Monday, February 06, 2006

My Special Hospital

The hospital that I work at is not your typical hospital. This huge behemoth is not what one would call a well-oiled machine or anything remotely similar. Besides the fact that it is over 100 years old and is still confined to most of the same buildings all these years, this is, after all, a general hospital, meaning that it treats everyone who walks through its doors, both insured and uninsured. It’s overpopulated with patients, understaffed (which is why students are allowed to do so much), and short on space ... a deadly combination that results in lots of work that doesn’t get done and also many disgruntled employees sporting the typical government employee attitude of “I don’t care”.

However, as unpredictable and quirky as this hospital is, there are definitely a few things you can always count on. Here are just a few:

The Smell
It hits you before you even reach the patient’s bed. You can’t tell if it’s the smell of the hospital in general, the disease itself (for awhile I was convinced that appendicitis had its own unique and disgusting smell), or the smell of a person who hasn’t showered for as long as they’ve been in the hospital. It’s a strong and foul odor that smells like a mix of vomit, poop, and bad breath and it makes you want to cut short your interview and physical exam so you can quickly run away to somewhere, anywhere, where there are no patients ... the hallway, bathroom, your car, somewhere, just get the rotten air out of your nose. Whatever it is, every patient has it, and there’s no escaping it.

So what was it? In the end, no one knew. Most of us just concluded that the smell was probably the nasty stench of someone who hasn’t brushed their teeth in days.

STAT Lab Tests
You know it from the show “ER” ... you probably don’t know exactly what it means but you’re pretty sure it means something like “do it now!”. It’s the phrase “STAT”, medicine’s popular yet cryptic term to describe some order — a blood draw, for example — that needs to be performed immediately. Even though on TV it’s yelled out aloud, in reality it’s only written on forms. For example, when ordering an X-ray, you check off one box indicating the level of urgency: Routine, Expedited, or STAT. Now, based on common sense (as far as practicing medicine goes), it’s assumed that ordering something as “Stat” means that whoever is in charge of processing that order will drop whatever they’re doing and immediately start your order. So a stat lab draw ordered at 3pm will hopefully be drawn by 3:05pm and have results back by 3:30pm. Right?

Riiight. Not here, as you might have guessed. At this hospital, one is lucky if that 3pm STAT lab is even noticed by the nurses at 4pm. Realistically, you are looking at blood being drawn by 5pm and results returned by 6pm.

And that’s for a fast test. If you think that’s slow, take an X-ray. Here, you’re lucky if it even gets done. Put in an order for a STAT chest X-ray for 3pm and then pray; if all the stars are aligned properly (meaning the nurse clerk doesn’t accidentally lose the order, the radiology techs don’t forget about you, and the computer system isn’t "down for upgrades"), you’ll have it by nighttime. Sad but true.

Now you see why the X-rays we need by 9am are ordered as “3am X-ray, STAT”. And now you also see why our patients never, ever leave.

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