How To Get Out Of The Hospital Alive

If you have a choice and are not involved in an emergency, you can improve your chances of coming out of the hospital alive if you time it right.

I have read lots of articles suggesting that mortality in American hospitals is higher around July 1, when a new group of trainees finish medical school and start in their hospital based clinical training positions. This is not just an aberration in the USA, but apparently is also true in the U. K, where the new training programs start on August 1. Another cause of in-hospital mortality has been identified — When nursing staff falls below certain target levels, patients die. I do recall that nursing schools, at least when I was close to such things, did not have the same kind of fixed scheduling for trainees that medical schools did. When nursing students were present, they always seemed to be observing and logging in time, although whenever they had procedures, they were more rigorously monitored than physicians.  

We were always impressed with the ease with which we were supposed to aquire the ability to do procedures.  “See one, do one, teach one” was the standard for young surgeons like me. Although my experience was in France, I soon found the same standard in the US when I did my general surgery internship in Ohio and neurosurgery residency in North Dakota. I have a vivid memory from the first month of my residency.  I actually remember being written up by a nurse after I had done my very first subclavian artery puncture, as an American first year surgical resident, because she thought she heard me murmuring some of the directions under my breath.  I remember doing it correctly.  I also remember being called into the office of the chief of surgery, who that early in the year seemed to treat me as if I were I neophyte pain in the neck.  

Later, when it was time for me to move on to neurological surgery, he said they would have loved to have me here; that the entire senior surgical staff, “loved me — to a man.” But at this point I was not there. I told him that I hardly thought murmuring something under my breath was an issue, especially since I had done the procedure correctly. The chief told me, “Estelle, you did fine. This is piddly-ant nurse crap and the hospital regulations say that I have to read it to you.” “There is only one thing you need to do.” He was silent.  

“Please, tell me what.”

“Be a better actress,” he said.  “Everybody is always doing things that they have not done before. You got to be the boss and ACT like you already know everything there is to know about them.  You’ll be fine. Just get out of here and go back to work and be a better actress.” I scrambled. This doctor was famous for speeches when he ripped residents to shreds, but fortunately this was not one of them. Maybe other people need acting lessons, too.  Maybe that is, at least in part, the resolution from the doctors’ side. My recent read of longevity statistics suggested that Hispanics, whom it is classically said have the most limited access to health care of all races, also live significantly longer than Euro-Americans, who are magnificent users of healthcare facilities and may be “insuranced” to the gills. I have had a gut feeling for a while, based at least in part on the sometimes horrific nature of my own experiences, that being in a hospital is not a good thing for humans in terms of their future prognosis. Maybe sharing that feeling is not the most hopeful thing in the world. I still feel that for those who need emergency services, an American Hospital is the best place to be. They have saved my life more than once, when I had funny comas of unknown origin. The problems come when we get to less intense care, even to chronic problems, which I feel Americans do less well. The truth of the matter is that if I can inspire anybody to take a preventive program seriously, there is something good going on. Let’s frame this positively. Nobody looks at death across the board. Let’s look at just a few of the best ways to stay alive if you have to go to a hospital. You can look at the surgical volume.  Try to find the hospital that does the most of whatever procedure you need, and you will probably come out better (alive is better). In-hospital mortality rates continue to decline for females who have heart attacks. More risk of death is for men under 55.  So if you are planning to get a heart attack, by now everyone knows the risk factors. Things like smoking, obesity, a really nervous personality. Men need to take these warning flags more seriously, while they are still young. If your heart has problems, a hospital is still the best place to be. Here we have a bouquet of hospital news, which runs the gamut from attempting to quantify death from preventable error, to looking at the burden placed on the system by immigrants.  It is a mess, and you would do well to protect yourself when you are in a hospital. The things you can do are many. Having an advocate and/or empathic relative with you is helpful. If they are kicked out of the room when someone needs to concentrate on a procedure, you better go with it. But they can help make sure the surgeon is the correct one (If you are in for appendix and the doc wants to deliver a baby, you know he’s in the wrong room).

You can put signs or magic marker writing on your body, too, as some recent highly-publicized amputations targeted the wrong limbs.

You can decline unnecessary procedures as these often pad the bill (I have done this when hospitalized).

If ambulatory, you can go to the nurses’ station and wait patiently if the bed-side bell is not answered. But in these situations, always be courteous.  Keep the staff on your side with politeness; don’t go and alienate them. According to the literature cited above, a nurse can keep you alive.

Medical errors are one of the leading causes of death, but they are never included in the reports that put heart disease, cancer and such things as the main causes of death in this country.