35 years in health care in 10 minutes

nancy - MPLS, Minnesota
Entered on March 10, 2009

35 years in healthcare

I’m not in the business of healthcare or the politics of healthcare, I’m at ground zero, on the frontlines. This is my report from three and a half decades in the trenches.

My first job as a nursing assistant paid $1:75 per hour. We were promised a raise after 6 months but we didn’t get one. That was my first experience of a lie by the healthcare industry. I would witness many, many more.

I was 18 and had never seen a naked adult. Suddenly I found myself having to bathe people I didn’t even know,…..people I didn’t want to see naked. A tub bath meant taking every stitch of clothing off another adult, and lowering them into a bathtub, washing them, then drying them, even between the toes.

There was no training back then. It was soposto be common sense.

But it wasn’t. It was shocking, embarrassing. I felt clumsy.

Then one day something clicked. What if one of these people was my mother or father? How would I care for them? Suddenly it all became simple. I knew exactly what to do for them.

I began to love caring for these people.

They became like my own family

They had no one else

They needed me

And I cared for them

I found this to be the most profoundly meaningful thing one human being can do for another.

I started working at a university hospital and did a variety of odd jobs. One of those jobs was called a sitter. A sitter was anybody willing to just sit with a patient for an 8 hour shift because the patient can not be left alone. Sometimes I would be hired to just sit with someone who was waiting to die because the family did not want them to be alone.

One of my first sitting jobs was to sit with a girl about 18 years of age. She had taken a gun and shot herself in the head through the mouth. She did not succeed in killing herself. She simply blew off half of her face. That was one of the most profound 8 hours of my young life.

Last winter one of my mentally ill and psychotic patients had been wandering around outside for days without gloves. When she was admitted to my unit her hands were swollen to twice their normal size. When I last saw her, her fingers were black and shriveled. She will lose all of her fingers.

So now you know a little of what it is like on the front lines. Lets take a look at the underpinnings of healthcare, the structure within which these patients are cared for.

Whenever my healthcare facility is going to be inspected, the management audits the patients charts, runs around making sure all the I’s are dotted and the t’s are crossed and everyone has washed behind their ears. It makes me think of this metaphor. I call it the story of three cars in a two car garage.

Once upon a time

The administration told the staff to put three cars in the company garage.

The workers said, “We only have a two car garage.”

The management said, “Well, try harder, I’m sure you can do it.”

So the staff tried a number of different strategies. All the cars had been in the garage at some time or another and this of course was well documented.

The management looked at the documentation and said, “Looks good.”

The CEO said, “Well done!”

The health department inspector said, “You Pass.”

And they all collected their paychecks and lived happily ever after.

I began to notice that there were two worlds. The one on clean white paper and the one down the hall that sweats and stinks and cries.

I went to the director of nursing and told her that I noticed things written in the chart as done weren’t done. She said “I know. They are doing the best they can but there just aren’t enough hands to get the work done.”

I went to the administrator and he said “ We just do the best we can, there isn’t enough money for more staff.” (The lobby, chapel, dining room and offices had all just been redecorated).

In years to come I would hear that phrase many times. “We are doing the best we can.”, came to mean, “We have failed our patients and we return to do it again day in and day out.”

Look at the names of hospitals, Mount Sinai, St, Josephs, Mercy hospital, Methodist Hospital. It is no coincidence that the first hospitals were run by churches. Churches were about mercy and caring for the needy. It was a natural match for churches to run hospitals. Now hospitals are run by corporations, which are run by politics, which are controlled by even bigger corporations.

I’ve been on the ethics committee of a large hospital and found it to be a worthless pretense, An ivory tower of mental masturbators used by the hospital for public relations.

So what is wrong with this picture ?

I once believed that we as a society had lost our moral compass and that was why we could not get to our destination of caring for the sick. Now I believe our compass is just fine, it is our destination which has changed.

Our goal is NOT to care for the sick. Our goal is to make money (by caring for the sick). We USE the sick and elderly to make money.

Finally at the age of 55 I have come full circle. No longer concerned with the healthcare system, I simply focus on the patient I am with and am grateful I have the most honored job in the world. I get paid to love people. I am the luckiest person in the world. I believe all that matters is the present moment and the people present.

Finally at the age of 55 I have come full circle. No longer concerned with the healthcare system, I simply focus on the patient I am with and am grateful I have the most honored job in the world. I get paid to love people. I am the luckiest person in the world. I believe all that matters is the present moment and the people present.