A View From the Other Side of the Rail

I recently had a several-day stay in the hospital after surgery. While it did not involve an ambulance transport, it was an interesting experience that gave me a new perspective into the healthcare system: that of an inpatient under the care of physicians, nurses, and other professionals. While thankfully I should recover fully and be back on the ambulance in a few months, my first time as a hospital patient gave me some insight into what it’s like on the other side of the stretcher rail.

Introductions

From pre-op to surgery, from post-op recovery to being sent to a room, I met a lot of people. I certainly wasn’t at my best when I met them; I was anxious, confused, and at times had considerable pain medication on board.

With masks, eye protection, and scrubs, everyone looked alike. Several caregivers, most of whom were significantly younger than me, called me by my first name and terms like “honey” or “buddy.” I really appreciated the folks who took a moment, looked me in the eyes, and introduced themselves. I felt less anxious when I at least heard the name and level of training of the folks who were part of my care team, especially before they started touching me and doing procedures. I appreciated folks who had the respect to ask if they could call me by my first name—which of course was fine!

Lesson for EMS: Sometimes on a scene, especially a busy one, everyone in blue with a radio can look alike. When you make patient contact, introduce yourself by name, title, and level of care. With this simple greeting you establish a friendly baseline, and they know who is taking care of them. Next ask the patient their name and what they wish to be called. Every adult is “Mr./Ms.” unless they give you permission to use their first name. A little introduction coupled with respect goes a long way.

Keeping Warm and Comfortable

It seemed to me this hospital liked keeping its temperature low. While all the medical folks in their scrub tops and sweatshirts appeared comfortable, I was freezing in my hospital gown. Additionally, I think I never fully realized how not warm those thin hospital blankets are and how they do not fit the average human body well. I was particularly thankful for the nurses and nursing assistants who took the time to make sure I was warm enough with what seemed like five or six blankets at times from my feet to my neck.

Lesson for EMS: I was freezing in a climate-controlled hospital. Imagine how a trauma patient who has had clothes removed for assessment or a patient whose shirt gets removed for a 12-lead EKG feels on a cool winter’s night or in the freezing-cold air-conditioned ambulance box. While the providers might be comfortable, think about keeping your patient warm. Add extra blankets—especially with those thin hospital blankets we carry on the rigs. It takes a lot of energy to stay warm!

Conversations and Good Questions

When you’re in a hospital by yourself, it can get lonely. Adding an uncertain prognosis or the prospect of a long recovery can make it downright scary. I appreciated the nurses and nursing assistants who took a few minutes to make conversation. Whether it was asking about a t-shirt I wore or inquiring about my family, it made a difference for me that they took a personal interest.

Further, beyond the social questions, I appreciated when they would ask me specific questions about how I felt. When you’re dealing with sensitive topics like urine output or flatulence, I appreciated that there were caring questions first, followed by specific questions, followed by the rationale for why they were asking. I also appreciated that, despite the need for many caregivers to chart large amounts of data, many of them paid more attention to me than the computer. All of this added to the feeling that I was being cared for by competent and caring professionals.

Lesson for EMS: Be curious and take your time to explain things. You have an opportunity during your encounter to leave an impression that you care about the patient. You should want to know more and ask questions to uncover medical and social details. Your verbal assessment and questions are as important as your detailed physical assessment. Additionally, it puts the patient at ease when you can explain procedures or assessments in ways they understand. They have a better comprehension of what is happening to them. Try to pay more attention to the patient than your laptop.

The Importance of Pain Management

After surgery I was hooked up to a pain pump attached to my IV. After a certain amount of time, if I was in pain, I could click the button and self-administer pain meds. After I could start ingesting liquids, they took away the pump and replaced it with oral pain medication given to me on a schedule—usually every four hours.

As nurses sometimes get busy or distracted, the administration of those meds was not always right at four hours on the dot. Instead I’d feel my pain levels rising to high levels and press the call button, hoping the nurse and my pain relief would come soon. Being in pain is awful, and just because I wasn’t a loud complainer didn’t mean I tolerated it any better. I was thankful for those providers who took my pain seriously and stayed to the time-scheduled dosing.

Lesson for EMS: Pain is a hard thing to quantify, and I think at times in EMS some providers get suspicious of folks in pain, thinking some may only want pain medication for a “fix.” If you can provide relief to someone in pain, do so without judgement and with the patient’s best interest in mind.

Advocacy for Your Patient

The caregivers who made the biggest difference for me in the hospital were not the ones just doing their jobs. They were people I felt were on my “team” and not only showed caring and compassion but were my advocates. They were the nurses who were proactive with physicians to make sure I got the correct medications. They were the nurses who triple-checked that there were no known effects from taking certain medications at the same time. They were the nursing assistants who did their best not to wake me while taking required vitals because they knew I wasn’t sleeping well. The ones for whom I’m most grateful were the providers who proactively advocated for my care and well-being.

Lesson for EMS: Always advocate for your patient. Be the voice that gives more than expected and looks out for patients as people, not just run numbers. Just because some calls aren’t your definition of an emergency doesn’t mean they’re not emergencies to someone else. Treat every patient as if it were your grandmother or grandfather and make their care and comfort a priority on every call.

Final Thoughts

I am grateful to the nurses, physicians, nursing assistants, food-service workers, and housekeeping professionals who took care of me during my surgery and subsequent hospital stay. I am especially grateful to those who introduced themselves, showed respect, kept me warm and pain-reduced, who took a strong interest in me as a person, and who advocated for me. Those who did that helped in my recovery.

I’m also grateful for the experience of being a patient and seeing things from the other side of the bed rail. It will make me a better provider when I’m back on the truck.

Barry Bachenheimer, EdD, NREMT/FF, has been active in EMS and the fire service for 35 years as a provider and instructor. He is a frequent contributor to EMS World.