Monday, January 25, 2016

Alarm Fatigue

I felt like the stack of charts rose past my head and all the way to the ceiling.  I pulled out my pen, opened the first, and started charting.  I took a moment before each note to collect my thoughts.  The patients were complex, the problems sometimes insurmountable.  The nursing station at the facility was buzzing with activity around me.  Phones were ringing, alarms were crying for attention.

On the desk beside me was a case filled with a dozen pagers.  Every thirty seconds, one of the pagers would sound off and vibrate.  The motion would send the case rattling against the desk and not only obliterate my concentration but also fray what was left of my poor fragile nerves.  Every thirty seconds a chorus: rattling, chirping, beeping, or chimes.

Every now and then a staff member would distractedly reach out, press a button on a particular pager, and then go back to whatever they were doing.  Hell, I even silenced the racket from time to time when the noise became unbearable.

I endured this dance for an hour as I finished writing my notes.  By the time I was done, my eyes were red and my hair was disheveled from running my hands through it.  As far as I could tell, the only function of this barrage was to drive the poor doctors, who often had no other choice but to use the desk for charting, crazy.  I had not seen one definitive action taken in response to the buzzing pagers, besides turning them off.

I passed the secretary on the way out of the nursing station and couldn't help but inquire.

Me: Hey, you know those pagers on the desk.  They are always going off.  What a racket!  What are they used for.

Secretary:  Those pagers?  They are connected to the patient's call lights.  Every time a person hits the button at the side of the bed for help, one of those goes off.

Me: Really?

Secretary: You know, like if a patient needs to get out of bed, or is hungry, or has to go to the bathroom.

Me: Or if they have chest pain, shortness of breath, or fell and broke a hip?

Secretary: Yah, I guess that stuff too.

Tuesday, January 5, 2016

Doctors, He Felt, Were No Longer Helping People

It was never his intention that the name would stick.  A decade ago, when he first began working in the restaurant, some of his fellow employees knew that he was formerly a practicing physician and started to call him "Doc".  Although many of his coworkers had since moved on, taking the knowledge of his previous profession with them, his moniker persisted.

Doc liked the simplicity and tedium of his bartending job.  He spent the majority of his nights doing what he liked most, interacting with fellow human beings.  He remembered a time when medicine offered such enticing rewards.  When he could sit across from a patient with a paper and pen and record only the most salient information.  He could look into their eyes, wax philosophical in the exam room, and still have enough time to comfort a grieving family member.

The practice of medicine was once both amazingly complex and laughably simple.  The convoluted path of the ailing body was matched by the enduringly straightforward need to be loved and cared for.  And Doc loved his patients.  He loved them so much, in fact, that the wave of computerization, legislation, and compliance almost got the best of him.

He no longer enjoyed his day to day activities.  His warm greetings and kind words were overtaken by a nagging electronic medical record system and voluminous rounds of paperwork.  Doc was deeply depressed and on the verge of suicide when he made the life altering decision.

He had no children, no wife, and no debt.  He would leave the job he once loved in order to save his own life.

And save his life, it did.

As the months past, Doc felt the stress wash over his body and fall like a puddle to the ground.  He started to laugh again.  He smiled at strangers as they shimmied up to the bar.  He became a spectacle on his own.  A group of regulars appeared at all times of the night to chat as he worked.

It took a full year before the phantom sensation of a pager buzzing on his belt loop finally disappeared.  Double that to get used to sleeping the whole night without being interrupted by a phone call.  Doc was happy, but couldn't forget quite everything about being a doctor.

Although his mind was elsewhere, his keen eye kept lurking back to his training.  He might notice a Bell's Palsy or the shuffling gate of Parkinson's in some unlucky patron making his way to a seat in the restaurant.  Occasionally he gave advice for minor ailments.  Originally his customer's eyes would raise in disbelief, but eventually they learned to trust his instincts.

Once a young man started to choke on a piece of steak.  When Doc heard what was going on, he leaped over the bar and ran to the table.  He performed the Heimlich, and cleared the man's airway.  It appeared as if his actions were too late.  But Doc expertly delivered a few breaths and started CPR.  The man recovered by the time the ambulance arrived.

It was times like these that Doc wondered if he made the right decision.  He still loved medicine deeply.  But he also knew that what doctors were practicing today was no longer medicine.  It was a bastardized version overtaken by technology, administrators, and rules that made little sense.

Doctors, he felt, were no longer helping people.