Warm Blankets in an Emergency

The blanket warmer in the Emergency Department is dead. There is no doubt about that. Dead as a door-nail

It has been dead for a while. Most of December at least. The thin industrial blankets kept there are as cold as a fish, offering little comfort. An "Out of Order: Cold Blankets Only" sign hangs on its door.

We still have the two warmers in our trauma rooms, but they are on the far side of the department from triage and you have to intrude on the patients in those rooms to fetch them.

Long ago, I made it my habit to stop by the blanket warmer to grab one for any patient I brought to a room. A warm blanket was my one consolation after unceremoniously pointing to a hospital gown and saying "it opens in the back."

The ice machine is down too. So it is hard to get ice chips for patients when mouths are dry.

There are worse things, and more important pieces of equipment. Heaven knows we can't bill insurance for the price of a warm blanket. Yet, it is one of the acts of nursing that has a great deal of influence on a patient's visit.

When people come in to the hospital, they are suffering from more than just pain or illness. They are anxious, often struggling with fear of the unknown and loss of control.

Few who come into the emergency room planned this as part of their day. Their world is disrupted and no longer operating at their direction - even if their emergency is minor. Most of us these days operate on tight schedules and coveted interludes of weekends and vacations. Moments are precious and thus organized for consumption. Disruption by an illness or accident throws everything up the air. Who will let the dogs out; get the kids off the school bus; cover for me at work?

Then there is the fear of the diagnosis. Is it serious? Will I need an operation? How will I pay for this? Cold beds, long waits, hurried doctors combine with the unkowns to stretch taut fraying nerves.

Stress and pain are intricately linked. While we are still learning about the relationship, the physiological response to stress appears to increase our receptivity to pain and reduce our immunological response. Long term, stress can increase our susceptibility to a number of different disease processes. If we can -- in little ways -- reduce the stress of a emergency room visit, it is one more tool we have to help patients get better.

While I can no long grab a warm blanket on the way back to the room, I can address a patient's fear and stress in other ways. I give information and reassurance and that is another tool I have.

We who live and breathe the hospital air have a good idea what the doctor is going to want and what will happen soon, and what we will have to wait for. The patients usually has no idea. So I tell them what to expect the best I can and prepare them if they are going to have to wait for tests to come back. I offer myself as a guide to their visit and offer to answer questions.

"I don't know"  -- when it is the truth -- is a perfectly good answer as well. Explaining the variables, the known and unknown helps build trust in the patient, which in turn reduces stress and allays fears.

While the practice of medicine gains ever more sophistication in science and technology, we always must remind ourselves that our profession is an art as well as a science. Our interactions with patients influence the success of our brief role in their care.

So when you look at it from that perspective, the blanket warmer can be a pretty important piece of equipment after all.

Further Reading:
Stress and Anxiety backgrounder from New York Times Health Guide

Carrying The Old Woman

I often find myself thinking of an old zen story. 

In the story, two traveling monks reached a river where they met a woman. The woman was wealthy and had porters for her litter, but the porters were afraid to cross the river carrying their mistress. The woman was bitter and cursed the servants. When she saw the two monks, she angrily demanded that they carry her to the other side. 

The young monk hesitated, uneager to help someone who appeared so spiteful, yet the old monk silently picked her up onto his shoulders, transported her across the water, and put her down on the other bank. She did not thank him. Instead she continued to spit venom at the monk, complaining and cursing as he walked away. 

.

As the monks continued on their journey, the young monk was brooding and preoccupied. 

Unable to hold his silence, he spoke out.

"That woman was cruel, and when you helped her, she offered you no gratitude. Instead she cursed you. You should not let her treat you that way."

"Brother," the second monk replied, "I set her down on the other side, while you are still carrying her."

I learned long ago that the way people treat you has little to do with your actions or your value as a human being. Our ego, constantly insists that we deserve respect. So much so, that we think this is the calculation of our worth. 

What I have found in my two careers as a journalist and as a nurse is quite different:

People will yell at you whether you do the right thing or the wrong thing.

People will resent you whether you tell them the truth or a lie.

People will treat you cruelly whether you help them or harm them.

Thus, if their treatment of you is independent of your actions, you should not let their attitude dictate how you proceed in the world. Particularly in nursing, people come into our care with a lifetime of emotional pain that we cannot expect to repair in our short encounter with them. Some live lives so fettered by darkness that they develop antibodies to kindness and light. 

People so often treat the world based on their pain and their ego, not on the human being in front of them. So we should not let their behavior dictate ours. Nor should we take personally the condition of their soul. They may have been broken long before you encountered them and they likely will be broken when you walk away. 

In the meantime, you do what is right, because it is right not because of expected praise or gain. The elder monk did not expect kindness from the rich old woman, nor did he let it bother him. 

We should help, we should be kind, we should tell the truth, we should do the right thing not in some expectation of reward, but rather, because it is the right thing. 

It is OUR actions that define us. Because we are kind, because we are truthful, we do not allow others to germinate unkindness, mendacity or cruelty within us. 

It is easy to allow mistreatment to fester in us, to claw at our awareness such that we do not see everything good around us. Resentment is a handicap to living. 

The is a cross post from my other blog TheebbTIDE, where I usually write about non-medical things.

Ed's Note: The version of this story is from Zen Shorts a book by John J. Muth. The original story referred to a religious prohibition of monks touching women. Muth's version is much more helpful and the book is wonderful.