Some ghosts rest
My sister is 38 years old. She is married, not for the first time, but hopefully for the final time, to a good man. Together they’ve made a life that could be called simple, as it involves farming and animal husbandry, but anyone who knows them knows that the life they’ve made together is anything but simple. The paths that lead them together were wild, badly overgrown, dangerous. Trails were closed. Bears were in the woods.
But what does that have to do with dead patients?
My sister came to visit us about a week ago, and we were talking about dreams. I rarely remember my dreams, though they’ve been more frequent lately, but she told us about a dream she’d had recently.
She was in the hospital where she worked, and in one of the rooms, a balding, skeletal old man waited in a bare room. It was clear to me, at the time, that the man is waiting to die. In fact, he is.
She said when she walked the halls the family of dead patients came to talk to her, on their way to visit their dead relatives.
In her dreams, the dead live, and speak, and remember.
My sister is haunted by her dead patients. She is not responsible for their deaths. She works in a liver transplant floor, so anyone who comes under her care was already quite sick. The liver is one of the largest organs in our body, and it does some important stuff. If you need a new one, well, you’re not doing so hot.
My sister has run into her fair share of difficulty. She is no stranger to pain, to heartbreak, to desperate times and desperate people.
But what does all this have to do with dead patients?
My older sister is rebellious. She is headstrong, independent, and fierce. She carries the genes of our parents as a challenge to the world: though she be a woman, she be fire. She is bright, and she will burn you. She is warmth for people who have no hope. She held a soldier’s hand through the night who was still fighting a battle that killed his buddies years before, and she was a warmth that kept him here.
She is fortunate to work in a hospital ward where she has one or two patients at most. They need her help desperately. They need fire in their rooms, not mere heaters, no sparks, but blazing infernos of compassion and professionalism.
I should say, her patients are fortunate to have her.
But what does this have to do with dead patients?
It is easy for me to sit here, in utter worship of all the women in my life, to tell you my sister is a hero, unsung, unacknowledged save by those she’s saved. It is easy for me to do that because I am her little brother, and I love her.
I can sit here and write that she’s a perfect nurse, a perfect person. I could sit here and tell you stories about, even as children who hated each other, she threatened to hit a person with her car who bullied me.
But the truth is, she is legion. There are thousands of her working across the hospitals in this nation. In the world. Men and women who have dedicated their lives to helping others, to curing the sick, to holding they who are soon destined for the grave and whose families have abandoned because they cannot bear the sight, cannot let them go. It is nurses who sometimes have to be family to men and women they only met that day. They hold hands until hands go limp. They listen to a long breath, and then the lonely silence that follows. They hear heartbeats stop, start, stop.
But what does this have to do with dead patients?
The truth is, it has a lot to do with dead patients. My sister, who I love, cannot be the only nurse in the nation who gives a good god damn about her patients. My wife is a nurse, and I know she cares.
I’m not a person who is uncommonly lucky to be surrounded by dedicated women (and a few men) who do this difficult, thankless, scary, terrible job. I am just a regular person.
I say all that to say this: our nation is grinding our nurses to dust, and we’re killing people while we do it.
Depending on the floor or ward of the hospital, nurses are to be restricted to a certain number of patients. Sometimes you could have as many as five or six patients, and sometimes critical patients need one or even two nurses per. Nurses juggle medication, physical and occupational therapy, procedures, IVs, and so many other things I can’t even think to name them because, despite knowing many nurses and being married to one, I’ve got no idea what their day is truly like. I can relate it to my teaching experience in some ways, but like so many of the difficult careers in the world, the only people who “get” it are other nurses.
Patient outcomes are generally better when we see more nurses on staff, though I imagine support from administration, morale, pay, and other things influence that as well. But the fact remains that if we don’t have enough nurses, then the patients aren’t being taken care of. If the patients aren’t receiving the time and attention they need, then errors, even fatal ones, may occur.
Who do we blame when this happens?
Nurses are highly visible and in and out of rooms constantly. It’s a job that we’ve seen nurses do from time to time, and we think we could do it ourselves, if it came right down to it. People think that way about a lot of careers...teachers, police, and I could go on.
When something goes wrong, we blame the person on hand. The nurse. Maybe the doctor, sure, but doctors are facing problems alongside our nurses. When a patient dies, I guarantee someone is in there with a clipboard wanting to know what’s and how’s and why’s. It makes sense. If I lost a loved one in a hospital, I’d want to know.
The thing is, sometimes nurses are so covered up with patient loads that they can’t be there for every patient, to translate doctor-speak, to fill out boards with inane information that has nothing to do with actual patient care and everything to do to making it looks like an efficient, customer-centric business.
Ah, and there we are, the word that explains so much.
In the United States, unlike civilized countries, we still treat healthcare as something we should be able to shop for. Yes, please, I’ll take an emergency appendectomy. That’s a choice I can make right now.
Let me ask you this: are you buying something by choice if someone holds a gun to your head and tells you to pay?
What if your child was sick? What would you pay? How much? Everything? More?
Americans face those decisions. We lose money from work because we need to take time off. People wait until they’re critically ill and then take an ambulance ride ($$$$) to an emergency room ($$$$$$) for emergent care ($$$$$$$$$) for a health issue that was minor ($$) before it became major.
When I listen to the nurses I know, they complain about administrators with nebulous duties wandering around the hospital asking patients if their pain is being managed well, if they’re happy with their service, if they want a drink or something. They look at boards to see if nurses have followed the protocols and circled a number that describes a more ideal amount of pain.
Where are the administrators who walk around asking the nurses what they need? Where are the bosses walking around making sure each nurse has time to take care of their patients, and eat a lunch, and maybe even pee once or twice?
When we treat healthcare as a business, we’re chickens asking foxes to vote on dinner. People are going to get sick, it’s unavoidable. The false ideal of customer choice makes us think that we should seek and pay for the “just-right” healthcare for us. And if we can’t afford it, well, it’s a purchase we can go without. A small cough doesn’t keep us from working, does it?
How else can we make money on this whole sickness thing? More customers! Yes, stuff the hospitals to breaking point. Stretch your staffing razor thin. Business-minded folks can tell you the biggest cost of business is almost always labor, so let’s see just how many patients a nurse can handle before someone dies. If we keep the line just so, we can even account for the occasional wrongful death suit and, hell, there’s always more nurses. Fire the one we ran to death and finally made a mistake, and let’s replace him or her with a new one.
The nurses in my life tell stories about too many patients, dangerous med students, uncooperative, sometimes even violent patients, with too many duties, too many hoops, and too much risk.
The nurses know what’s going on. They know that the people who run for-profit healthcare are running a business. They know that they are treated as cogs who can be run at max stress until the teeth wear down. Just replace the cog.
When will we, as Americans, demand a right that so many in the world have claimed? When will we, as Americans, do the right thing, and promise to take care of each other?
When will we, as Americans, demand that healthcare be about patients and good health, and not about money?
My sister is not haunted by her patients because she’s incapable of doing her job, not because she is not knowledgeable, or professional, or sloppy, or anything else.
Patients walk her dreams because she has made that human, personal connection to those who need her. They are not numbers, not diseases, not a diagnosis, not customers. They’re people who were hurting.
She, and no other nurse, in our nation should ever be haunted by a question.
Did they die because I couldn’t care enough?
We can no longer afford to spread our nurses so thin that they break like spider silk. We must demand that profit be taken out of healthcare. We need Medicare for all, because we’re all Americans, and America is strongest when we pull together.
We don’t ask for hands out, but hands up. We are strong enough to help the weakest, the sickest, the neediest among us. It’s time we did.
Medicare for all.