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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

evaluated.

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

miserable.

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

Psychological Impact

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

the bulletin

JULY / AUGUST 2008

35

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