Hello my dear friends.
A few days ago I received and e-mail from Juan Manuel Leyva Moral, he is Nursing Lecturer and International Coordinator at Escola Superior d’Infermeria del Mar in Barcelona (Spain).
He told me about his experience on his father’s bedside when he died at the hospital two years ago after suffering a hemorrhagic stroke. From the horrible experience he had as a son, as a citizen and as a nurse, he wrote a descriptive account, originally intended to be a complaint that was finally left in a drawer since he did not dare send it.
It’s quite long, so I leave you here a summary and for those who want to read it I share the PDF with permission of Juan Manuel.
Barcelona, ??December 7th, 2011
To the attention of the General Hospital Services Manager at the General Hospital XXXXX
This is Juan M. Leyva Moral, male nurse currently developing my professional career as a lecturer in a School of Nursing in Barcelona, after many years of nursing experience (manly at ICU and Primary Care). I do write these lines to express my dissatisfaction regarding the care that my father received during the days he was admitted at the center you are in charge.
During the afternoon of November 13, my father was admitted to the Hospital XXXXX suffering of a hemorrhagic stroke. Once all the assessments were conducted, it was decided to admit him urgently at the Intensive Care Unit (box 1) for close observation and treatment. The medical care provided was objective, quick and efficient, but as much as I hate to say this, nursing care provided was devastating. I take here the opportunity to provide some of the graphic details that I hope they will prove as daunting as they turned to me and my family:
1. Visiting hours.
The emotional state of my mother and siblings was delicate and they understood what they could. Nobody cared about that. (…) The problem came the next afternoon when nurses or assistants in a sassy, threatening, dominant and demanding tone told us that it was only allowed the presence of just one family member inside the box and they firmly indicate us not make many family changes during the day.
Just a quiet, close and empathic explanation would have been enough to avoid this conflict.
While accompanying my father that evening I had the chance to hear the conversation of some nurses in relation to what happened:
· Nurse A. “Well, look what the daughter of box 1 told me, that I have treated her rudely. I have not been rude! I just have explained to her the rules of the unit and she got angry with me”
· Nurse B: “What happens is that we cannot make exceptions, we must treat everyone equally and we must mark the rules from the first day!”
I wonder what he meant when she loudly said, “mark” as it seemed to me as if she was talking about cattle rather than people (…). Just one nurse within three shifts of the ICU introduced herself by her name.
2. Humiliating treatment to other patients / families
· Nurse C: “What diagnose should I give to Box 4?”
· Nurse D: “Diagnose? Put her annoying! That’s what she is!”
This was out loud in the middle of the nursing control unit. I wondered where the humanistic values (and general education) were that from both teaching and nursing practice I had always enacted.
Furthermore, the same nurse D, specialist in interrupting the rest of the patients given the extremely high voice tone she used, literally told a patient, “Do not complain so much! If it hurts, you hold that. I have to cure you, haven’t I?
I do not want to forget that we were informed that it was compulsory to have someone always in the box during mealtimes or otherwise “he will be left the last and he will eat cold since we cannot be for everybody at the same time”, a brilliant comment to say to add anguish and guilt to our process.
The admittance to the general ward was in the afternoon. On the arrival, my mother was worried since father had a few days without deposition. With warm and friendly tone she told the assistant (because I could read the label on the uniform, not because she introduced herself) if it would be possible to do something to help him to defecate. The response received was “Wow! It also took some days without doing it at the ICU, and they could have given him something there. Today we have a lot of revenue, it shall be tomorrow.” We were speechless.
I asked her if she could put some heel protection to prevent the occurrence of pressure ulcers and the response was similar “at the ICU he was not wearing it, wasn’t he?” Once I told her that I was a nurse her attitude changed a bit and she was more permissive and friendly. The RN came in the room once or twice, not introducing herself as usual, and with a hurry and conveying a sense of “now I cannot be for you, and besides little can be done for your father” Fortunately, the days passed and we found that her attitude was something punctual, and, although distant, she was always right.
Another painful experience was the intransigence of the medical team at the time to inform the family. It should always be done between 7:30 and 8:00 am and away of these hours no information were given. It seemed as if the time was conscientiously chosen to avoid informing families, especially considering that it was a hospital giving attention to people living dozens of miles away. The explanations were always brief and hurried, never by the same physician, and sometimes contradictory.
No one ever asked us how we were, if we needed anything, if anything was worrying us.
No one ever offered us a place to speak, to express our emotions. It seems as if they shunned us to avoid open our box of emotions.
Fortunately, a Saturday morning it appeared a nurse assistant who treated my father by his name, without previously consulting his wristband, which came to me as a son; she asked me how I was, she made me understand that what happened was hard and long and, ultimately, that she cared what we were going through. I began to cry as much as I wanted to do it for days and she allowed me so, accompanying me with empathetic gestures and sincere hugs. I can only congratulate her. Unfortunately, I did not see her, and no one took his paper except one male nurse in morning shift who I did not met personally but my father and my mother spoke wonders of him.
Another experience happened during one of the nights. In full possession of his faculties, my father rang the bell as he was not feeling very well. When they came he was suffering a tachyarrhythmia. Interestingly, a few days before a night shift professional had the pleasure to inform my father that if he called the bell so much “we might cut it!” My father explained this, with tears in his eyes, during the morning medical visit with a sense of fear and guilt, accompanying the story with this depressing “I had a dog which I looked after better than you care for me here”.
At this point, I decided to talk in person with the Nursing Coordinator of the ward, which met me calmly, politely, and showing empathy for my feelings but questioning many of the things I was saying. I have to say that days after this meeting I felt guilty about what happened and I even doubted whether what I was experiencing was true or was blurred by the highly emotional process.
Every time I thought about the tears of my father, my mother and I were convinced that everything experienced was real and that’s why I summarize my lived experience as a “CARING EXPERIENCE BASED ON LACK OF HUMANISM”.
I am aware that the economic situation in our country is very delicate, as well as the compensatory measures that had to be used to improve the situation. But our profession, based on humanism, cannot afford a shortcut in solid theoretical and existential foundations such as the support, empathy, education, discretion, warmth and respect.
I hope this personal account helps you to reflect on and try to find ways to avoid the evil that others can suffer. Jus with that we conform; damage has already been done to us, but we will feel fully satisfied to know that measures will be taken to avoid situations such as what we have experienced these days.
Juan Manuel Leyva Moral
Juan Manuel Leyva Moral