Noise and Sleep and More
supplemental oxygen, they came up into the
patients. Maybe this concept needs to be
The complaints I’ve heard from other
mid 90s. If I used the incentive spirometer
patients seemed to be true. I was in a
vigorously (and that hurts), I could get the
double room converted to a “private room”
room air sat into the low 90s for a short
Nurses and COWS
by installing a plywood panel and door so
time. It took me concerted effort with deep
I have only the deepest appreciation for the
thin you could easily hear quiet conversation
breathing for several hours to get rid of the
nursing staff and nursing aides with whom
on the other side. And overall, the alarms
atelectasis I had developed during the night
I came in contact. They all were genuinely
going off continually, conversations,
and maintain room air sats in the mid 90s.
concerned and helpful. However, they
footsteps, motors, and the like persistently
Good thing I know what I’m doing, I guess.
did seem to be struggling with the new
inhibited any attempt at solid sleep. But
Most patients would simply lie there and be
wireless mobile data entry devices, called
the distractions didn’t stop there. I had the
COWS, which they wheel from patient to patient to use in lieu of carrying a clipboard.
misfortune to wear compression boots from foot to knees. These inventions of the devil
Interestingly, a recent article by the
Fancifully, I imagined we could put a bicycle
at first seem like a good idea (after all, who
Anesthesia Patient Safety Foundation (APSF)
seat and pedals on the COWS so the nurses
wants to get DVT?). However after several
points out a high incidence of morbidity
could maneuver them more easily.
hours, the constant inflation-deflation cycle,
caused by hypoventilation with atelectasis,
coupled with the noise of the compressor
hypercapnea, and respiratory acidosis from
motor, start to drive me crazy—not to
the effects of PCA and epidural narcotics.
The biggest impact of my hospitalization
mention contributing to sleep deprivation.
The APSF says that monitoring oxygen
was psychological. I have had deep thoughts
The incessant noise, however, is a serious
saturation with a pulse oximeter gives a
about what to do with the rest of my life,
problem, and perhaps we should take a look
false sense of security when supplemental
accompanied by a fair amount of depression
at some corrective measures.
oxygen is administered. The O2 sat will be
and fatigue. I’m more optimistic now that
OK, but everything else is going south. The
my diagnosis is actually quite favorable. An
bottom line is that the APSF will probably
earlier than previously planned retirement
and at least this component of my stay was
recommend that exhaled CO2 monitoring
from clinical medicine may be in the cards,
quiet—but only at first. I was offered from
should be added to pulse oximetry as
since I have discovered that daily high stress
0.2 to 0.4 mg of hydromorphone with a
mandatory monitoring for postoperative
in the OR is not necessarily a good thing.
lockout of 10 minutes and no basal rate. This
patients receiving narcotics. Unfortunately,
Coming face-to-face with your mortality is a
is where the rubber hit the pavement for
our technology is not quite good enough yet
real eye opener.
me as I transitioned from anesthesiologist
to do this well on nonintubated patients.
I was placed on a hydromorphone PCA,
More important, I hope that I can transcend
to patient. Although I should know better, I hit the button whenever I felt any pain.
Playing doctor on myself probably
the clichés and truly be more empathetic
I became confused and had a number of
contributed to stress, but I’m convinced
with the experiences patients have. I hope I
very bizarre dreams and nightmares. Yet,
the stress would have been worse if I had
can find ways to put that knowledge to work
whenever I awakened, I hit the button again.
remained ignorant. Think of the anxiety a
in practical ways that will incrementally
Then it got noisy. Strangely, I discovered that
patient without a medical background must
improve the hospital experience for those
whenever I took off or lost my nasal oxygen
feel. Trust the doctor? Easier said than done
patients who can’t read a pulse oximeter.
cannula, the pulse oximeter alarm would
when you are feeling terrible in a noisy bed.
They’re scared in a noisy environment and trust us to do what’s right, both on a
go off and wake me up. Fortunately, I could stop the alarm by keeping my nasal oxygen
So after one night as an inpatient, I decided
hospital-wide basis and in the patient room
cannula in place. The next morning I felt
if I were to get some sleep, I’d have to leave.
itself. We need to make sure we do just that.
absolutely terrible—confused, disoriented,
Fortunately, I was able to do so. Thanks very much for reading. Go ahead
nauseated, with pain. That’s when I figured out that PCA was to blame, so I decided to
VIP Status—The Red Blanket
and use my thoughts to apply to your more
stop using the device. Things cleared rapidly
Stanford gave me a red blanket, telling
general musings and discussions. I welcome
after I made that decision.
everyone who came in my room and saw
your comments about this article.
it that I was a “VIP” patient. While I felt But even after discovering the truth about
honored, my caregivers weren’t so sure
PCA, I continued to play doctor. I turned the
this was a good idea. Some of the nurses
pulse oximeter around so I could see it. My
and others asked if the blanket meant they
saturations were not good. On room air, my
should treat me better or differently, and if
sat would drift down to the mid 80s. With
so, whether this sent the right message to
JULY / AUGUST 2008