Television

VIP Patient Rooms: Are They Real?

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When most think of hospitals, we envision sterile environments with mediocre food and beds that lack the comfort of home. However, while watching an episode of The Resident, the concept of VIP rooms emerged.

In the scene, the hospital admits a wealthy donor and hospital board member to their VIP room. The space is decorated with lavish furnishings and a duvet cover to compete with those in most hotels today. However, the scene pales in comparison to the real accommodations some multi-millionaires experience in the US.

How the rich endure their hospital stay never crossed my mind before, but apparently, they receive five-star rooms with services that the average American can’t afford.

Some hospitals cater to the those with vast amounts of money, the famous Hollywood crowd or politicians and diplomats who live in the US and abroad.

Luxury three-bedroom, two bath suites, beautiful living and dining areas with sweeping views of the city await them when admitted. Kate Hudson, Victoria Beckham and the Kardashian sisters have all experienced the posh treatment when delivering their babies.

Not only are the furnishings top-notch, but the affluent patients receive meal delivery from private hospital chefs, their own personal doula, hair and nail services along with free bath robes or anything else their heart desires.

As for the average Joe, our wallets can’t afford the four thousand dollar a night stay.  Our rooms are less ornate. We get one clean bedroom, one small bathroom, mediocre food from the cafeteria and bland furnishings. No personal doula for us although, breast feeding centers and coaches are available.

The maternity suites are not the only area where the wealthy thrive. Even when emergencies strike, affluent patients often skip past the ER department and straight to luxury accommodations. Where an average patient will spend hours waiting, the rich fast-track their medical care, bypassing the conflicts assigned to the rest of us.

My father always used to say, “Money doesn’t buy happiness,” and I agree. However, having some cash might make a difference when faced with a hospital stay.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Someone Please Rescue 911: Teach Them to do CPR Correctly

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I’ve been teaching CPR for almost thirty years. Can you believe that? I hardly can.

I’m pretty passionate about CPR because time after time studies have shown that this is the patient’s best path for survival— high quality CPR given as soon as the patient needs it. It’s not rocket science and it’s pretty easy to research. Here’s a Google link to a bunch of images that show the algorithm for CPR.

What you want to be sure of is that you’re using the most recent guidelines. For the American Heart Association (AHA), their most recent set came out in 2015. The AHA reevaluates their CPR guidelines based on research every five years. Next update will probably happen next year, but the educational materials likely wouldn’t be released until 2020.

In episode nine of this season’s 911, Hen and Howie rescue a boy from a submerged vehicle. He is unresponsive and pulseless once he reaches the shore. They begin CPR (just compressions) and after every set of compressions they do a pulse check. After about a minute, they revive the patient.

Did you know that even healthcare providers are not that great at determining whether or not there is a pulse? It’s true. On top of that, imagine trying to do a pulse check with cold hands, in the dark, in the rain. Not easy to be sure.

The reason the pulse shouldn’t be checked that much is that it ultimately delays compressions and we don’t want to do that. Every time compressions are stopped, the blood perfusion to the heart also stops and it takes several compressions to reperfuse the heart. Some fire departments have gone to doing two hundred uninterrupted compressions for this very reason.

In lieu of this issue, I did like this episode quite a bit. It’s Hen’s origin story and I do think it highlighted some of the issues minorities face in the fire service.

911— let’s just stop messing up the little things.

New Amsterdam and The Law: Real or Not Real?

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In Episode Two of the new NBC show New Amsterdam, there are some pretty amazing claims about two specific laws. Keep in mind, I’m not a lawyer, and this blog is for fiction writers so you might be interested in doing your own research, but these are my thoughts on these “two laws”.

Law #1: In one scene, a man is standing outside his room complaining that he must choose between his wife’s care and a car— eluding to how expensive the medical care will be and that the hospital won’t tell him how much it is. Dr. Goodwin says in passing, “Congress actually made it illegal for hospitals to disclose prices to you.”

Having worked in health care for twenty-five years, I understand how frustrating this can be and there definitely needs to be reform in this area. However, let me give some insight into why it is hard for hospitals to give you an exact price up front. Simply, humans are not machines and often do not medically act the same in every situation.

Let’s say your child comes in for stitches and we tell you it costs “X” amount. This assumes your child only needs a topical numbing agent for the procedure. However, your child is not on board with the medical plan and won’t hold still for his stiches so a decision is made to give them some sedation— and the topical medication isn’t enough to numb the site so we then have to inject a medication. Since the child received sedation, now there’s increased monitoring time to make sure the child is okay to be discharged home. Things like this happen every day in healthcare.

The problem is when you quote someone a price, they want to (rightly so) hold you to it. When you can’t, then it creates dissatisfaction for both the patient/family and the hospital.

Despite this, I could not find any such law that congress has passed that prohibits a hospital from disclosing prices. I think the reluctance is on the side of the hospital for the reasons I mentioned above. In fact, there seems to be movement legislative wise, in the other direction for more transparency. You can read the American Hospital Associations thoughts on it here.

Law #2: A young boy is brought in for psychiatric treatment and the psychologist on staff believes he’s being overmedicated and wants to wean him off all his meds. Quick note on that— not sure why a neurologist would be involved in this process. A psychiatrist, yes.

There’s a statement made regarding the Prohibition of Mandatory Medication Amendment of 2004. As from the link, this law does exist. Put very simply, a school cannot force a child to take medication to receive educational services. However, in the show, it’s stated that the school can force a child to take meds for educations purposes if the mother has signed an IEP otherwise known as an individualized education plan.

I could not find any source to support this statement. This blog post written by a mom who seems familiar with this issue would be a good one to read. Do I believe that schools try to “strongly suggest” that kids are medicated. Yes, I do. However, I don’t think it’s supported by law.

New Amsterdam: Prioritizing Epinephrine Over Oxygen

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New Amsterdam is a new medical drama on NBC this year. You can see my first post about it here. Today, I wanted to review a medical scenario with you and the problems with they way it’s presented.

As I discuss the scenario remember that all medical providers are taught this from the very moment they step into medicine: A, B, C— Airway, Breathing, Circulation.

Here’s the setup: A man travels from Liberia where he begins to exhibit signs of Ebola. They place him in isolation (a good move). A big lecture is given by Dr. Max Goodwin, the new medical director, that no one is EVER to enter the isolation room without the proper PPE (Personal Protective Equipment). From there, it gets a little bit strange.

The first issue is that it’s stated that the isolation room is “stocked with every available medication should the patient need to self medicate.” A few problems. A sick and deteriorating patient is going to have the wherewithal to find a drug and give it to himself? This is later proven to be a bad idea when the patient can’t even reach for an easily accessible oxygen mask without falling out of bad.

Also, everything in the isolation room is going to get thrown out and likely charged to the patient so for a medical director who is so concerned about minimizing costs for the patient . . . well, you can see where I’m going with this.

The patient begins to cough up blood, bleeding profusely from his mouth, and has difficulty breathing. As the doctor is getting into her PPE, she instructs him to give himself oxygen which he is unable to do and then falls out of bad. Without getting into full PPE, she enters the room to help.

I actually like this aspect of the show. As I’ve said all along, medical people can make bad choices, as long as the writer shows repercussions for them which they do in the show.

The doctor immediately begins to work to aid his breathing. This is the right choice. She believes the airway is too obstructed so she immediately moves to a needle cricothyrotomy. This is generally done as a rescue measure when other attempts to secure an airway have failed— it is not the first choice.

However, as the doctor inside the isolation room is generally doing most of the right things, Dr. Goodwin (the new medical director) is telling her to give the patient an IV dose of Epinephrine before she gives him oxygen. He tells her to prioritize the epinephrine over the oxygen. At the screen shot to the right, what’s obvious is that the blood pressure (82/40) is low and that the patient’s oxygen levels are REALLY low at 64% (normal is generally considered above 90%).

There really isn’t an indication for epi IV (as in a code dose) in this scenario. The first two reasonable thoughts for this patient’s low blood pressure are sepsis (low blood pressure caused by overwhelming infection) and blood loss from the obvious hemorrhage. Epi can be given in this situation (for low blood pressure related to sepsis) as a continuous drip, but not as a push medication.

Most importantly in this situation, epi would not be prioritized over the patient’s alarmingly low oxygen levels.

New Amsterdam: A Problem with Repetition

/ Jordyn Redwood / 1 Comment

For you, my faithful reader, I took in the latest foray into the medical drama by watching New Amsterdam. I was hesitant because of being burned recently by The Good Doctor and The Resident. I know, some of you are loving those two shows, but let’s try to be somewhat medically accurate if you’re going to write a medical drama.

Anyway, I decided to give New Amsterdam a try. It stars Ryan Eggold as bright and shiny new medical director, Max Goodwin, at the healm of a safety net hospital called New Amsterdam. He’s a flawed character, which I liked, and he’s in charge of a staff where they’ve had a new medical director every year for the last five years.

Of course, his moral center is to upend the system for the benefit of patients and not necessarily the gain of money. This is in itself strange since they make it a point to say this is a public service hospital— which still needs to worry about money— but the feeling is different than working at a for profit hospital.

To carry through his moral center, he needs to make big changes fast. I’ll step through some of what I found problematic with the first episode, but I was intrigued enough to keep watching so I’ll keep you posted.

Problem One: One of his first acts as medical director is to fire the entire cardiothoracic surgical team— like every. single. one. Put aside that generally there are a lot of hoops to go through when firing anyone, particularly a doctor, this action puts the hospital at risk of not being able to serve the people he wants so desperately to save. Level I trauma centers must meet certain requirements in order to keep their doors open and firing the entire cardiothoracic surgical team is going to put this in significant jeopardy.

Problem Two: Committing a patient to inpatient psychiatric treatment to keep her out of foster care. Again, as with my recent post on the movie Unsane, there are strict laws on how long you can involuntarily commit someone and generally it needs to be reevaluated on a weekly basis. So, though commendable (because she does like the staff where she is and it would keep her safer than where she’s been), it’s just not feasible that any scenario like this would ever pan out.

Problem Three: Saying the same thing, but fancier. Sometimes I wonder who they find to be medical consultants for these shows. There must be someone. Then I wonder who this someone is and what is the nature of their medical background. In two different areas of the show, the doctor is basically saying the same thing.

Here are two examples:

1. “The patient got diazepam and Valium.” Okay, awesome. These are exactly the same medication. So, you gave the same drug twice?

2. This is a set of orders given by an ER physician. “I need a CBC, BMP, Chem 7 and a saline lock.” Sweet! A CBC is a complete blood count, however a BMP (basic metabolic panel) and a Chem 7 are the same test.

Overall, an intriguing show and I’ll give it another try, but I’m also available for medical consulting!

911: Let’s Provide Some Medical Care

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In the Season Two/Episode Eight airing of the FOX television show 911— there was a great scene on how to really provide no medical care.

The setup: A gay couple is getting ready to go on a bike ride. Much time is spent in a musical montage showing their lives together. It’s clear they have had a loving relationship and remain deeply in love. One gentlemen goes to load a bike onto a SUV when, in a series of unfortunate events, he gets pinned by the SUV to the entrance gate— akin to Anton Yelchin’s accident (though they do show in the episode the SUV was placed in neutral).

He is discovered by his partner who then calls 911. Upon arrival, there isn’t much done for his lover. He is essentially declared dead on arrival.

Then, the gentleman who discovered his partner, goes unconscious while a firefighter has his back turned. Literally only a few seconds have expired when the firefighter discovers he’s passed out. They provide one and a half cycles of CPR and kind of shrug their shoulders declaring that he’s died, too.

This is unacceptable management of this patient. It’s essentially a witnessed arrest so they were correct to start CPR immediately, but at the very least, he should have been connected to an AED for rhythm analysis and probable defibrillation. A very common reason for sudden collapse are arrhythmias that will respond to electricity. There’s no reason why this gentleman’s treatment  should have been so sparse. It would have increased the drama and the tension of the episode to have this patient get a full resuscitation.

Lifetime Movie Killer Twin: Killing Nice People Needlessly

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As with all television networks these days, the Lifetime Channel could use a good medical consultant as well. In a recently aired movie, Killer Twin, not only (Spoiler Alert!) does the main character, Kendra, have an maniacal unknown twin sister trying to end her life . . . the writers aren’t helping her out too much either.

There will be spoilers for this movie in this post so you’ve been warned.

The plot revolves around the heroine, Kendra, whose life is perfect. She was a twin, but the adoption agency didn’t disclose that and she was adopted as a single child, leaving her twin sister to suffer in the foster care system. Now her twin wants her life and wants Kendra dead.

The main attempt to do this is to expose Kendra to poppy seeds, of which she is deathly allergic to, via a conveniently delivered fruit basket— oh, and steal her epi pen so she can’t save herself.

Thankfully, Kendra’s mother is with her and calls 911, but the attempted murder plot lands her in the hospital.

Here are the following problems with this scenario.

Problem One: Twins aren’t necessarily allergic to the same thing. Can they be? Sure, but it would have to be proven out. For instance, if a mother were to tell us in the medical sphere that a patient’s twin sister is allergic to penicillin, but the patient has never had it, we would still give it a try. It’s presumptive in this movie to assume that because evil twin has the allergy, so would the good one.

Problem Two: Unnecessary Hospitalization. It’s actually very rare for a person having an anaphylactic reaction (which is life threatening if untreated) to land in the hospital. Most of the time, they are observed in the ER for several hours and sent home with medications to take over several days. I’ve outlined the treatment for anaphylaxis in this post. Also, the heroine, who is six weeks pregnant, is told that the medical team admitted her overnight because “a lack of oxygen and toxins could hurt the baby.”

First, let me mop up the blood that just shot forth out of my eyes.

Poppy seeds are not a toxin. They’re a food item. There’s no evidence given in the movie that the character stopped breathing and therefore suffered a loss of oxygen. If you claim this— let’s at least put the character on a monitor to watch her oxygen levels. Lastly, you can’t monitor a baby at this point in any way and isn’t a justification for staying in the hospital.

Problem Three: Killing people with the wrong IV solution. The picture on the right shows the IV solution they were “running” on her (explained in the next section) which is sterile water. Flat out, this will kill people for reasons I won’t go into here. It is never used as an IV solution.

Problem Four: The IV tubing goes into the pump. Honestly, if you’re going to park a piece of medical equipment at the beside, and have a nurse check on it, then know how to use it. As noted in the photo, the IV tubing is not loaded into the IV pump.

Sadly, sweet Kendra doesn’t need her evil twin to kill her, the writers are doing their best on their own with this medical set up.

 

Modern Family: S10/E7 Disclosing Pregnancy Results

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This blog post does contain spoilers for episode seven/season ten of Modern Family— you’ve been warned!

On a recent episode of the wildly popular ABC series Modern Family  (which I personally thoroughly enjoy) it was disclosed that Haley Dunphy is pregnant. However, the way her pregnancy was disclosed was a violation of patient privacy.

In the episode, Haley and her boyfriend, Dylan, are playing bumper cars when he playfully rear ends her while she’s applying lipstick (yes, in the bumper car). The end of the lipstick gets shoved up her nose and breaks off leading to a trip to the ER.

Evidently, Haley was given anesthesia to remove the piece of lipstick from her nose. They also x-rayed the nose (at some point) because they tell her it’s not broken. There’s some witty banter about how the injury happened and that she and Dylan want to remain childlike as long as possible which is when the doctor says, “Oh, we did a pregnancy test prior to your anesthesia and you’re pregnant.” This was done via a blood test.

Problem One: There’s really no reason to give anesthesia in this case. We remove foreign objects from pediatric noses all the time and never give anesthesia. Anesthesia is reserved for the OR. Sometimes, a patient might need a little something to chill them out for a procedure, for which we would use nasal Versed or Fentanyl. You don’t need to start an IV and recovery is not too long.

Problem Two: Not even sure why they needed to do an x-ray for a broken off end of lipstick in the nose. I don’t think the mechanism of injury warrants even thinking the nose is broken. Lipstick is soft after all.

Problem Three: A blood test used to determine pregnancy. This is rarely done and would be used more specific to determining pregnancy where problems in early pregnancy might be the concern— such as ectopic pregnancy or early pregnancy miscarriage. In this case, a urine test would suffice.

Problem Four: These days, disclosing pregnancy results must be done very carefully. As healthcare professionals, we don’t know who the male is at the bedside and if the patients wants that male to know about the pregnancy or not. The doctor should have asked Dylan to step out of the room as she disclosed the results to Haley. Then it’s Haley’s decision about whether or not to tell her boyfriend. The same is true if we discover a teen is pregnant in the ER who might be there with her parents. The parents are asked to step out and we’ll tell the teen. It’s up to her whether or not to disclose the results to her parents. We as healthcare professionals will encourage her to do so, but it is ultimately her decision.

I think the best way to have handled this situation would have been to perform the pregnancy test prior to her getting an x-ray of her nose, but even this would be a little outside the norm because shielding her abdomen would have been easy in this scenario.

The Good Doctor S1/E6: Killing Patients

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At some point in every medical person’s career, we face a time when we think or may have altered the course of someone’s life either by a medical error causing serious harm or death.

Truth is, it’s a team effort to keep patients from suffering from these complications. We are all responsible for looking out for one another regardless of scope of practice. For instance, if an EMT sees something the doctor (or new resident) is doing wrong, they should speak up to prevent harm from coming to the patient.

In this episode of The Good Doctor, the staff is dealing with an MCI or Mass Casualty Incident. A bus full of wedding guests has crashed. After several of them are treated, it is discovered that a woman is missing at likely still at the crash site.

A resident leaves with an EMS crew (this in itself is highly unlikely) and finds the missing woman. On scene, the resident diagnosis her with a flailed chest and subdural hematoma (a collection of blood on the brain).

What is a flail chest? It’s when two or more consecutive ribs are broken on the same side creating a free floating segment of the chest wall. This can inhibit the patient’s ability to breathe and also puts the patient at a higher risk of having a pneumothorax (or air collecting outside the lung inhibiting the lung’s ability to fill with air.)

The resident chooses to intubate and then drill a bur hole into the patient’s head for the swelling. Upon arrival to the hospital, the ER doctor notices that the patient’s oxygen level is low (like in the 70s— normal of 90 and above) and pulls back the tube and the oxygen levels increase.

When someone is getting intubated, it’s natural to push the tube in too far and because of the anatomy of the lungs, it will pass into the right lung. It’s later noted in the show that because the resident intubated the right lung and that’s the side that had the failed chest, the patient suffered from persistent hypoxia (or lack of oxygen) and her brain died because of that.

Was this patient’s death preventable?

Putting aside that this patient could have been hypoxic during the time she laid for an extended period of time in the ditch, this death could have been preventable if the EMS crew, who would have been monitoring the patient’s oxygen level (and so should the resident if involved in transporting the patient) had spoken up about the dramatically low level.

When a person is intubated, these are the following checks that happen to ensure the tube is in the right place.

1. Does the chest rise and fall equally. In this patient’s case, the right side of the chest would not have risen that much if several ribs were broken and the lung was deflated which should prompt the doctor to do number two on this list.

2. Are the breath sounds equal? The patient’s lungs are auscultated (listened to with a stethoscope) to determine this. They should be equal. If not, then there is a problem with that patient’s lung (one is deflated, etc) or the tube is in the wrong position. At that point, the tube could have been adjust. If the patient’s breath sounds were severely diminished on the right side (especially after trauma) then a need decompression should have been done on that side as a rescue measure to try and reinflate the lung some.

3. Are the patient’s vital signs improving? This would be primarily the oxygen level. It can take a few second to a few minutes for the patient’s oxygen levels to reach normal but they should improve. If not, then something is wrong with the tube and it should be evaluated.

4. Is there the presence of carbon dioxide measured as end tidal CO2? There are quick measure devices in the field to check that carbon dioxide is coming up through the tube. This also ensure the tube is in the right place. In the hospital setting, we will watch this number continuously.

5. Ultimately, in the hospital setting, an x-ray is done to confirm proper placement in the field but if the above items or done, the tube (or endotracheal tube in this case) should be in the right position.

If the EMS crew would have spoken up and/or if all three of the crew members had been performing their job correctly by monitoring the patient’s oxygen levels (which is a very basic thing to be monitoring) then this patient’s death could have been prevented.

It’s up to every member of the healthcare team to ensure patient safety.

911 S2/E2: Determining Death

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In Episode 2 of this season’s Fox series 9-1-1, a devastating earthquake has hit LA county.

The team is searching for victims when they come upon a patient where only her lower legs are visible. The paramedic reaches down and assesses her pulse at her foot and determines that she’s dead. Time to move on.

Can you feel someone’s pulse in their foot? Yes, you can. He’s palpating what’s called the dorsalis pedis pulse.

Should it be used to determine if the patient is dead? To this, I would say no. The problem is, when the body goes into shock, it shunts blood toward the central aspects of your body to ensure blood flow to your vital organs so even though the person is alive, you may not be able to feel the pulses in the feet. This is why when checking for life, the use of central pulses is encouraged— for instance the femoral or carotid pulses. Also, this victim could just have two broken legs with compromised blood flow to her feet causing the lack of pulse.

However, I’m not going to give them too much grief for this. In a mass casualty situation, sometimes you do just need to move on and save who you can.