I Am a Bar Code

By Miryam Ehrlich Williamson

bar-code

The last time (before this one) I was a hospital patient was in May 1965. The difference between my two hospital experiences is so vast, I have to tell you about it.

I was 29 in 1965. The hospital was attached to a university medical school in what was then the US’s third largest city. The reason for the hospitalization is neither interesting nor relevant. What is is that part of my treatment was a course of antibiotics, delivered by hypodermic needle intramuscularly. The muscle the needle goes into is not your biceps, it’s your gluteus maximus. If you don’t now where that is, stand up and take a load off it.

On one of the many occasions I was awakened (to take my temperature, take my blood pressure [two different nurses, two different awakenings], ask if I wanted a sleeping pill [!]) a nurse crooned, “Roll over, sweetie. It’s time for your penicillin.”

Since I was 17, the first thing about me I have told anybody I met in a medical encounter is that I am allergic to penicillin. I do this because I had an allergic reaction to it in my teens, and the doctor said I should never again have it.

“I don’t get penicillin, I get tetracycline,” I said, pushing cobwebs out of my head and trying to get alert. I was not about to move.

Said nurse put on her Nurse Ratched voice. “If you don’t turn over, I’m going to get an orderly to help me turn you,” she said.

In those days I would have qualified for assertiveness training, but I had a strong wish to see my three small children grow up in my care. I spoke between clenched teeth. “You put a hand on me and I’ll scream so loud I’ll wake this whole floor,” I said. (I should have said “loudly,” but I forgot my grammar for the moment.) “Go look at my chart and come back with what I’m supposed to get.”

The part of me that watches me was watching with dropped jaw.

Nurse Ratched stalked off, I waited, and she was back with in a few minutes. She said, with something between a giggle and a simper [resume singsong voice], “You’re right. You get tetracycline.”

“Let me see the bottle,” I ordered. Observer Me nearly fainted. I should have said “vial,” but I didn’t know better. She held it up. I pulled her wrist close enough for me to read the label (my monitor-self was getting CPR), let go, and rolled over.

No kidding: she could have killed me.

Thus was born Ms. Medically Assertive, a woman who has learned – is still learning – everything she can about how the human body, hers in particular, works and how to keep it working well.

In my 1965 hospitalization, if I asked a question of a nurse, her answer was, “You’ll have to ask the doctor that.” No matter whether the question was about the temperature she had just taken, or my blood pressure, or why I was scheduled for an X-ray and what was to be X-rayed. I think any nurse would have said the same thing if I asked her the time. When I asked the doctor the same questions I got that “what planet are you from?” look and either no answer or one that was inaudible or unintelligible.

When I got home from the hospital, I started teaching myself to translate from Doctor into English, and that’s how I earn my living these days.

One other thing: surgery was involved in the hospitalization, hence pain, hence, one would hope, pain meds. But if I said I had pain and asked for something to relieve it, I was treated like a drug-seeking hypochondriac. And if I got something to help, god forbid it didn’t last a full four hours as it was supposed to do. I’m pretty stoic, but the pain management was brutal.

Fast forward to last week.

This time I didn’t know why I was in the hospital, only that I had more pain than my doctor thought I should stay home with. (I don’t mean to be suspenseful: the cause of my pain turned out not to be life-threatening, but it could have been. I’ll have my strength and energy back in a few more days. When you’re 74 you don’t bounce back, you crawl back.)

My pain med of choice is acetaminophen (generic Tylenol), and when I was admitted to the ER the first question after my name and insurance stuff and what brought me there was, “On a scale of 0-10, where 10 is the worst pain you’ve ever had, how is your pain now?” I gave a number and was asked if I wanted something to help. I asked for acetaminophen – I actually know how much I need for various pain levels. I’m not such a stoic that I let the pain get ahead of me. If you do that, you wind up needing more pain meds than if you keep yourself at a steady state. The nurse asked if I didn’t want something stronger. “Thanks,” I said. “I won’t be shy asking if I need something more.” Later, I did ask.

First revelation: There is a recognition now that a patient’s pain is real and deserves to be relieved.

During the admission process the admitting clerk asked me about my allergies (penicillin – remember?), made me a bracelet with my name, doctor, some other stuff, and a bar code; and another specifically devoted to allergies that could be read without a bar code reader.

No nurse ever showed up at bedside to give me anything without rolling in a computer on a cart. Every time I was given anything stronger than water, the nurse scanned my bar code, and scanned the bar code on the medicine I was being given. Saline solution (given through a vein to prevent you from dehydrating) is stronger than water. Even that was scanned.

Second revelation: I’m sure that if Nurse Ratched had come back with “my” penicillin, the computer she wheeled in along with the bar code reader would have burst forth with a barrage of digital warnings, the equivalent of my screaming so loud I’d wake the whole floor. Still I asked, “What is that?” but it was more of a reflex than a challenge. I didn’t feel I needed to demand to see the vial. And no nurse I asked gave any indication that I was being impertinent.

When they came to take my vital signs (blood pressure, temperature, pulse, and a count of how often I breathed [they watch your belly for that one]) I asked the results. I don’t know if this was normal practice, but soon the nurses’ aides were placing the computer monitor where I could see and didn’t have to ask.

Third revelation: Information that I had to pry out of a doctor in 1965 is freely available 45 years later.

1965 nurses wore starched white uniforms and caps that indicated what nursing school they had been graduated from. They clearly had been taught not to be friendly with their patients. Some took this to mean they should be downright cold. If the intention was to intimidate patients, it worked well (except for the time the nurse bid fair to kill me with the wrong injection.) Today’s nurses wear street clothes and could be mistaken for visitors. The atmosphere is more informal, friendly, and conducive to healing, both physical and emotional.

Fourth revelation: With the exception of one hospital-employed doctor who was pleasant enough, but either unsure of herself or afraid of being sued (doctors are more likely to be sued for what they don’t do than what they do) every person I encountered at this hospital was friendly, competent, and interested in whatever patient s/he was dealing with at the moment. Some of us swapped brief stories. I know some of what I said wound up in my narrative record, but I’m years past modesty, and some of what I told may have taught somebody something.

I’ll be fully well (and posting regularly again) in a few days. Pain’s not fun. Being away from home is not fun. Even though the bed was comfortable and easily adjustable (in 1965 you had to ask a nurse to turn the crank at the foot of the bed – Garrison Keillor‘s Sleep Number sponsor has nothing on the modern hospital bed) sleeping in an unfamiliar location is not fun.

But I have warm feelings for the hospital I stayed in and the people who work there. And I know Nurse Rached has gone to her just reward, and is giving improper injections to her fellow residents of you-know-where. The rest of us are, for the most part, safe now, thanks to computers and bar codes, and the human beings who work in hospitals these days.

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8 Responses to “I Am a Bar Code”

  1. Great article. Great to know health care has become more competent and patient-centered than in days of yore. But there’s a problem these days. Nurses all over the country are fighting for their rights and patient rights as hospital management tries to cut staff and increase nurse-to-patient ratios. We can’t let that happen. May you mend quickly so you can keep up the good fight.

  2. It’s wonderful to have this perspective. When people talk about progress in the medical field, they aren’t usually talking about this kind of thing, but it’s very important on so many levels.

    I think recognition is due also to the early patients’ rights advocates who helped bring about this change. I don’t know who they are, but they’ve made the world a better place.

  3. This is a big (and very welcome) change since 1998, when my R.N. sister flew to California to make sure I was able to navigate the shoals of medical care.  Thanks for pointing it out.

  4. Very fine, Miryam, and very true. I am glad to say that I have always had excellent, caring medical and nursing attention when I was hospitalized. I believe being able to ask intelligent questions and also showing concern and appreciation for one’s care givers make a big difference in the quality of care you get.

  5. [...] greenhouse, but I’ve had other things occupying my mind, as you know if you read my most recent [...]

  6. I am so glad you are getting well. Once again, a stellar piece of writing about a subject very much on all our minds these days.

  7. 5.29.10
    Miryam–
    Glad to hear you’re on the mend. Now if only we had national recognition of a nasty phenomenon: Doctors who fly into rages at patients. _The New York Times_ published an article about doctors who rage at & humiliate colleagues on the job. But it said nothing about doctors who have a tantrum if a patient asks a reasonable question in a courteous tone of voice; about doctors who become enraged if a patient persists in requesting a copy of the biopsy results despite a six-week run-around by the doctor’s staff;   or about doctors whose prosecutorial fury leads them to demand “a blood oath” from a patient & to scourge a staffer young enough to be their granddaughter—all within the hearing of many other patients & staffers & all at a shout.

    I strongly suspect that the patient most likely to be afflicted by this is (1) female; (2) intelligent; (3) behaving exactly as patients are advised to behave by how-to-be-a-competent-medical-consumer articles.

    Marie Shear
    Widely unheralded writer & editor

  8. [...] out (he probably just thought it was because I’m old and overweight, but if you’ve read I Am a Bar Code, you know where I’ve [...]

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