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Tuesday, September 24, 2013

What's a Good Scare Worth?

What's a Good Scare Worth?

Hi.  Welcome to my post on behind-the-scenes at a state of the art - highly rated acute care hospital that I am familiar with.

Just an ordinary, busy day in cooker-care-medicine down in the Imaging Department.  Highly qualified professionals on duty.
A young man (between 30 and 50 yrs old) laying there on the hard cold slab we call a "table", waiting on the big exam.
Actually, it wasn't all that big of an exam.   Inject a little dye into his vein (an IV is already going to "establish" an open access to his vein) and then snap the images and we are "good to go"!
The nice man on the table is what we call a patient.  That does not necessarily mean he is patient, but this man is patient and agreeable.  He has signed all the forms allowing the professional team to work on him.  He is trusting and  "good to go." 

Tech has laid out all needed supplies for the injection on the near-by small scootable table, and she is exceptionally happy because it is the END of her shift and another tech is taking over.  She is "good to go", right in the middle of the exam.

I don't care what they say, at change of shift you, the person, are momentarily forgotten, maybe even abandoned, while the oncoming shift gets to hear about you, your condition or disease, and your treatment plan.  And we do like to update ourselves on our own lives and challenges ......so you may hear laughter, expletives, exclamatory noises and all sorts of talk about the upcoming weekend, even the latest sports scores. (Whispering means they are talking about hospital administration, or who's sleeping with who, or maybe they are whispering about your condition.)  Hospital administration tries hard to get professionals to have no personal life, but no matter how hard they try they cannot get human nature stamped out completely.
Not to worry.....the robots are coming, are even edging in at present!

But this day there are no robots.  Human nature is in full cry.

The word is passed that "he" is ready for his injection, and the first tech leaves.  The second tech takes over, surveys the supplies on the scootable table and sees that the syringe is "good to go".......he injects the contents which is NOT the clear fluid dye, but is, instead, 50 ml of air waiting to be plunged  into the vial of dye so the 50ml of dye can be easily drawn up into the syringe & then injected into the patient!!!


The patient immediately "codes" (dies).  A big bolus of air when it hits the heart is lethal since it contracts and expands with the beating of the heart and disallows room for blood to enter the chamber of the heart.
That air has found a home and it is going nowhere.  Contract....expand....contract...expand...
The patient has died clinically....not biologically....and the highly qualified team discern the problem immediately and spring into action.

Ordinary CPR won't do it.  This big bubble of air in the patients heart can be dealt with only in a hyperbaric chamber (such as those used to treat the deep sea bends).

Miracle of miracles the hospital has a brand new hyperbaric chamber......and the race to save the patient is on.

He is not only saved, he is saved "intact".....no damage whatsoever.

He wakes up in a different area of the hospital and has no clue where he has been.......but fear sets in.

Good to go, he leaves the hospital on schedule, a well man.......but he decides to sue the hospital for his unexpected ordeal.

I was with a risk management group listening to the pleas of the competent team to NOT let this patient win big bucks.  Come on!  They SAVED him!  Where is his gratitude?  He was not damaged and aren't you supposed to not be able to sue unless you are damaged?

I shall never forget our own corporate lawyer speaking to us as  a group.
"What's a good scare worth?
In terms of money.......what could we pay you to lay on that table and get a 50ml bolus of air intravenously?"

We were all silent.  No response.  No matter how badly we wanted that second home on the mountain. or a year off to tour Europe, or enough money to make our kids suck up to us, we were all smart enough to know to avoid flatlining (even temporarily ) on the way to a rich life.

Naturally the patient won.
He didn't even have to go to trial.
No hospital wants bad press and there was no way to make this one look good or even ok.
These situations are worked out behind closed doors, away from the consternation babble of competent team members who did a magnificent job saving a patient.

But some patients really are grateful.  A doc once told me that he found his most grateful patients were the ones he rescued from his own mistakes.

Change of shift time in a hospital puts a bit of fear into all of us health care professionals whether we are leaving our shift or arriving for our shift.  Our nighttime nightmares are often studded with "what did I forget?" or "the next shift isn't coming and I have to stay!"
We health care professionals really are great.  We care.  We dream about you.  We have nightmares about our responsibilities to you.

Yet Hillary Clinton said RNs are the biggest waste of money in health care!
Do you suppose she would value my opinion on Bengazi?

It is true it would be nice if no mistakes were ever made, but my bias is I want a team that is highly competent and motivated to rescue me from their own mistakes.

And my advice to all is that should you ever survive a Good Scare in the hospital, get a Good Lawyer.

A good scare is worth a lot!

Thanks for your visit,
Riverwatch, RN