Hospital hygiene – it's in the details

It started with a chair.

But unlike the movie Juno, that’s where the gynecological similarities between this and that story end.

I had been admitted to Centrallasarettet (Västerås County Hospital) for a hysterectomy. A small armchair stood in the corner of the room. It was not an unattractive chair and it added a little warmth to the room. The evening before my operation I sat on it and noticed the back was broken. This is a little dangerous, I thought. If someone leans back too far they could get hurt; now I know why the chair is propped in the corner.

A day or two after the operation, my husband came to visit. He pulled the chair forward and it flopped back. Look out, I called, the chair is broken. Another time, a nurse came into the room and the chair was looking floppy. She nonchalantly propped it back into the corner. No one took it upon themselves to have it removed before someone got hurt.

(When you're stuck in a hospital bed for a week, there’s not much to do except observe - like the picture of a sweet child on the wall of a room in a ward for women facing reproductive issues such as difficult pregnancies, miscarriages, hysterectomies, and gynecological cancer. Bad choice.)

Due to challenging surgery and a complication, there were two drains and a catheter protruding from me the first couple days. Each time a nurse came into the room to check me, she’d (all my nurses were female) pick up the drains, which had fallen on the floor, saying “These shouldn’t be on the floor.” Inevitably, since hospital beds are narrow and, at first, I wasn’t even aware I had drains in me, they’d fall on the floor again and another nurse would come in and say “These shouldn’t be on the floor.” (I couldn't pick them up myself.) One nurse did pause and look to see if there was a way to fasten the drains to the bed but nothing came of it.

Soon the drains were removed, but I still had the catheter. As I began to get up and move around, I noticed dried spots of urine on the floor, where the drains had lain, and where nurses emptied the catheter. The spots were sticky-looking and dirty because each day a custodian came in and dry-mopped the floor, thereby smearing the semi-dry urine.

I felt ready for a shower. I went into the bathroom, which was shared by four patients, two per room, and their visitors. I noticed a sign above the toilet and large bottles of anti-bacterial disinfectant next to the sink. The sign said that patients, for their own safety, should clean the toilet, I assume the seat, before using. I took a quick look in the bowl. Not disgusting, but not the cleanest toilet I had ever seen. (After abdominal surgery, patients’ bodily functions are not quite what they should be.) It stayed like that for days.

As my own body recovered and I started using the toilet. At least once I slopped excess disinfectant on the sink and the floor as I was wiping the seat. I thought about the effect of this on the worldwide overuse of anti-bacterial agents, but never mind.

One afternoon there was a problem with my catheter. As I lay in bed and the staff attended me, they put used tubing and instruments on my bedside table. When they were done, they took everything away, but no one wiped down the table, which was also used for food and medication. When they had left, I got up and did a little cleaning. Thank goodness for that disinfectant in the bathroom!

At meal time, staff would bang on a pot lid - like farmers summoning pigs to the trough or, more kindly, troop leaders rounding up kids at scout camp - to let patients know the food cart had arrived. There was also a coffee cart in the corridor where patients could get a light snack and something to drink during the day. When I was able to walk, I got up for coffee. The floor in front of the cart was splattered with coffee and juice.

One day as I sat in the patient lounge, I smelled something - it was the custodian’s mop as she casually made her way down the corridor.

I’m sure the chair is still there.

Kafkaesque

I had to call Bleak House - I mean Västmanland County Hospital - today to schedule a gynecological exam.

The first thing I noticed was telephone time: 7:00 am - 3:00 pm, Monday through Friday. While I realize some women may appreciate an opportunity to make an appointment before running out the door to work, if the trade-off is to call at 7:00 am or 3:00 pm, I opt for the latter. I think I can safely say the first thought of the morning of most women I know is not "I want to call the gynecologist." (Note: abortion services are another number!)

Second, this is the number to make an appointment for an appointment. When you call, you get a recording that asks you to leave your name and number and a promise that someone will call you "around" a designated time. (My callback was 10-15 minutes late.) If you call too late in the morning, all the callback times are booked and you have to start over the next day. This arrangement is a slight improvement over the old system when you were allowed to call only one or possibly two hours a day and you had to sit on the phone in a telephone queue, often for half an hour or more, waiting your turn. But the fundamental question is: When they decided to make the appointment system more "user-friendly," was this really the best scheme they could come up with?

When the clinic does call you back, you can request an appointment. But first you must justify your need. When I explained my problem, I was asked if it was urgent or if it could wait. If it was an urgent problem, I could get an appointment within a few days. If it was a non-urgent problem, I would have to wait about 2½ weeks. Urgent? Non-urgent? Huh?

I don't know about you, but I don't usually plan my medical problems weeks in advance. When I call to schedule an appointment, it means I'm ready to see a doctor now. If I could wait three weeks, I wouldn't be calling this day; I'd be calling three weeks from now! When I call, it means I've done my waiting for the problem or pain to go away. I'm ready to see someone today (or as soon as possible). That's why I'm calling!     

And so it goes

The orthopedist was supposed to call me today at 11.55 to talk about the results of an MRI on my knee that was performed two months ago. By 12.25, he still had not called. I emailed the department (it's virtually impossible to reach them by phone) and asked if he was going to call today.

Don't know if they had read the email, but ten minutes later - 40 minutes after the designated time - he called (with no apology). I said I had not had a chance to talk to anyone about the MRI, which had been done two months ago. Didn't I call and leave a message, he asked? Yes, I said, you left a message on my cell phone, which I didn't find until two days later. You asked me to call if I had questions. Well, I do! We talked, and I pried out of him some ideas about what could be wrong with my knee and some thoughts about what to do next.

In Sweden, you do your job. His job was to report my test results, not to assist with or solve my problem. It seems obvious, but I guess it's necessary to articulate that actually assisting a patient is part of a physician's job description.

Job description: physician. Blah, blah, blah. Must also attempt to solve patient's problem by talking to patient live and identifying action steps for treatment. Disdain for people automatic disqualification for this job.

The orthopedist did his job: he reported the test results. But did he attempt to help the patient?