A college professor, knowing of my experience as a clinical nurse specialist, sought me out to discuss a disturbing event that happened to him during a recent hospitalization. He first described his pertinent medical history which included 2 previous myocardial infarctions and coronary artery bypass surgery. On the evening of this present hospitalization, he began experiencing a very rapid pulse with intermittent pauses and rather serious indigestion. When he took his blood pressure, it was very low. He and his wife agreed that they should go immediately to the local hospital emergency department. There, he was attended to in a rapid fashion, hooked up to an electrocardiogram machine, 2 intravenous lines, and nasal oxygen. The emergency physician called his cardiologist who listened to the findings and ordered him to be transported to a medical center in Boston via the lifeline helicopter.
The helicopter arrived within minutes and landed on the rooftop of the tallest building of the medical center. He was rolled into the emergency department of the medical center within 15 minutes of leaving the community hospital. There, he was carefully examined and monitored. The medical and nursing staff treated him with kindness and attention to minute details. A physician and a nurse transferred him to the cardiac care unit. During the transfer, he was monitored. A portable automatic defibrillator was placed on the gurney in case it was needed during the transfer time in the elevator. The reasons for all of these actions were carefully explained to him. In the coronary care unit, he continued to receive careful attention under the watchful eyes and expertise of the coronary care staff. Then all of a sudden, in the early morning hours, a person arrived with a wheelchair and ordered him to get out of bed and into the wheelchair. Once in the chair, the professor, feeling quite groggy from lack of sleep, asked where he was being taken. He was alarmed because he had not been told that he was going anywhere and also because he was disconnected from his monitor. In addition, there was no portable automatic defibrillator available should he suddenly develop tachycardia or something worse. And how would the disinterested transfer person even know or, worse, be able to help him if he began having cardiac troubles? The transfer person mumbled "echocardiogram" in answer to his question. In the intervening 15 minutes, this person did not speak. In the waiting area of the echocardiogram laboratory, he parked the professor next to 2 other men who were also waiting silently. Two receptionists seemed unaware that the patients were even present. Looking around the drab and dirty waiting room with bits and pieces of trash on the floor, he saw, on one soiled wall, an old print of Van Gogh's Sunflowers.
He waited for 30 minutes for the echocardiogram during which he became anxious and then forlorn. Memories flooded back of a snowy night in Maine years before. He had taught an evening class and was driving home on a country road during a snowstorm when his car skidded off the road and plunged down a ravine. He was not physically hurt, but when he managed to get out of the half buried car, no one was there to help, only total silence. He managed to climb up the ravine onto the icy road. He mused that he was thrown from a protective and warm car into a cold and silent world. The analogy does not escape the reader, I am certain.
His reason for seeking me out was painfully obvious. He wondered and still wonders to this day how such expert continuity of care can suddenly be so seriously interrupted due to the lack of human factor. The fact that this stark experience delayed his recovery goes without saying. As clinicians and administrators in nursing and patient care services seek to ensure continuity of care and patient safety, attention must be given to such serious lapses in care. The human factor, recognizing another's humanity, is central to health and healing.
As an afterthought, it is disconcerting that something which is so well and imaginatively captured in literary fiction can at times be so absent in experiential fact.