by Paul Dowling
Above All, Do as Much Nothing as Possible
“The delivery of good medical care is to do as much nothing as possible,” writes Samuel Shem, in The House of God. This has never been more true than it is now, when, left to the devices of clinically-untrained nurses from the Time of COVID, a hospital patient must tolerate the untutored ways of virtually-trained caregivers who know not what they do.
Emergency!
A woman known to this author (to be called Ima Nurse, due to her being an R.N.) recently visited a post-COVID emergency room while experiencing stabbing abdominal pains. A CT scan was performed, which identified a small bowel obstruction as the cause. The attending physician recommended a do-nothing approach as the first treatment option, hoping the blockage might ultimately resolve without surgery.
Almost Unscathed
Ima would eventually leave the hospital without surgery – almost unscathed. What caused the scathing that did occur was – in a word – ineptitude. During COVID, the men and women pursuing nursing were educated online, leaving them bereft of the clinical training they need to succeed in caring for real people in authentic hospital settings. Being a well-informed woman, and a retired nursing instructor, Ima knew the importance of bringing an advocate along with her to the hospital, a role this author was happy to fill.
One of the first experiences Ima confronted was having a ham-fisted E.R. nurse pass a nasogastric (NG) tube up her nose, down her throat, and into her stomach. And it was this author – not the nurse – who reminded Ima to “swallow, swallow, swallow” during the procedure. The nurse came off as quite the greenhorn. Her coup de grâce was the grotesque way she taped the NG tube to Ima’s cheek, causing her now-disfigured nose to tug against her left eyelid, thereby transforming the left side of Ima’s face into a sculpture of anguish – all of which occasioned Ima to quip, “I look like Quasimodo.”
The Wild West of Nursing
Finally, Ima was admitted to the hospital and, thereby, to the Wild West of nursing that held sway within its precincts. This low-information wasteland featured politically-correct nurses’ use of chin-hanging masks (the better to virtue-signal with), unscientific nurses’ belief that their use of gloves protected the patient (a notion Ima disabused her nurses of, reminding them that “gloves become dirty, just like hands”), and rookie nurses’ inability to figure out how to obtain common comforts, such as ice chips, drinking straws, and acetaminophen tablets. While the seasoned nurses generally possessed good clinical assessment skills from years of experience, the masked newcomers covered up their ignorance – discouraging patient requests for their services by projecting a façade of boorishness.
One clueless R.N. did not know the difference between Tylenol tablets given orally and Tylenol suppositories administered rectally. Another nurse tried to correct the overdone and clumsy way Ima’s NG tube was affixed to her cheeks; she employed the use of oversized, dull shears, until Ima taught her to use a small pair of needle-nose scissors to butterfly the tape prior to reattaching the tube properly to the bridge of Ima’s nose. Late one evening, Ima complained of noise, due to the carnival atmosphere into which the nursing station had devolved, only to discover that the charge nurse had abandoned her post! Indeed, the nursing unit’s commander-in-chief had bailed on the hospital to go out to eat. Of the ensuing chaos, Ima remarked, “It was like a pilot leaving the airplane in midflight.”
The Importance of Clinical Training
Had Ima been in the hospital for the purpose of bestowing an award for the best nursing care, its winner would have been an L.V.N.-turned-R.N. She had learned, during her training as a licensed vocational nurse, the basic clinical skills so conspicuously absent among the new registered nurses. Under COVID rules, newcomers had never been required to learn practical skills on patients in the hospital under the guidance of nursing-school clinical instructors.
Eventually, rather than risk having her NG tube removed by unskilled hands, Ima did it herself, early on the morning of her planned break out. It was only the L.V.N.-trained nurse who noticed that Ima had removed her NG tube. Nor did she bat an eyelash at Ima’s taking regular strolls around the ward – which Ima quotes as the Mobility Rule of Nursing: All nurses shall encourage patient mobility to prevent pneumonia and other infections of the lung. Most of the COVID-era trainees expressed alarm at seeing a patient out of bed, walking through the ward!
Leaving A.M.A.
After Ima’s initial CT scan, she was later given a contrast X-ray which indicated, upon visual inspection, that the blockage no longer existed. As confirmation of this, Ima ceased having any gastric pain, and her stomach – no longer distended – commenced to growl (meaning that gases and liquids were moving through the digestive tract unimpeded). Eventually, she would experience what should have amounted to her ticket out the door – the good news of a genuine bowel movement! Yet there seemed to be no eagerness on the part of medical staff to discharge Ima. Instead, continued X-raying was prescribed. In the end, four images were taken, all of which showed the same result: no more blockage.
Having formerly been a nursing instructor who versed her students in the perils of hospital overstays (due to hospitals’ harboring many dangerous healthcare-associated infections), Ima knew that it was time to call the ball, even if that meant leaving A.M.A. (Against Medical Advice). So, she staged a break out, removing herself from hospital-harm’s way and back to the realm of science, sanity, and sensibility.
Do Good or Do No Harm
Hippocrates wrote, in Of the Epidemics, “The physician must . . . have two special objects in view with regard to disease, namely, to do good or to do no harm.” After all, the raison d’être of medical care is to relieve trauma, not to cause more of it. The selfsame ethic should guide all medical practitioners, including nurses. To correct the current state of affairs with an eye to passing down nursing traditions from one generation to the next – l’dor v’dor – all nurses trained during the Time of COVID must be required to receive, at the cost of the nursing schools they attended, the clinical training to which they are entitled. The future of safe nursing demands it.
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Paul Dowling
Paul Dowling has authored a book about the Constitution and written articles for American Thinker, Independent Sentinel, Godfather Politics, Eagle Rising, and Free Thought Matters.
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