The Call Button

NYT article on the consequences of nurse staffing.

I began to emerge from a truly black sleep, only to feel a wave of agony coming from the front of my face. I felt as if a train were hurtling into my head, over and over. I found myself panting and grunting, unable to even cry out in pain. A soothing voice, next to my ear, told me that she was going to take care of me. The waves subsided, but only because I was falling asleep again. It seemed only second later that same voice was now imploring me to wake up, to come back to her.

I am told this cycle repeated for two hours, although I had no sense of time. In the seconds of what passed for lucidity before passing out each time, I was dimly aware of another human nearby – also in distress.

I was in “recovery” following surgery to repair a deviated septum, and yes: it can be as painful as you have been told. Utterly worth it in the long run, but the most pain I’ve ever imagined. The voice, alternately soothing and scolding, belonged to the nurse who crouched forward in a chair positioned between two beds. I noticed that her relief stood just behind her. The second nurse tapped the owner of my soothing/scolding voice on the shoulder, and they switched out rapidly – the chair was unoccupied for less than a second. My treatment that afternoon included probes containing cocaine inserted deep into my nostrils; removed only when my blood pressure dropped below a certain threshold. They were re-inserted only when my blood pressure exceeded 260 (the number was carefully documented, and was second only to cocaine as the most alarming bit of data contained in my chart). I suspect my expressions of agony were not the trigger for this pain relief, but the danger presented by a blood pressure well above 200.

Once I was stabilized, I was wheeled out and only then caught a glance at my fellow sufferer. A woman my age, now sitting up in bed and looking like I felt. I gave her a grim thumbs up, but she was able only to follow me with her eyes. All other voluntary movement, I believe, was coming at too high a price.

I remember that afternoon as I read of hospitals where the pain relief is subject to shortages in nurses on the floor. My fellow sufferer and I took the full time attention of a nurse for the better part of an afternoon – so intense that the nurse had no other duties but sustaining two surgery patients and keeping either of us from having a stroke. Had that occurred, I am certain other nurses would have appeared. Without this intense treatment, I cannot imagine how that day would have ended.

I remember this, because the vision of pushing a call button and receiving no relief is a terrifying one. My daughter is a nurse, and she speaks of patients who keep both hands on the call button as if it were their only source of life. She must balance the true needs of her patients, never letting one overwhelm her attention to the detriment of the rest. She must also balance the ever-changing number of nurses available to her, as unseen forces determine who is working which floor for any five-hour block throughout her shift. A medical unit is a collective, whose beds are populated by loud libertarians. And nurses are the commons. The dance of staffing a medical unit is driven by patient needs, balanced by costs and – in the U.S. – profit. The notion that a balance must be struck is understandable when there are competing human needs. Competing corporate needs are somewhat harder to swallow when we are on that call button, desperate for relief.

There are no grand conclusions here, just a shudder. Grateful I had that voice when I needed it (and yes, the cocaine). And pushing away the thought that if my physical problems ever result in the need for a call button again, I can only hope it is connected to a solution. I’m reminded once again: hope is not a method.

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