Mrs. O'Hunny and Harborview Hell

There is a genre of alert and oriented customer in a skilled nursing facility that can cause more aggravation than ten demented screamers. I've known some who were on dialysis, some with other short-lived ailments, and some have fractures and come to Homeland for rehabilitation. They are almost all female and in their sixties or seventies. Very fussy, with a perception of personal helplessness that would make a three year old blush. Usually, the second your heels cross the threshold on the way out, you hear, "Oh, Honey, could you just . . . " and your heart sinks.

So Mrs. O'Hunny was daytripping in Seattle when one day she did trip, on the curb, and wound up at Harborview Hospital with a broken femur and a series of incisions on her thigh, with staples. Most of the time now, surgeons don't sew you up, they staple you up. [Surgery has gone from the sewing room to Office Max.] The problem is, Mrs. O'Hunny is now at Homeland on the south side of Tacoma, and she was expected to report for a follow up appointment in Harborview with her orthopedic surgeon, and she refused to go.

The noive.

I came to work at 0930 and it was already a done deal. The shuttle ride was canceled, and the surgeon needed to be notified to cancel the appointment. The way I saw things was that any nurse at Homeland could take out staples, the incisions looked great, but naturally the surgeon would want to see her and make sure the bones were knitting up well.

So, why did she cancel? Being alert and oriented [drat the luck] she realized that the Shuttle would pick her up at 0945, the appointment was at 1230, the return ride was scheduled for 1630, which would take her back to Tacoma at 1730. Or so. Eight hours sitting in a wheelchair getting bounced around in shuttle vans. She refused to go through the ordeal.

I called Harborview and talked with a very sweet and pleasant receptionist, gave my name and Homeland's number and a nutshell explanation. The nurse who called me back was not so sweet. She basically implied that allowing a patient to avoid coming to her appointment was putting her in grave danger, and verbally raked me over the coals for collaborating in such a rebellious move. "Would it help," she asked, "if I faxed over to you her discharge summary?" The idea was that this case was in no way routine, that there was some esoteric complication that would endanger the patient's wellbeing if she did not see the surgeon.

I said that if the patient was demented, she would have gone up, suffered, and returned without a hitch, but that unfortunately she had the right to refuse. This nurse could not imagine what was wrong with spending hours on a journey, which, if a healthy person drove, would take about an hour one way. "Is she in some kind of uncontrollable pain? We can put her on a stretcher."

After a few minutes of this impass, I was able to give the nurse the patient's cell number so they could converse directly. I was tired of being in between an unstoppable force and an immovable object. I imagine the solution will be to find a local orthopedic surgeon who agrees to see her.

Later I looked at her discharge summary from Harborview, which was already in the chart. I scanned it up and down trying to find the situation which would label the case as anything but routine, but couldn't find anything. Broken bone: gamma nail repair.

Post Script: Maybe all nurses who don't understand what travel by shuttle is like, need to undergo some training. It would be very simple. Clock in, sit in a wheelchair, get jostled around for eight hours, clock out. Maybe then they would develop some empathy.