way her contorted left limbs "rested" on the bed that she most certainly had fractured her hip and arm during the fall she'd just taken.

Before attempting to track down the doctor for his medical assessment and plan, I asked my aunt what she immediately required for comfort. "Blankets," she replied, and "to urinate -- but, please, not in this bed."

I tensed immediately -- realizing that the ritual of trying to establish caring connections with complete strangers on a medical staff had begun. I would initiate the ritual by trying to broker my aunt's requests for warmth and dignity, which, on the surface, seemed easy to remedy and worthy of concern.

Still, as both an insider physician and veteran patient, I knew those requests could be otherwise perceived by the staff -- as an intrusion or annoyance, perhaps. Or a judgment about inadequate attention to my aunt. At worse, as an imperious claim of entitlement to the staff's valuable time. The stakes were high -- I feared that any staff displeasure I might inadvertently generate could jeopardize the quality of my aunt's future care.

The ER nurses were sitting at a desk 15 feet away, in direct line of sight of my aunt. I took a deep breath and approached them.

"Excuse me," I began apologetically, "but my aunt needs to urinate, and if we could please just get her a couple of blankets "... ."

The nurse barely glanced up from her computer and mechanically replied, "We're busy. Besides, we need two people to move your aunt onto the bedpan."

"I'm sorry things are hectic for you," I replied empathically. "But I can help to move her -- I have medical training. And I'm happy to fetch the blankets if you just tell me where they are."

"I told you we're busy," she repeated.

"Please," I continued, "my aunt's been here over an hour, freezing and shivering with broken bones, and she's received nothing for pain."

The nurse stood up, exited into the corridor, and replied with her back turned to me: "It will take a few minutes."

I had somehow blown it. I had come crashing up against "the great hospital wall" -- that immense steely barrier that keeps patients and families on one side, and doctors and nurses on the other where all the controls resided.

I returned to my aunt's bedside, draped my overcoat across her body, and tried to distract her until help arrived. Now her physical pain was beginning to compete with her discomforting need to urinate, her fears about preserving her dignity.

About 10 minutes later the nurse appeared, placed a bedpan on my aunt's side table, and announced that she was still waiting for assistance. "And the pain medication?" I asked. During her prompt exit, she only reminded me that she everyone was busy.

Still, my aunt was preoccupied, too -- with considerable pain and discomfort, with fears that her independence had ended with this destructive fall. I knew I had to return to the wall and continue advocacy for my aunt. But how to succeed after my prior attempts -- infused with empathy, politeness, humor, patience, and helpfulness -- had failed miserably? Would I have to grovel and ingratiate myself further? Become "the squeaky wheel" or "angry family member?" Threaten to call the hospital's CEO? Flash my doctor's card and demand to speak to the ER chief?

I'm relating this particular incident because it is raw and fresh in my life. And while it happens to involve a nurse, in my experience, it is more often we doctors who are problematically unapproachable behind the great hospital wall.

The vast majority of hospital nurses and doctors are professional, caring, and responsive human beings. Still, there's a few too many of us within each profession who stand solidly behind the great hospital wall, protecting ourselves from patient and family "demands," and refusing to bend our work schedules to accommodate even small acts of charity on the wards.

There's a few too many of us who, for various reasons, cannot tolerate requests from patients' loved ones and family members, precisely because those requests are weighted with feelings that are hard to acknowledge and absorb. Imbued with intimations of love, fear, humanity, and kinship, those requests exert strong gravitational pulls on the recipient whose only choice -- it may seem -- is to resist to survive the job. A request for a blanket is not merely "a blanket request" when you must also be reminded about an old woman suffering for it -- once, twice, a dozen times each day.

My friend, an ICU nurse, recently stayed at the bedside of her husband who had been hospitalized after a heart attack. Like me, she did not initially disclose her profession to the medical staff, expecting that it should not have to matter. But as a medical insider, she also worried that the quality of her husband's care might be risked should the doctors and nurses find her to be unlikable. She bouhgt lots of doughnuts for them.

Last week, New York Times columnist Maureen Dowd wrote about her brother being hospitalized with pneumonia, but acquiring four new infections while in the ICU before he died. Although she had witnessed lapses of infection control procedures within that ICU, she wrote: "I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses, and orderlies, irrationally hoping that they'd treat my brother better if they liked us."

From decades of experience -- as a patient, family member, doctor, and hospital ethics committee member -- I have been on all sides of "the great hospital wall." I have learned that the wall does not reliably separate people into good or bad, sinners or saints. And I know the wall does not always prevail in a hospital.

Still, I will bet that most patients and families who have tried to negotiate hospital care have come up hard against that wall at least once. I will bet they know what it's like to stand powerlessly at that wall, trying to uphold their own dignity while also strategizing how to advocate for someone they love -- for that overdue pain medication, a blanket, a doctor's promised visit, those ice chips, that urinal, the call alarm that no one's ever answered.

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Kate Scannell is a Bay Area physician, syndicated columnist, and author of the memoir "Death of the Good Doctor" and the novel "Flood Stage."
Copyright, 2011 Kate Scannell