Praise the nurse and pass the bedpan

By Howard Troxler, Times Columnist
In print: Tuesday, April 15, 2008

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Take a perfectly healthy man or woman, strip away the clothes, slap on a plastic wristband and a flimsy gown, stick 'em in bed for weeks with tubes and bedpans and hospital food, with blood drawn daily and vital signs taken hourly, and he or she will come out the other side as weak as dishwater, blinking at the sunlight in pathetic confusion as somebody asks in a forced, cheerful blare, "Do you know what day it is?"

Here is what you do not see much of in hospitals: doctors. The doctors are legendary creatures, like leprechauns or unicorns. If you are a patient or relative, you soon learn to build the entire day around the utterly unpredictable appearance of a doctor. If you step out to the canteen, or the restroom, or to call the family with an update, you will get back to the room only to learn that You Just Missed Him, and you must wait until tomorrow.

Not that the doctor actually knows anything. He or she is likely to be a rent-a-doc whose job is to read the charts and inform the patient only when he or she has died. Otherwise, this doctor, known as the "hospitalist," simply waits until the patient gets better or worse, to be discharged in case of the former outcome, or transferred for the latter.

The practical result is that the hospital is run by nurses. This is just as well, because the natural tendency of nurses is to pay some dim attention to what is happening with the patient. As an added bonus, some of them are friendly and compassionate and patient beyond reason.

A good nurse is worth twice the price of admission. As a visitor, I watched them put up with more than I could stand: patients and families unreasonable, loud, insulting, panicked and desperate. In one room a nurse tended to a patient near death; in the next, she was berated for being slow with a pillow.

It certainly is an acquired skill, rolling a patient over with a cheerful sing-song and changing the sheets from beneath him no matter what has happened, and by that I mean, no matter what has happened. It is better not to be too specific here.

In short, the nurse's reassurance is the only thing the hospital has going for it. There is a delivery of a plastic tray three times a day from some guy saying, "Nutritional services," although I am not sure anyone is in charge of seeing that the patient ingests any of it. A tech pops in regularly, usually once the patient has mercifully drifted off into a ragged nap, to wake him up to take his blood pressure.

Otherwise the biggest advance as far as I can tell is the hospital bed itself, which has a mind of its own, subtly shifting automatically beneath the patient every few minutes to aid circulation and prevent bedsores. The head or foot may be lowered, or the whole contraption molded in a particular way; the bed rolls for transport anywhere, so there is no need for the patient to be lifted; it even serves as a scale. And yet, the IV-fluid stand is the same simple pole that it always was, so that nurses must drag along that clattering nuisance, nearly losing it at each bump.

This is what it is like to visit. As for what it is like to be a patient, I cannot imagine, except for this: I have taken a vow never, ever to address a hospital patient using baby talk, or to use the pronoun "we" in making inquiries, or to stand over the poor fellow while discussing his bodily functions with all comers.

Other than these things I have mentioned, it was all very pleasant.