Åtta.

Total volunteer hours for Spring of 2015 = 64 hours = 8 hours in Habitat for Humanity (construction) + 56 hours in Neuro ICU for Tulane Medical Center

I always had the impression that technology would make everything better; in particular, the keeping of medical records of patients and charting by nurses and doctors.  Yet, it would be technology that I hear nurses and doctors complained about a lot.  Switching to electronic seems to have slowed down productivity and decreased the time nurses and doctors can spend with patients.

 First of all, oldies who lived through the internet-less era were thrust into a rapidly-changing age of technology and advances; any new hardware, software, and policies are a maze of extra actions tacked upon what people were already doing with paper (hard-copy charting does not usually gets changed abruptly to electronic, and sometimes hospital keeps both old and new for the sake of habits, doubling or even tripling the work load).  But perhaps that is just a generational thing?

We should look at the things in the long term, the generation of doctors growing up with technology should navigate perfectly the advances of our age and use technology to smooth the work flow of the hospital.  But even that has not panned out.  The reason, secondly, is that every hospital and sometimes even clinics within the same hospital, usually uses different software.  Ideally, all the things done to a patient would be documented in one hospital could be seamlessly transferred to another hospital, eliminating the need for retesting and allowing doctors to get right to diagnosing and treating.  In practice, every hospital wants its own software to the exclusion of other hospitals, a frustrating circumstance for up-and-coming doctors who learn in one hospital, does residency in another, and specialization training in yet another (not to mention rotations in different departments which may also use different software).  Why haven't we implemented system that makes sense yet?

 There should be a consolidated program that all hospitals agree to use, just to get a little order in this mishmash.  But wouldn't that be lucrative for the company that gets that gig?  Technological companies all vy for the same post; and when the dust clears from this marketplace competition, perhaps one software will finally be adopted unanimously.  And how long would this take, while the sick are neglected because the nurse and doctors can't get through the slogs of inefficient electronic charting?  What we need now is order and user-friendly charting.

Until next time...

Septem.

I've been thinking that this blog is called rebuilding NOLA, but I've totally changed it up to volunteering at a Neuro ICU.  Sorry if anyone didn't like the shift, but I feel I've learned a greater amount talking to nurses and watching their interactions with patients, doctors and other hospital staff; and the most interesting things I have to offer stems from my experience there.

So, let's talk about team-based healthcare.  Simply put, the goal of recovery for a patient is a responsibility taken equally by every person involved: the doctors, the nurses, the patient and the patient's family.  To do what's best for the patient's health, egos and power dynamics should be done away with.  A shame it is when a doctor's ego stifles and discourages nurses' or anyone else opinions and concerns, which leads to a decline in health care and harm in some unfortunate cases.  If anything, it is not problem of individuals, but a problem with a system; if hospitals can institute a structure (and incentives) for team-based approaches to healthcare, I suspect both patient satisfaction and overall health of the patients will improve.  Drama only gets in the way, and steals the focus from what's important, the patient's health.

These are just thoughts I have as I ask nurses about how healthcare should be delivered.  Although drama is everywhere and to deny it is denying our humanity, perhaps if we learned how to compose ourselves like a team rather than a top-down power dynamic, we may be able to overcome our selfish and petty concerns for our patients.

Sorry, no story for now, just thoughts.  Until next time...

六.

The Neuro ICU can either be a place of healing or of delaying inevitability.  I have see patients discharged healthy as can be, and patients in a deep comas, breathing only through machines.  The service that the hospital tries to provide is to help a patient attain as close to a normal state before whatever they were afflicted with.  Maybe it can be as easy as stitching up a patient or sending home the patients home with pills; but in the ICU where patients have undergo great traumas, surgeries and interventions, "close to normal" is nigh out of reach.

I have learnt that of the diseases that a person can be afflicted with, particularly insidious diseases are the hardest to treat.  An example: epidural hematomas stem from arterial ruptures whereas subdural hematomas stem from venous ruptures.  Given that a patient will arrive to the hospital with one of these conditions, which is worse?

My try at reasoning out this question was that arterial is worse because of the greater blood flow than veins, faster blood loss when rupture occurs.  However, epidural hematomas give better warnings that subdural hematomas.  A person might collapse due to quick bleeding in the head, but provided that they'll get into a hospital, there are surgical interventions and treatments.  A person with subdural hematoma would not even notice they need to go to a hospital until it's too late.  The bleeding happens slowly, without any conscious changes to the person's livelihood; and when symptoms does finally occur, it is probably too late for any interventions.  Subdural hematoma patients are the saddest cases I have ever seen in my volunteering.

Please checkout any head injuries at a hospital, despite how okay you may feel.  Until next time.

Cinque.

Let's talk about Neuro ICU.  ICU =Intensive Care Unit.  In the Tulane Medical Center, patients coming from spine or brain surgeries get a get bed in the Neuro ICU.  Patients just coming in gets evaluated for brain functions, reflexes, temperature, bed sores, etc.  They get hooked up to machines that read heart rate, breathing rate, temperature, blood pressure, oxygen in the blood, sometimes pressure in the skull; and machines that infuse drug into the patients in a controlled fashion.

An unconscious patient that may start seizing gets hooked up to an EEG (electroencephalogram), which records brain activity in real time, and also a camera that records the patients movement.  All of these data will help doctors evaluate the brain and seizure severity.

The nurses handle patient's basic needs, such as food, water, excrement, urine, etc.  The nurses may clean the patient, and follow a doctor's instructions for treatment displayed in the hospital computer system.  Any nurse would be responsible for 2 or 3 patients usually for a 12 hour shift.

My part in this only extends to chatting with the patients, making sure they have the refreshments they want, and helping with general things nurses need like answering the phone and opening the door for visitors.  I do it for 4 hours, once a week.  Volunteering for the nurses station let me perceive the bed-side care givers, the ones in contact with the patients most.  But more on that next time...

IV.

Total Hours of Volunteering: 48 Hours @ NOLA construction + 36 Hours @ Tulane Medical Center = 84 Hours

When I wasn't frantically/lazily studying drugs and their mechanisms, I was helping Habitat build houses and the nurses of the Neuro ICU with patient care (at Tulane Med Center).  I enjoyed both settings despite the stark contrast: unfinished, dirty, dusty house sites versus complete, bright, clean hospital unit.  The greatest benefits I reaped were the knowledge and experience: nothing really compares with going on-site and stumbling over my own ineptitude, then correcting myself.

Happy Holidays!

Tres.

Working on a roof for the first time is scary.

Harness for Safety from High Places

I couldn't stop from splaying on my back onto the particle boards that were nailed into place by previous workers.   Anything to lower the already increased chance of death by gravity.  The scared-for-my-life reflexes left dots of red all along the undersides of my arms and legs, evidently from the rough particle board biting to my skin whenever I had to move.

Hammer and nails.  Lots of hammering, and many nails bent and misshapen.  They were cheap nails, and I would say that given the amount of cheap nails we wasted, could we not have bought more expensive, yet more easier-to-drive-in nails?  A question I would ask every time a nail crooked the wrong way.

Maybe a good 5 hours before I could stand with confidence, and even without the safety of a harness—although the harness is on; others, including me, eventually gets too lazy at the hassle of adjusting the slack or changing the stationary support, BOTH OF WHICH IS CRUCIAL FOR IT TO WORK.  Too much slack, you'll just hit the ground before the harness could pull taut; and without changing the stationary point, you can imagine being the bob at the end of the pendulum swinging down, colliding with a ladder or two and forcing everyone's jaw to drop.

But there it is, some people have done it long enough to really not feel the danger of high places; and here I am, still scared but not enough to overcome the hassle of safety.  Is this not a major source of easily-preventable-accidents?  The extra effort hinders work.  If only safety came without effort.

Can't wait until we have anti-gravity boots or maybe some gravity-deployed forcefield, but would we still be building houses ourselves then?

Safety first.

Round Two.

It's all about the grass this time around.  Or the lack of.

Leveling the dirt, getting ready for the sod.

Drizzling rain, wet soggy mud, cold air and lots of shoveling.  A wheelbarrow would've made this job a whole lot easier, but our Habitat supervisor had just come back from break and missed dibs for the good equipment.  

However, outdoors was preferable to applying insulation or sealant in the attic of the house: surrounded by all the hot air of the house concentrated in one place without circulation.  Guys coming out from that job came out drenched, not by rain, but sweat. 

Trimming the front lawn, by shovel.

The shoveling of dirt lasted about 2 hours, and sodding took another 3 hours.  A house's gotta have a good looking lawn right?  We laid the sod in a brick pattern, tucking the sides to make seamless the patches-to-patches of sod.  Even the picture you see above looks like regular grass rather than whole bunch of patchwork sod.  

The result and all the players.

Visually satisfying.  Something about changing the brown landscape to green grass gives a feeling of accomplishment.  The next hours would be spent cleaning up this site and another site down the street.  A truss was laying by the side of a fence, it had to go: for that we took out a reciprocating saw (sawzall). 

Reciprocating Saw

Learning to use one of these was interesting.  Safety first: if not working at a workbench, you'll need someone to keep the object steady as you cut.  Always keep the safety-plate flushed with the object.  And always SAFETY GOGGLES.

Another fun day.