From the Other Side of the Stethoscope.

I am a primary care physician who recently had the opportunity to play a different role when my 96-year-old aunt was hospitalized for a cardiac issue. Though she lives in a neighboring state >2-hour drive away, my wife and I are her support network. Acting as her support and guardian angel during her hospitalization, I saw how fraught with risk a hospital stay can be. (Spoiler: this story ends well.) At noon on a Thursday, we received a phone call from the home health aide, telling us that my aunt was on the way to the hospital by ambulance. The aide could not tell us what had happened, or even what hospital. A flurry of frantic phone calls over the next hour determined that she had just arrived in a nearby Emergency Department (ED) with a rapid heart rate problem. I spoke with the ED nursing staff, faxed them a copy of her medical proxy and Advance Directive, packed a suitcase, and hit the road. My wife stayed home to be a communication center for extended family and to make sure my office knew I was going to be out for several days. I arrived in time to accompany my aunt from the ED to her room on the cardiac care floor. No physician in the ED was available to talk to me about her medical status, but the nurse told me she had arrived with a fast heart rate and chest pain, got some medication through intravenous that slowed her heart down to normal, and that she needed to be admitted to make sure she was stable and to see if further testing was needed. As a physician, I could easily read between the lines, but anyone not medically trained would have remained in the dark. When we got to the cardiac floor, a nursing assistant got her settled in bed, checked vital signs, oriented us to the room and staff, told us what to expect over the next few hours, and spent time entering information into the electronic record using a bedside computer. About 30 minutes later, a nurse arrived to do what she called intake. She reviewed her medical and social history, medications, and allergies; repeated her vital signs; and spent time entering information into the bedside electronic record. An hour later, the hospitalist physician arrived. He conducted a thorough but efficient history, did a brief examination, assessed her mental status (serious short-term memory deficits but intact judgment and personality), and explained that she had had atrial fibrillation with a rapid heart rate and chest pain when she arrived in the ED that her rhythm and rate had returned to normal with medication given through a vein in the ED, and that the purpose of what he hoped would be a short hospital stay was to make sure her rhythm and rate stayed normal and to see if her heart had been damaged by the stress, causing a heart attack that might require other testing or treatment. He answered our questions well. Events during this admission illustrate both the powerfully good and the dishearteningly bad aspects of hospital care. The nurses and the hospitalists were polite and attentive. They introduced themselves and described their role. They made eye contact. They evidenced care and compassion. Though obviously busy, they never seemed rushed, impatient, or frustrated. They solicited and answered our questions and said “I don’t know” where appropriate. They were obviously good at what they did, inspiring comfort and confidence, but it was also apparent that they worked in a system where doing the right thing was harder than necessary.