Part 3: Hospital Stay, Day Five...

My friend, Dory, hearing I would be spending the weekend in the hospital, contacted me to see if I'd like a visit on Saturday.  Oh yes!  You'd better believe it! 

I got up with new purpose on Saturday, showered, put on normal clothes (including shoes), and waited for Dory's arrival.  I checked with my nurse to see if there was anywhere other than my room where we could meet.  Not that Dory wouldn't have been fine with meeting in my room, but I was ready to spread my wings and visit some other corner of the hospital after being given permission to do so the day before.   I was told there was a "Friends and Family waiting room" that we could use.  Great!  I met my friend at the elevator and we went to this little "kitchenette" room to spend an hour or so.  Dory brought us milkshakes (a heavenly treat after nearly a week of hospital food), and at some point, she broke out some cards and we started playing - what, I don't remember.  Thankful she had thought of cards, I was nearly giddy to be doing something - anything - so ordinary.

At some point in the visit, I decided to make a trip back to my room to get some things (one item being a cup of ice water for me).   On my way back to the room where Dory was waiting for me, I had to pass through two different sets of double doors.  As I approached the first set, a motion detector started two doors opening in opposite directions in front of me.  Now, I don't know if you've ever had this happen to you, but as I walked (maybe a little too quickly) the soft rubbery toe of my right shoe grabbed onto the highly waxed tile floor, pitching me slightly forward.  When this has happened to me before, I've sort of jerked my arms out a bit to keep my balance, and then a tad embarrassed, regained my footing and simply carried on. But this time, I suspect because of the opening doors ahead of me (and the one coming toward me that I needed to avoid), and maybe because my hands were full, and maybe because I was walking too fast and happy...  I fell.  To the floor.  On one knee, and possibly my posterior.  I don't remember exactly as I was up nearly as quickly as I went down.  But the nurses saw it and came running.  

While certainly embarrassed at my clumsiness, I didn't think it was a big deal.  I mentioned that I spilled some water and I think I even said, "I'll get some paper towels", to which a nurse replied, "We'll take care of it."  They were only concerned that I was okay.  I assured them I was fine, and thinking nothing more of it, I happily made my way back to my friend who was waiting for me to return.  I told her what happened, laughed off some of my embarrassment, and I think I was beginning to deal cards when my nurse and technician came into the room very somber.  They explained that they would have to report the fall, and check me over to make sure I wasn't hurt.  They communicated that they felt terrible about it, but it would mean that I would need to go back to my room.  And that I would have to have alarms turned on on my bed and recliner.  I'm still stunned remembering that moment.  I had just gotten freedom to leave my hospital room in some meaningful fashion, and the freedom was being snatched away over a stumble that could have happened to anybody!  I started to make the argument that controlling my fall (rather than tumbling into a moving door which would have surely injured me), and picking myself up as ably as I did was clearly evidence of my being able bodied.  It was my shoe that was the problem, not me.  The issue was so ridiculously obvious, I was having trouble taking it all seriously.  In disbelief, I even joked, "What are you going to do if I don't comply - kick me out?  Please do!"   I was just incredulous.  And heart broken.

Even though they felt sympathetic, and they knew the stumble had not been a reflection of my ability to walk, they had to comply with hospital policy.  This is the point where I learned that a patient's "fall risk" is a compilation of things, some of those things having little to nothing at all to do with any individual's actual fall risk factors.  In the end, determining a patient's "fall risk" is about statistics and liability.  Statistical factors, as well as real factors (of which I had none at that point) are entered into a computer and an algorithm takes the decision out of nurses' hands to assess an individual for his or her personal risk factors for falling.   Things like medicines and various signs of instability (these I can appreciate), age, and even sex are typed into the computer.   I have no idea if certain statistics are true, but even accepting for the sake of argument that say, statistically woman perhaps fall more than men (though without knowing why, the statistic has very little value), that statistic has nothing to do with me as an individual.  It has nothing to do with my personal "fall risk" and everything to with the hospital's liability risk. 

After Dory left, I sat in my room for a couple of hours on an alarm pad that would sound if I got up.  To say I was indignant would be an understatement.  As I stewed over the whole thing I became increasing angry over the stupidity and wrongness of the situation.  And not just for me.  I was incredulous that a hospital expects patients to trust the professionals it hires to care for them, but the same hospital will not trust those same professionals to asses a patient and make reasonable conclusions about something like this - after hours (in my case, DAYS) of observation of a patient.  Nurses that I had literally trusted with my life all week, were stripped of the ability to make a decision that would respect my actual abilities and mobility - that they could clearly see were fine.  That a hospital would adopt a policy to allow an algorithm to make such a decision and turn a trusted relationship into potentially an adversarial one was just ludicrous to me. 

This might be a good time to mention that on Monday night after my emergency surgery, and at least part of Tuesday, there was an alarm on my bed.  I was weak and on medicines and at times could barely keep my eyes open.  I was hooked up to various things, and I couldn't get up and walk anywhere without someone unhooking me from something attached to the wall (a heart monitor, I believe).  There was no thought during that time that the alarm was for anything other than my protection.  I didn't resent it.  I understood its purpose.

But once I was unhooked from the heart monitor, I demonstrated numerous times that I could take the IV pole to the bathroom and manage perfectly fine.  In fact, it wasn't until they took me off the heart monitor that I began to question the need for the bed alarm.  At that point, I had become strong enough, and the staff had had time to see that I was stable.  I don't remember asking more than once before the bed alarm was turned off for me.  The alarm wasn't an issue to me when it was needed, and it seemed to be an easy decision for them to remove it when I became stronger and it was no longer needed.

Anyway, after stewing about my new confinement for a couple of hours, I unplugged the chair alarm I had been resentfully sitting on and walked myself out to the nurses' station and asked if there was an actual human being I could speak to about the situation.  To be clear, these were my nurse and tech who felt bad about the whole thing, and who wished there was a way around the policy.  They appeared happy that I wanted to talk to someone higher up.  They said they would request this person come and talk with me.  With new purpose, I went back to my room to put some of my thoughts down on paper while I waited for this person to arrive.  A half hour or so later, I heard someone(s) coming into my room.  My back was to the door, but I began to greet my visitor(s) as I pushed my chair back from a little table I was sitting at.  Imagine my shock when, as I turned around, I saw a police officer standing in my room. Beside the police officer was the person who I was told would come to speak with me.  I don't remember what her title was, so here on out, she will be known as the administrator.

Now...  while I was incredulous to see the police officer, it only took me a few seconds to realize she was there in case some sort of protection was needed.  I guess.  Or was her intimidating presence the sole reason for her to be there?  The administrator referred to the police officer as "her friend" that she always brought along to this kind of meeting.  Feeling patronized that that was her explanation of a police officer's presence in my room, and I'm sure stifling an eyeroll, I concluded I just had to "be the adult" in this whole situation.  I stated that I was surprised to see a police officer, and said her presence made me nervous (my voice was now shaking a bit and I figured it was better to just be open about my discomfort), but in spite of that I pressed to explain my issue.  Actually, just before this, I asked the administrator who was a young woman and towered over me if we could both have a seat.  She hesitated, but when I sat down and motioned to the couch where she could sit, she did so - even though she didn't look like she really wanted to.  What I had moments before I envisioned as an opportunity to reason with someone in authority, and bring a little humanity into a situation that was being controlled by an impersonal policy and a computer algorithm, was suddenly feeling very unfriendly.  But I pressed on.

The administrator seemed nervous, too, from what I could tell.  I'm in no position to know how often a police officer is needed in a situation like this, but in my estimation her presence in the room was a complete negative in this case.  Afterwards I wondered, Could the officer not have been outside the door waiting for me to - do what, I don't know?!?  But just in case the administrator really did need her help.  Like if somehow this 64 year-old woman who is supposedly too weak or unstable to walk around freely, is strong enough to inflict harm on a nearly 6 ft tall athletically built young woman.  

I'm sorry.  It gets really hard for me to not get sarcastic as I recall all of this.

Interestingly, about 20 minutes in (though I have no idea, really, how much time had passed), the administrator evidently felt safe enough that she dismissed the police officer.  The atmosphere changed immediately.  I know I instantly relaxed, and the administrator appeared to let down some of her guard.  At some point, the charge nurse came in, and we actually had some friendly discussion amongst the three of us.   At some point, when we were in this more relaxed state, and I brought up issues of privacy - which I felt more keenly because I had a male nurse and tech that night, the administrator actually began to suggest "work arounds" to the problem.  Things that could give me some autonomy and privacy (for things like going to the bathroom, for crying out loud).  That I had to even ask for that in my able-bodied state troubles me - still.  While, on some level, I appreciated the suggested work-arounds, they really only made a mockery of the whole thing.  That they were offered, highlighted that there was a problem with the systematic, impersonal way in which patients are identified as fall risks.  In the moment, it felt like something, though.  But when I discovered later that I would have to negotiate these work-arounds with each new nurse/tech combo, and they were not compelled (probably didn't even have the authority) to negotiate anything regarding my movement, I realized the "work-arounds" were meaningless offerings.  I was on my on to manage the situation as best as I could. 

Really, while my complaints were freely voiced, it seemed the whole thing was a pointless exercise.  While never giving a hint at being persuaded by any of my words, the administrator finally camped out on she herself feeling helpless because of the hospital policy.  How convenient.  She could sympathize with me, but she had no power to change the situation.  And she didn't seem the least bit troubled by it.   In fact, she seemed to see it as her duty to keep to the script.

The message was loud and clear.  No one who actually matters in the relationship of patient/caregiver has any autonomy anymore.  The nurses said they had no autonomy, the administrator said she had no autonomy.  It's as if they all had memorized the script.  It seems I surrendered my autonomy when I presently myself for surgery on Monday night.  Lawyers hold the cards, and in this case a patient suffers for it.  Up to this point, the suffering felt is mostly emotional and mental, but it was suffering, nonetheless.  It was a maddening situation.  A patient, who on one hand was considered well enough to go home, is caught in an algorithm that decides she must be confined to bed or chair with alarms - not because she fell from mobility or other health issues, but because she fell from a stupid choice in footwear.  But there is no blank for explaining things like that.   And there is no way to redeem oneself from this decision.  The decision is made, and it stays made until you leave.  I asked, and that's what I was told.

And for a bit of irony...   When I described what caused the fall to whoever would listen, almost every nurse or technician (and even a different administrator) admitted they have tripped similarly, and recognized how easily the fall happened.  Just looking at the highly polished floors, and the footwear the staff wears, no one had to tell me for me to know that this sort of tripping happens on the job, but I sure appreciated the sense of solidarity it felt like in the moment (even if none of that matter in the case of my "confinement").

And I haven't even mentioned how my health began to suffer between Friday and Monday.  The stress from earlier in the week, waiting day after day expecting to be released, started to look like a cake walk.

To be continued...