Tag Archives: hospital

Book Review:Confessions of a Professional Hospital Patient

Confessions of a Professional Hospital Patientby Michael A. Weiss. 1stBooks, ISBN 0 75960 473 8, 2001.

Confessions of a Professional Hospital Patient: A Humorous First Person Account of How to Survive a Hospital Stay and Escape with Your Life, Dignity and Sense of Humour is a guide to spending time in hospital of value to first timers and veretans alike.

Aimed primarily at people with an imminent hospital stay and their families/supporters this book should also interest medical staff working in grastro-enterology who want to develop their understanding of the patient perspective.

I was delighted to receive my copy of ‘Confessions’ direct from the author, and when it arrived I was pleased to see that the book was well put together, with a good binding, nice readable typeface and a good size to carry with you into hospital.

The book is divided into chapters beginning with ‘Pre-admission preparation’ and ending with Weiss’ perspectives and opinions on healthcare in the US. Weiss is generous in the amount of material he makes available to others to help them deal with the administration side of the US healthcare system – this was fascinating to a UK based reader like me. Weiss supplies proforma letters, along with sound advice about what to copy and file.

The author has had over 50 hospitalisations so within the text there are plenty of lessons learned and tips which are based around a varierty of his own experiences. I’ve had quite a few hospitalisations and you do soon realise that some of the more perplexing aspects of hospitals aren’t down to your mirunderstanding, it is the system or a lack of communication. Some of the more common areas of confusion are explained carefully and tactfully, such as in the case of catheter removal – unless someone tells you, you don’t realise that you have to show the nurses everything you wee otherwise they force you to have the catheter replaced!

There is a plentiful appendix full of extremely useful outlines of things such as living wills and powers of attorney. I really appreciated the author addressing these issues as they can be easily overlooked.

It was really intersting to see that the hospital day, and general management of wards was virtually the same in the US and the UK. Then disheartening to read that dismissive treatment in accident and emergency also occured, albeit, very rarely.

(WordPress ate this section of the review, I will rewrite it tomorrow!)

In conclusion I think that this is an excellent book for anyone who has just been diagnosed with a chronic disease and expecting to spend some time in hospital. I also heartily recommend it to anyone in the medical profession who wishes to gain a patient perspective. I think it would particularly suit patients in the US who are trying to get to grips with the medical and insurance interface as I am sure that Weiss knows all the tips and tricks by now!

You can buy ‘Confessions’ from Amazon . Happy reading! Disclosure: I was delighted to receive a complimentary copy of ‘Confessions’ from Michael A. Weiss to review for my blog.

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Joint mobilising series

This collection of movements is a multi-purpose series designed to:

  • warm up some of the major muscles of the body
  • warm up some of the major joints of the body
  • develop your physical awareness of some of the major muscles and joints in your body
  • help transition from the stresses and strains of the day towards a calming Yoga practice

It is also a very useful sequence to do if you are confined to bed, or the sofa, but are feeling achy and in need of doing something.

1. Shoulder mobilising sequence from this post

2. Leg stretch

Have your knees bent and feet on the floor/bed. Draw your right knee in towards your belly and hold the back of your right thigh with both hands. As you breathe in (inhale) straighten your leg as much as you can and as you breathe out (exhale) bend your knee back to the starting position.

Draw your left knee in towards your belly and hold the back of your  left thigh  with both hands. As you breathe in (inhale) straighten your leg as much as you can and as you breathe out (exhale) bend your knee back to the starting position.

Recommendation: repeat up to five times, building up to ten times.

Extension 1: Extend your leg, and hold the stretch for up to 10 breaths.

Extension 2: repeat the movement using both legs

Extension 3:extend both legs and hold the stretch for up to 10 breaths

3. Ankle twirls

Have your knees bent and feet on the floor/bed. Draw your right knee in towards your belly and hold the back of your right thigh with both hands. As you breathe in (inhale) straighten your leg as much as you can. Twirl your ankle around one way and then twirl your ankle around in the opposite direction. As you breathe out (exhale) bend your knee back to the starting position.

Have your knees bent and feet on the floor/bed. Draw your left knee in towards your belly and hold the back of your left thigh with both hands. As you breathe in (inhale) straighten your leg as much as you can. Twirl your ankle around one way and then twirl your ankle around in the opposite direction. As you breathe out (exhale) bend your knee back to the starting position.

Recommendation: repeat up to five times, building up to ten times.

4. Hip openers

Gently rest both hands on your right knee and move your knee in a circle by pulling it towards you. opening to the side, pushing it away from you and then taking your knee over your left hip.

Repeat with your left knee.

Recommendation: repeat up to five times, building up to ten times.

5. Reclining cobblers pose

Start with knees bent and feet on the bed / floor. when you are ready, drop your left knee out to the left side, and then drop your right knee out to the right.. Bring your soles together. If you want to you can place cushions underneath your thighs to help support your legs. You may wish to put your hands on your thighs to help increase the stretch. Just do what feels right.

Recommendation: hold for between 5 and 10 breaths.

3 gentle moves to alleviate discomfort from being in bed – mobilising your shoulders

This series of movements focusses on the shoulders. These movements can be done lying in bed or sitting up. See which position your prefer by trying them both. If you decide to practice these lying down in bed, scoot down the bed a little and make sure you have plenty of space above your head – you’ll need to freely be able to move your arms above your head.

 

Make sure your read the guidelines first.

1. Shoulder mobilising A

Start in the lying on your back, knees bent position with your arms by the side of your body, palms down. This is your neutral position.

a) Slowly bring your right arm up over your head as you breathe in.

b) As you breathe out, return your arm back to the neutral position.

c) Slowly bring your left arm up over your head as you breathe in.

d) As you breathe out, return your arm back to the neutral position.

Recommendation – repeat five times, building up to ten times on each side.

2. Shoulder mobilising B

Start in the lying on your back, knees bent position with your arms by the side of your body, palms down. This is your neutral position.

a) Slowly bring your both arms up over your head as you breathe in.

b) As you breathe out, return both arms back to the neutral position.

Recommendation – repeat five times, building up to ten times on each side.

3. Shoulder mobilising C

Start in the lying on your back, knees bent position with your arms by the side of your body, palms down. This is your neutral position.

a) Bring your right hand across to your left shoulder and try to pull your arm across as far as you can, feeling a stretch at the upper back.

b) Release and return to neutral

c) Bring your left hand across to your right shoulder and try to pull your arm across as far as you can, feeling a stretch at the upper back.

b) Release and return to neutral

Recommendation – repeat five times, building up to ten times on each side.

Round off the routine by stretching both hands up over your head and having a good stretch.

3 gentle moves to alleviate discomfort from being in bed – mobilising your neck

This series of movements is all about mobilising your neck muscles. These movements can be done lying in bed or sitting up. See which position your prefer by trying them both.If you decide to practice these lying down in bed, scoot down the bed a little and make sure you have plenty of space above your head. Remember to read the guidelines first!

1. Mobilising your neck A

Start by tucking your chin into your neck and then:

a) Roll your head towards your right shoulder

b) Roll your head back to centre

c) Roll your head towards your left shoulder

d) Roll your head back to centre

Recommendation: Repeat between 5 and 10 times to each side.

2. Mobilising your neck B

Start in a neutral position and then:

a) Drop your head to your left, as if you are trying to bring your left ear towards your left shoulder

b) Keeping your chin tucked in, roll your head to centre and then towards the right, finishing with your right ear towards your right shoulder

c) Keeping your chin tucked in, roll your head to centre and then towards the left, finishing with your left ear towards your left shoulder.

Recommendation: Repeat between 5 and 10 times to each side.

3. Mobilising your neck C

Start in a neutral position and then:

a) Keeping your chin level, turn your head to the left

b) Return to neutral

c) Keeping your chin level, turn your head to the right

d) Return to neutral

Recommendation: Repeat between 5 and 10 times to each side.

3 gentle moves to alleviate discomfort from being in bed – lower body

Sooner or later after surgery, the novelty of a morphine pump will wear off, and horror (@.@) you realise that the nursing staff will actually take it away from you so you will have to retire from your career as an opium eater. You aren’t quite ready to get out of bed let alone go for a walk, but you are starting to want to move about a bit. As you are weaned off pain relief, aches and pains related to being immobile and in bed will present themselves to you.

This sequence of movements is aimed at mobilising the lower body and back, and you should be able to do them whilst in bed.

This series of movements is fantastic to do at any time, at any point. I use them all the time as warm up or cool down before my Yoga practice and also if I have back ache, it’s an excellent first aid treatment for getting rid of aches and pains.

Check out the guidelines first!

1. Pelvic tilt

In addition to helping you to engage with your abdominal muscles, this practice has the added benefit of stretching your lower back as well as activating your abdominal muscles.

a) Start by lying on your back and if possible come to a position where your knees are bent and your feet are on the floor or the bed. Put your hands on your hips and begin by pressing the back of your waist into the bed. When you first start doing this, this might be as much as you can do, and that is absolutely fine.

b) To move on, as you press the back of your waist into the bed, try to draw your navel in towards your spine.

c) For the third stage try to tilt your pelvis towards you as your press the back of your waist into the bed.

d) Finally you press down through your feet in order to lift your hips slightly off the bed.

Recommendation – start with 5 repetitions and gradually build up to 30 repetitions

2. Hug knees to belly

This is a movement which complements the pelvic tilt very well. This stretches out the back of the body and can be very helpful in starting to restore your mobility. The action of bringing your knees up on to your belly helps you to get to know your insides again after your surgery.

a) Begin with your knees bent and feet on the floor / your bed. If you can, use your hands to draw your right knee towards your belly and hold this position for a few breaths and then release.

b) Keeping your knees bent and feet on the floor / your bed. If you can, use your hands to draw your left knee towards your belly and hold this position for a few breaths and then release. notice if this side feels different to the first side.

c) If you want to you could repeat this movement on each side, but this time pull your knee in closer to your belly. You should feel a stretch in your lower back and the back of your hips along with gentle pressure on your abdomen.

d) Once you have become familiar with the movement on each side, try bringing both knees on to your belly, one at a time. Hold for a few breaths and then release.

e) If you want to you could repeat this movement with both knees on your belly, but this time pull your knees in closer to your belly. You should feel a stretch in your lower back and the back of your hips along with gentle pressure on your abdomen.

Recommendation – start with 5 repetitions and gradually build up to 30 repetitions

3. Supine Twist

a) Come to knees bent and feet on the bed or the floor, if you are doing this on the floor. Have your knees and feet together. Use your folded towel and both hands to apply gently pressure on your abdomen. Very gently drop your left knee to the left until it is resting on the bed / floor. If your knee won’t go that far, then use a pillow to support the knee at whatever height is comfortable for you. Then drop your right knee to the left knee so that the right knee and ankle are resting on the left knee and ankle.

b) Rest here for a few breaths feeling the stretch along the right side of your body.

c) Come back to the starting position. Have your knees and feet together. Use your folded towel and both hands to apply gently pressure on your abdomen. Very gently drop your right knee to the right until it is resting on the bed / floor. If your knee won’t go that far, then use a pillow to support the knee at whatever height is comfortable for you. Then drop your left knee to the right knee so that the left knee and ankle are resting on the right knee and ankle.

d) Rest here for a few breaths feeling the stretch along the left side of your body.

Recommendation – start with 5 repetitions and gradually build up to 30 repetitions

Finish the sequence with a couple of repetitions or the pelvic tilt or the knees to chest.

Draft medical history proforma – so you don’t have to repeat yourself endlessly

One of the most frustrating things about Crohn‘s (especially if you have blockages and adhesions) is that you can unexpectedly end up in hospital all over the place. I had a period of a few years where every holiday was doomed to end up with me in hospital somewhere – eventually the problem was found.  It turned out that there was a grapefruit sized abscess wrapped around my bowel which led to exciting impromptu re-enactments of ‘that scene’ from the exorcist.

I now have an outline of my medical history to give to medical staff on my ‘travels’. The aim of the outline is to help me remember key dates and events, which can be forgotten in the begging for morphine confusion of admission.

I have attached a draft version of the outline here to share with readers: Summary of medical history_Draft in order to get some comments from you about it.

  • Is there anything I have missed?
  • Is there about the right amount of space or do you want more?

Medical staff often ask you to repeat your medical history as a way of:

  • building rapport
  • checking you are compos mentis (composed mind)
  • checking that you are not suffering any ill effects of medication
  • checking for delirium that comes with fever

So having an outline to hand won’t necessarily reduce the number of times you are questioned but it will make a difference when it matters.

It is also useful to have to hand so that a carer, friend or relative can give all the important details to medical staff if you are not able to coherently communicate. This can happen if you have a fever or are in considerable pain.

So do let me know what you think about the draft version (here: Summary of medical history_Draft) and then I will upload a final version for you to write your own outline.

Hospital parking* in an emergency

*And by parking I mean ‘not parking’.

It has been a while since I last had an emergency admission into hospital and because it has been a while I completely forgot that such an activity requires intense logistical planning, moral / ethical mazes, financial forecasting and nerves of steel.

1. REAL Emergency flashing blue lights and screeching brakes admissions, accident and emergency for the conscious and walking / wheeling wounded admissions and ‘Shropdoc’ walk in demountable clinic for those who don’t know if they are ill enough to merit access to a bricks and mortar building are all located within 30 metres of each other.

2. There is NO parking in the vicinity – except bizarrely for a staff car park on what looked like it used to be a grass verge, and an overfilled ‘drop-off’ car park for a clinic. So staff get priority for parking over people who may have suffered an accident?

3. So nerves of steel required to pull into a heavily guarded and marked ambulance bay to dash into minor emergencies reception to pick up a wheelchair to bring out to put my daughter in. She can’t walk you see. It is at this point that I realise that my attempt at being an adult has failed completely and I should have phoned my mum and dad and asked one of them to take us to hospital. Oh and before you mention buses or public transport, this is Shropshire, there are no straightforward public transport options from where I am to the hospital. Oh and my daughter can’t walk any way.

4. NO DROPPED KERBS!!!!

5. Logistics 1 Daughter ensconced in reception. Um. Now what. I am amazing in so many ways but actually being in two places at once is still a skill I need to master. Moral maze: I have to stay with my injured, vulnerable 9-year-old daughter, and yet I have to move my car, because I am parked in an ambulance bay that is guarded by all-seeing beings who will swoop in any minute to clamp me and fine me. I ask reception where the best place is for me to park.

“Parking is nothing to do with us”

“You see, My 9-year-old is in reception, which is out of your sight (It is completely out of sight of the desk, bizarrely), and my car is sitting in an ambulance bay. I know I need to move my car but I don’t particularly want to leave my daughter on her own”.

“Well the parking is nothing to do with us. The attendants check all the time though and there is nothing we can do to help you if you get a ticket”.

“Um…..”

So, here is the thing.

a. This is your hospital, parking is a service you provide to your patients. It is inextricably linked with what you do because this is how your customers arrive at your premises. You may have sub-contracted management of the parking, but you are the client and you call the shots.

b. I’m actually more concerned about first, my daughter and second, being in the way of the ambulance.

4. So I dash off and park in the general parking which involves driving around and around until a space becomes available. Then working the parking machine. I don’t have cash but there is a sign saying ‘You can pay by phone, look out for the signs near by’. WHY don’t you just put the phone number on the sign??? ‘You can pay by phone, Call 01743……….’ The sign is actually on the side of the machine. Not the most obvious ‘near by’ sign when you are in an ethically challenged panic state.

5. Fortunately payment is through a company I have an account with, but inexplicably it asks me how many hours I want to pay for, when the machines are a flat fee for 24 hours regardless of how long you stay. So that confuses me and means I have to wing it by asking for 4 hours. Who actually knows how long I will be at the hospital for.

6. I get back to comforting extremely brave and well behaved daughter. and I wonder why a car park company is getting all the money for the car park rather than it being reinvested directly in the hospital.

7. Logistics 2 Did I mention the wheel chair? You know those trolleys in DIY shops which only go backwards? They now make wheel chairs like that too. Have you ever tried to manoeuvre a backwards only wheelchair over a pot-holed hard standing with no dropped kerbs? Whilst a bunch of squaddies and paramedics look on (audience always adds pressure, let alone an audience of people who can probably excel at this challenge in their sleep). Not my finest moment. And that was with it empty. It was worse with my poor, pained daughter in it. She got out at the kerb. WHY not have level access??????? WHY not have simple easy to use wheelchairs like supermarkets do????? Needless to say there are a few more dents in the walls of minor emergencies courtesy of me.

8. Ambulances wait outside the entrance to A and E which is well within the hospital grounds WHY?  Why are they not on their starters blocks right next to the main road? Why do they have to traverse a twisting pedestrian and patient littered road before launching into their sprint to a patient? I can understand them being there dropping people off, but just hanging about waiting? In fact why isn’t the whole major emergencies department right next to the main road? That would probably shave a crucial 90 seconds off travel times.

9. Hungry and thirsty now, after triage assessment (Triage Sister was wonderful, exactly the right balance of compassion, competence and common sense that you want in a minor emergency) we decide on getting a diet coke from the vending machine. I have just the right money. It eats the money and does not give me a drink or give me my money back.

“Excuse me, the vending machine has just taken my money, it won’t let me cancel to have my money back and it won’t let me have a drink either”

“Vending machines are nothing to do with us”

“Would you be able to change this money so I can add an extra 10p to try to get a different drink?”.

“No, if we did that, we would be bankrupt. That machine has been broken for ages”.

“Um…..”

WHY not put a sign on the machine saying it is broken then????????

Subsequently, exactly the same thing happened to another patient in a different part of the hospital with exactly the same response.

Customer service was not the strong point of this day.

P.S. Daughter may have cracked a little tiny bone in her foot, plus lots of soft tissue damage. Nothing major, but she will need to wear a special shoe to support her foot for a few weeks whilst it heals.