Oxygen part 8

Good news! This morning the scummy container had been removed!

Even better, Marie was alert and quite possibly in the best shape she's been in since going to the hospital 7 weeks ago.

After I turned on the lights, I complimented her on her perkiness, and she said "It's because I just had a fight."

It seems someone had come to give her her morning medications. These are mixed with water and then injected by a large syringe through the feeding tube, followed by water to clear the tube out. This morning, whoever was giving the meds dropped the syringe on the floor. Marie has macular degeneration - she has very little vision in the centre but when something unexpected falls, that's when it will be caught by the peripheral vision.

"You can't use that," she said.

"Why not?"

"It's been on the floor."

The floor is generally not overly dirty - but I noticed yesterday that a brownish sticky fluid had spilled on the floor and the base of the pole. Probably nothing more than a bit of spillage from filling the feed bad with Pulmocare. I noticed it for the first time last night, and the cleaning staff were coming in as I was leaving this morning - so it hasn't really been there that long.

Marie is a former nurse. She was drilled in sterile techniques. Although things have changed in the nursing world in the past 50 years with regard to some procedures, you cannot convince Marie that you can use a dropped syringe.

She said the syringe was put back on the table. The person left the room, came back and fiddled with something by the sink. Marie couldn't see what, because that is in direct line of sight. [Despite our pleading with Marie to go to the CNIB and learn how to use her peripheral vision more effectively, she has never been willing to go.]

The person (I cannot be sure if it was a nurse, and LPN or what) came back to the table and prepared to give her the injection. But Marie noticed that the same syringe was picked up off the table.

"You can't use that," she said.

"Why not?"

"That's the same syringe, the one you dropped."

"You see more than we think." A new syringe was fetched.

This is, of course, Marie's report of the incident - maybe the person on the other end of the syringe would tell a different story.

I cannot be sure there wasn't a replacement at some point, a replacement that Marie could not see (although she is quite certain). I am interested in the degree to which the staff do not understand the nature of her blindness even after 7 weeks - and the possibility that they were willing to take advantage of that blindness.

Why would someone use that syringe? Lots of reasons. They might not feel they have time to go and get a new one. They might reason that the floor is pretty clean. They might be aware that the whole health care system is undergoing another round of budget cuts and revisions, so they are conscious of the waste. Are any of these reasons sufficient for potentially putting a patient at risk of infection?

It is not as simple as "Of course not! They should get another syringe and start over." The pressures on staff are constant - pressures from the administration, pressures expressed by the authorities and elected officials in the media. Like the stuff that was in the Medi-Vac pump container, these things breed a culture that might put patients at risk. There were lots of concerns over sterile technique when Marie was at her assisted living complex; Personal Care Attendants have minimal training, and there were lots of issues when they were admonished by Marie for improper procedures.

In that situation, when a resident speaks up about these things, it is the resident who gets labelled as "difficult". We went through a very difficult period at the residence - a period of shunning, of accusations of racism, of all kinds of things - after Marie spoke up about improper procedures. We eventually got things sorted out, but it took a long time. And every time there was a change in personnel, there would be new problems.

It is to her credit that Marie has not been cowed by that experience into remaining silent when she sees mistakes in the hospital.

On another positive note, the medical staff have largely been wonderful with her (with the exception of the one resident who had his arms crossed and was rolling his eyes, clearly wishing he were anywhere except at this patient's bedside). The nurses and aides have had a very difficult job trying to provide quality care for a woman who has been in pain and lacking in mobility, and they have generally been excellent given the constraints under which they are working. Taking care of Marie means having to take the time to ensure things are done and done correctly; time is one of the things that nurses are denied in the effort to maximize the efficiency of the system. The returns diminish quite quickly when nurses can no longer spend time to care for their patients.