Imagine what it would be like to find yourself struggling to manage an illness that you could not understand, being berated by frustrated doctors, nurses and allied healthcare professionals for failing to follow simple instructions. Consider how crushing it might feel to recognize that soon after returning home the suffocating shortness of breath begins to return, you are unable to walk more than a few steps and you are woken by the sensation of being smothered in the small hours of the morning.
Imagine not wanting to call 911, knowing that when you return to the hospital and time in the Emergency Department will get you the treatment and medications you need, but not without penalty. What if you knew that waiting for you was the scalding tone of the attending doctor reminding you once again that you must follow the instructions you were given when you were discharged home.
What if you were worried about what people would think of you? Last time some of the nurses looked at you with sympathy, some with an air of patience and some with pure frustration that you are here yet again.
Would you feel awkward and uncomfortable that you were adding to the waiting times of those around you?
Would you laugh with the well-intended registration staff suggesting that you should start to collect hospital 'frequent flyer' miles?
You would probably be well versed with the routine. Moved from the ER to the telemetry floor. You would see the doctor briefly, they always seem pleased with your progress, telling you that the tests were OK and that you could go home.
"Just make sure you follow the rules this time so that we don't see you back again next week eh?"
Like a reprimanded child you would probably hang your head, smile at the doctor and thank them for helping you to feel better.
Later that day your nurse will come in, hand you a stack of paper, tell you quickly about your medicines and ask if you had any questions before disappearing out of the door to attend to someone crying out in pain.
You will be expecting the afternoon snack, a hurried goodbye, a taxi ride and then to be sitting at home looking carefully at the stack of papers you were handed before you left.
Your nurse was very pleasant, but what if you couldn't remember what she had told you to do?
It would be OK because you had a detailed summary of your personal medical conditions, advice on what to eat and what to avoid, the importance of standing on the scales and alerting your doctor to any significant weight gain and most importantly detailed written instructions on each of the medications you were supposed to pick up after leaving the hospital.
It would be OK because it would all there written down for you, right?
And so this cycle played out repeatedly. One of our guests here at Saint Francis had been admitted through the ER to the telemetry unit so many times that most of the nurses knew him by name. He had been labeled as a CHF patient that simply refused to adhere to doctor and discharge instructions or comply with his prescribed medications.
One day, he was to be discharged from the telemetry floor again. The medicine he had received was the same, the doctor has been the same, the routine felt the same and he expected to receive the papers, the snack and the taxi ride home just as he had done many times before.
When Adelyn came in to visit with him, conclude his discharge and make sure he was ready to leave, something prompted her to spend just a little extra time making sure he was comfortable and understood. The patient seemed frustrated, reserved and did not want to talk. At this point, Adelyn, with a thousand things to do, other patients to see, charting to complete and the Charge Nurse pushing her to be swift chose to pause. She chose to really look and listen for what her dejected, frustrated and frightened patient was really trying to tell her.
She carefully explained the medications, his condition, required diet and things to look out for.
He didn't really respond.
She then took the time to ask questions about his home circumstance, about family and how he managed at home.
He didn't really respond.
Adelyn kept talking.
After a while, he started to respond.
He didn't have anyone at home. No one to take him to appointments. No one to go to the pharmacy for him.
Finally, after pausing for a long time, he admitted to Adelyn that he had never learned to read or write.
He was quick to tell her that he appreciated the care received in the hospital and that he always felt bad having to come back but that he always just seemed to get sick again when he got home.
He was unable to understand the simple and well-intended instructions that would allow him to keep ahead of his illness and stay out of the hospital.
Imagine what that must feel like.
Once he had opened up, Adelyn was able to learn about a friend near his home. She was able to connect him and help make a plan as to how he would get to his appointments. She worked with a nearby pharmacy to obtain medications for him and made sure that he understood how and when to take them. She took the time to carefully explain the most important things he needed to remember in order to help prevent him from becoming short of breath.
The patient broke down and thanked Adelyn for her help. For the first time, this felt different. He felt positive and that he now had a way to break the cycle of constant readmissions. He was discharged home that afternoon and has not been back since.
It might be tempting to say that this is what every nurse should have done, yet every other nurse missed what she took the time to see.
Adelyn's caring intuition and commitment to taking the time to provide him with what he really needed had a profound impact on this patient and may well have changed his life significantly.