Thursday, November 3, 2011

Information Flow

Meant to write about this a while ago, right after the story about my cat, but things didn't go well with the cat, and I was caught up in that for a while, and never got back to the story.

We ended up visiting the vet hospital several times, as the situation went from bad to worse. Turns out the cat had some rare form of bladder cancer. We started him on an experimental treatment, which helped for a while. Longer than we expected, really. But ultimately, there was no cure.

Part of the experience- the part I want to share here- had to do with getting information.

I understand more medical stuff than the average person. I have a fairly large working vocabulary of medical terminology. Anything a doctor (or vet) says to me that I don't understand, I ask about, and ultimately research on my own.  I am definitely the kind of person who wants to know what is going on.

It mystifies me that not everyone feels that way. I run into a lot of people who prefer NOT to understand medical issues, even their own.

So there we were, at the vet hospital, in the evening. Cat was whisked off to surgery, I was told to go home, that they'd call me.

They didn't.
I called them.
Was told the cat was doing well and that we could come visit whenever we wanted.
I wanted to go in the middle of the night, but I don't think that's actually what they meant.

We visited the next day, and talked to the vet student assigned to our case. She said there were tests still to come back, and they'd let me know. She ALSO said that the care so far, and the care he still needed, and I don't even remember (red flag!) what all she said, except that it was going to be extraordinarily expensive.  And that I had to pay half of it upfront, right now, or end of treatment.


To make a long story slightly less long, we ended up seeing two vets, three vet students, the pharmacist, several receptionists and the folks who took the payments.

We spent days (not all in a row) expecting them to call with an update that only sometimes came. Other times, we had to call them, and call them, and try to figure out when to call to get the person we wanted.

In short, I spent a lot of time wanting more information than I was getting. It was frustrating, and it was scary, and we were all already very stressed out by the situation.

And it was right about then that I realized that we see people in that situation ALL THE TIME.

The main problem was that I didn't understand the system there, not having had much experience with it. I didn't know who to talk to about what, how to know when to call or who to call. I had to juggle 5 different medications and their schedules and side effects, something I also had no experience with.

It gave me a huge amount of sympathy, and a reason to take a look at the environment we create when we walk into someone's house after they call 911.

Much of the time, they don't know who we are. They don't necessarily know what is wrong, although sometimes they do. Even when they know what the problem is, they don't always know whether this is capital-S-Serious, or not. They don't know which person on scene to ask, they don't know what our qualifications are, and they don't know what is going to happen next.

All of this "not knowing," on top of a high level of stress, does not generally make for an easy, happy situation.

I have been working on being much more proactive in helping patients and their families understand what is happening, when I can. If I'm involved in a true emergency, and direct patient care is taking all my attention, then I can't direct a lot of energy to the family. My goal is for all of us to get better at that so whoever is able to fill that role, will.

My partner a while back started something that we immediately adopted as our SOP. Hello, my name is ______, this is my partner ______. We're EMTs, and we are here to take care of you until the ambulance gets here.

That is the reality of our role out here. Amazingly, just giving them that much information is a HUGE help in their understanding the flow of things. We used to have a lot of confusion out here, about why so many different people show up, and why there are "two ambulances" when they only need one. (At the time, our rescue was an old ambulance, so although it wasn't actually an ambulance, most people thought it was and were very surprised to find out it isn't. We don't have that problem now- our new rescue looks like a state police car. An entirely different set of issues, that. But people pull over for us!)

As the ambulance arrives (and as the situation allows), I tell the patient that the medics are going to come in, and they will probably ask a lot of the same questions that I've asked. I then introduce the patient and the medics, by name, and make the transfer of care.

Once the patient is in the ambulance, I am usually (but not always) out of that loop. I will wish my (now former) patient well, and let them know I have every confidence they will be well taken care of by the ambulance crew. I can do this because I have made the effort to establish a working relationship with all of the people who might be on that ambulance, so I know them by name, and I know a lot about which I've seen be particularly good at which things.  I'm not just mouthing the words.

At that point, my focus shifts to the family and friends.
We make an effort to provide as much support as we can.
We lock doors, turn off lights, feed cats, bring in dogs, etc. We make sure anyone who is going to the hospital knows how to get there. I find myself often explaining to a spouse or child that the fact that the ambulance hasn't left in a hurry isn't because something is wrong- there are some procedures that need to be done that are better done when the ambulance is not moving.
I've talked to children about where their sibling is going.
I've talked to family members about what the sequence of events will be after someone dies, and reassured them that police presence is standard procedure here, and does not mean that anyone thinks they did something wrong.
I've answered I have no idea how many questions about what just happened, what is going to happen, and what isn't going to happen.

I hope I'm able to fill the gap a little, so that people don't feel that additional stress of not knowing who to ask, or what to ask, or where to go.

I just recently had occasion to go to the police department in a city a couple of hours from here. It was a large place, in a large (to me) city, and I had no idea where I was supposed to park, where I was supposed to go, how to get there or what to do once I got to the right window. The entire place was set up with an assumption that everyone who came in there was familiar with the procedures and such. I think almost every "public service" building I've ever been in, from police stations, to jails, to social services buildings, has always had that same sense about it- that you are supposed to already know the drill.

I didn't.
Trying to get someone to help me was a challenge, and the guy who finally answered my question would not win any awards for public relations.

It reminded me, again, of my experience at the vet hospital, and the importance of understanding that many of our patients don't "know the drill," either. They may be going through a totally new experience, having never called 911 before, and have absolutely no idea what is going to happen, or what to expect.

It is way too much to expect them to figure it out on their own under those circumstances. All the SOPs and protocols and procedures we do are very familiar to us, so it's easy to forget that not everyone knows how things go. We have to tell them.

1 comment:

  1. They are lucky to have you, Linda.
    I'm going to share this with Josh. As a new firefighter, he could set up some good habits from the get go. He has a great deal of respect for the department that hired him - he was an Explorer there for a couple of years before he went to the Fire Academy. But this was a really good point that he could pull to the front of his head.
    Thanks for writing it!