Nurse Ratched Revisited
Author Barbara MacLean Socialist Planning Beyond Capitalism
I awoke in the dark, alone, in pain and frightened. I pushed the call button for the nurse and waited for him to come. Ten minutes seemed like an hour. The pain from my incisions after lung cancer surgery was taking my breath away. When the nurse didn't come right away I struggled to get out of bed, as the pain was so intense I thought I would vomit. I had no idea my bed had an alarm on it and the alarm started going off - sound and lights. I made my way into the bathroom and was doubled over on the toilet, holding my lung drainage tube up as best I could off the floor when several nursing staff came running in and scolded me for getting out of bed without waiting for them. Looking at the clock on my way into the bathroom I saw that I had gone more than 2 hours beyond the scheduled time to take my pain medication. The nurse stood over me as I sat retching on the toilet and told me in a scolding tone that I was just having a panic attack. He asked if I had them often. I wanted to say that no, only when I had surgery for lung cancer and didn't get my pain meds on time - but I couldn't get any words out.
In the following article I'm going to give sometimes scary, sometimes smack-my-head funny and always unbelievable examples of what it's like to be on the receiving end of a for-profit health-care system.
The previously described nurse, whom I came to think of as Nurse Ratched, continued to torment me that night. For those of you who don't remember - "Nurse Ratched is a fictional character and the main antagonist of Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest, as well as the 1975 film. A cold, heartless tyrant, Nurse Ratched has become the stereotype of the nurse as a battleaxe." (From Wikipedia) When I asked for the stronger pain medication my doctor had promised me I only had to request, Nurse Ratched's response was, "I have to follow protocol. I first have to give you the milder pain medication, wait to see if that works, and if it doesn't, only then administer the stronger one." So there I lay on my bed, rolled into a fetal position, waiting for the 40 minutes to go by before I could get some relief. The only other time I had asked for it - from a different nurse - I received it immediately.
Once the stronger medication was delivered via I.V. and the pain subsided, I was able to think more clearly. When Nurse Ratched came back to check on me I told him I wanted to see a doctor - even though it was 3:00AM. He immediately started to cover his tracks. He told me I was the one who said not to wake me when it was time for my meds. I didn't try to argue with him - he was clearly in a power position. I didn't remind him of the conversation my husband and I had with him earlier before he left for the night. To my complaints at being woken up every three hours to take medication, Nurse Ratched had clearly said sympathetically "not on my watch". Now he kept insisting he wanted to wake me up but was following my orders and this was my own fault. When the doctor finally arrived, Nurse Ratched never left the room. He hovered, making sure I didn't share that conversation with the doctor or tell him of the nurse's insensitivity.
Second Surgery
I had been diagnosed with lung cancer just a couple of weeks before my surgery. In an interview with the surgeon before scheduling the surgery, he reassured us that he did this operation all the time and is was a fairly routine procedure. He said I would be in the hospital overnight and go home the next day. We were never told of any risks or complications. When I asked about pain after surgery, he kind of shrugged his shoulders and said that yes, occasionally, people had some nerve pain afterwards, but that was pretty rare and most of the time it went away. He also said that I should be up and about and pretty functional two weeks after the surgery.
When I was settled in my room after my initial surgery and started coming back to my more aware self, I noticed that there was a lot of attention from the staff being given to the tube that came from my lung in order to drain the excess fluid and air into a container that dangled at my bedside. The resident doctor and nurses were checking the tube frequently and conferring with each other. They also seemed to be monitoring my blood pressure and oxygen levels constantly. I didn't pay much attention to it all because I was still pretty much out of it. It wasn't until I heard one of them say "60 over 40 - get her back to surgery" and found myself being the center of a drama I had only ever seen in the movies, that I realized I was in trouble. Because my lung was bleeding too much, the need to stop it was urgent. Staff was running down the halls with me on a gurney, swinging me onto a CT-scan platform and then, just as quickly, racing back down the halls with me into surgery again. I watched the overhead lights go whizzing past from my supine position.
When they rolled me into surgery and lifted me onto the operating table, I couldn't believe I was back in this cold, scary room I had left only hours before. I was too weak and frightened to do anything but let the tears roll down my cheeks. I was never given a satisfying answer to my question of what happened to cause the excess bleeding, but have since read that the handling of blood vessels might be related to postoperative bleeding. I can't help but wonder if the surgeon, who was also overworked, felt rushed or tired as he operated on me. He told me several times after the second surgery that he felt terrible and that it was his fault. As a result of the second surgery I had more complications and a much longer projection of recovery time. I also needed to stay in the hospital for six days and nights, instead of the anticipated one.
The Doctors: One foot Out the Door and One Hand on the Phone
Once in my own room, doctors only came to my room once a day and it appeared that every day there was a different doctor. There seemed to be so many of them I couldn't keep track. They would come early, 6:30AM or so, while I was still sleeping and too drugged to follow their conversation. Because I was woken up every three hours, I was badly sleep-deprived and managed only catnaps for my entire hospitalization. The doctors would always come when my husband or friend was not there to track and record what they said, ask questions and be my advocate. I wasn't able to retain whatever they told me - although I tried. They said they would come back later in the day when my husband was there. They never did. Both the doctors and nurses had 2 or 3 cell phones they carried with them, which led to constant interruptions when they were talking to me.
Upon discharge I was released with a three-foot-long lung tube with a lung fluid-collection box that had to be always kept at least a foot below my lung. A doctor came to my room to teach us how to manage the tube, care for the wounds and drain the blood from the box in which it was collecting. The doctor raced through the procedure, making it hard for all three of us to follow or retain any of it. We also realized - after we got home - that in their rush, they had not provided us with everything we needed to manage on our own. These included tools like the hook to fasten the drainage tube onto the walker, as well as a shoulder strap so I wouldn't have to hold it in front of me every time I took a step. When we went back to the hospital after discharge to have the tube removed, we learned we had been incorrectly instructed in the proper way to drain the box the blood had been collecting in.
The surgeon never informed us that, even though they successfully got the malignant tumors out, there was a substantial chance the cancer could return, even in other parts of my body. He only discussed the operation as a success; the lymph nodes were clear; there was no sign of cancer anywhere else in my body as if that were the end of the story. It was only 2 weeks later that he informed us that there was only a 30-50% of the cancer not returning in the next five years. This was a complete shock to us and we still are processing it.
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