Truth, Lies and Fried Chicken

Chapter 1

The long anticipated and dreaded day had arrived. Every employee in the hospital, from CEO to Housekeeping stepped a little more briskly. The air seemed sharper. On the units, any whiff of bodily excretions was gone as quickly as it arrived: patients were turned, cleaned, dusted and room spray spritzed with toxic, lung-clogging concentration. If some unsuspecting patient had the misfortune to be nauseated and vomit, God forbid, the door closed with a safe-like click as he was quieted and cleaned. Next, the Zofran injection was administered to prevent any further noise that would indicate the hospital contained people who vomited or produced other unpleasant odors.
The phone call from the neighboring hospital had come. The Inspectors were on their way to Trenton James General Hospital―the Inspectors with the power to deny Medicare payments―the Joint Accreditation Commission for Health Organizations, otherwise known as JACHO.
The first phone call came in to the CEO, Mr. Evans. He quickly paged the Nursing VP, who in turn called all the Nurse Managers, the contact people for the nursing units. In Day Surgery, Annie Brown, RN, heard the announcement from Christine, her partner who happened to answer the phone. Chris called out to the hallway in general, not knowing Annie's exact location.
“They’re here!” For all the patients knew, this could be the word that the pizzas had finally come. But Annie knew exactly what Chris meant, and it sure wasn’t pizzas. She felt in her scrub coat pocket and yes, there it was, a small smooth laminated card, slightly larger than a credit card with bits of information crowded in so tightly as to border on illegibility. In preparation for the inspection, the managers had gone to frequent meetings. Every meeting addressed a new scenario. What if they ask “this” or even “that?” Other previously inspected hospitals shared questions that they had been asked, in a team spirit of survival for all. So to the card, another “important” bit of information was added. This was all part of what Annie had termed “inspection madness”. The day before the inspection, she watched as otherwise calm and competent nurses, who handled life, death, nausea and vomiting all with equal ease, became scurrying little mice, breathlessly returning from meetings, the papers they carried rustling along as they scurried, the sense of impending doom as palpable as thunder rumbling. Apparently, Annie had gathered from the last meeting, the very worst thing to say to an inspector’s question was “I don’t know.”
How very odd, Annie mused. She had learned sadly, that at this point inspection madness had fully infected all of the managers and many of the staff nurses as well. She had made the mistake of saying OUT LOUD, “but what if I truly don’t know? How can we possibly know every answer to every possible question?”
Nita Stromeyer, the hospital nursing manager who was conducting this meeting, glared at Annie, her eyes becoming little slits. She sighed, expelling all the air from her lungs with an angry swoosh.
“First of all, Anna, let me remind you. What do you have in your pocket?”
Annie’s mind went inconveniently blank, a pure white sheet of paper covering all previously functioning brain cells. As she tried to surreptitiously slide her hand into her pocket for the answer, Nita intervened.
“Can anyone help Anna out here?’
Here Nita peered out over the room of Day surgery nurses gathered in the empty patient room, most looking at the floor and just trying to survive one more of these panic-filled, hastily called meetings. Finally someone, there was always someone, Annie noted, intervened. Lee, gently waving her card in the air, as proud as if she had a winning lottery ticket, spoke. “You mean our information cards, Nita? Mine is right here.”
“Thank you, Lee, for being so helpful. Yes, that is exactly what I am referring to.”
Yes, thank you Lee.
“Anyway, as I was saying, simply pause and pull out your card and quickly scan down.” As Nita spoke, she acted out her instructions. As she looked down, her eyes became fixed in a squint. She realized she needed her reading glasses to get any legible information. Fumbling in her pocket, a tissue fell out, followed by a pen that rolled across the floor, like dice being thrown at a game table.
“I seem to have left my reading glasses in my office, could I borrow someone’s?”
Lee seemed to be Johnny-on–the spot today as she moved forward holding out her glasses obediently to Nita.
“Why thank you, Lee. As I was saying, you just quickly scan and then you will have the information that you need. For example, see here, if the inspector asks you if you know the hospital mission statement--and we’ve heard that is an actual question, girls--simply read it out. Of course, ideally you will have memorized the mission statement.” (Here, Nita glared meanly at Annie, but thankfully didn’t ask).
When Nita felt she had finally transmitted enough anxiety and infection madness to the staff, the meeting was adjourned and the countdown for the arrival of the JACHO team commenced.
********
The Day Surgery unit had been cleaned, buffed, and re-organized over the past six weeks. All six of the rooms in pre-op were spotless, except for the patients, of course, who at times seemed to be an afterthought in this process. And they tended to thoughtlessly dirty the otherwise sparkling environment. The weight of the inspection hung over each nurse, a dank smog infusing the pollution of fear to the very air. No one wanted to be the one to say the dreaded words “I don’t know” to the inspector, who had acquired God-like power by this time, one of the symptoms of advanced inspection madness. As Annie walked toward the desk, Lee came over from progressive care, the discharge unit, separated from pre-op only by glass windows.
“They are in the hospital in the main operating room now. They will be coming here next--that’s what Nita said.” Lee looked around the area, doing a last-minute check for any offending clutter. Chris took note of the “check-up” and responded.
“What are you looking for, Lee? We are just as ready over here as y’all are. We know they are here. We got a phone call too.”
“Well, just remember to look busy, that’s all.”
Usually that was one suggestion that nurses rarely ever needed. But there was an ebb and flow to day surgery. Sometimes all the rooms in pre-op were full, all the recliners in progressive care were full, and the waiting room had a backup supply of patients. It so happened that at this moment, there was only one pre-op room occupied and surgery could come at any time and whisk him off to the operating room. Which was of course, exactly what happened. The automatic door made its telltale click and Mary, an OR nurse, breezed in.
“I’m going to take Mr. Eves back to the OR now. Has the doctor id’d him yet?”
That was one thing that would delay his departure, and for a moment Annie toyed with the idea of lying, or at least claiming ignorance. But before she could, Chris spoke up.
“Yes, the doctor has seen him and Anesthesia has seen him. His antibiotic is going now, so he’s ready.”
So the only patient was whisked back to OR. Annie thought that surgery probably wanted him back there, so they wouldn’t be the ones with no patient, leaving them free to answer questions or scan their scrabby little cards.
She dawdled around cleaning the room after the patient’s departure, wiping it down with the disinfectant solution, moving in slow motion, swirling the cloth around every nook and cranny of the recliner, which had been dusted and cleaned to the point of dulling the varnish off the chair arms.
Chris came to the room.
“What are you doing in here? You don’t think you are going to leave me at the desk all alone when they get here, do you?”
At that moment, footsteps could be heard coming down the hall of the pre-op unit. Annie and Chris looked up to see a group of six people coming towards the desk. There was Nita, clipboard pressed close to her heart and Jan, the Day Surgery manager behind her. Several of the other managers were in tow and they were all gently surrounding an elderly man. He was slight of build, his jacket hung loosely and his hair was a little disheveled as if he had just received a playful tousle on the head from Nita. They moved as one organism, a giant amoeba advancing on Chris and Annie. She felt her heart beating faster, even as she looked at the dreaded inspector more closely.
He looks like a sweet little old man, a little like Einstein.
She so longed to be able to “look busy” at this moment, but there was not one dust mote, not one bit of clutter, not one patient calling.
“Good afternoon, sir,” Christine said with a military edge to her voice. She stood at attention and Annie felt slouchy, a lazy soldier picking his nose, next to the chief sergeant. The inspector nodded and sat down at the desk.
“Could you please access a patient chart?’
It was at this point Annie’s heart rate shifted to flight mode and in a bizarre response her brain function slowed down, combining to produce anxiety, which bubbled forth like the sudden appearance of molten lava preceding an eruption.
“Well, sir, right now. . .we don’t have. . . any patients.”
The words fell heavily to the floor, a shameful confession. Annie stood clutching the answer card tightly in her scrub jacket. She felt responsible, though the present absence of patients was completely out of her control. As the group huddled around the inspector in icy silence, Annie became increasingly fearful. What if he asked a question that wasn’t on her answer card?
Mrs. Brown, we no longer need your services at Trenton James General. There are plenty of nurses out there who have answer cards, or for that matter, don’t even NEED answer cards. They are filled with knowledge. In fact, the hospital policy and procedure book has been imprinted on their brains.
It was while quietly mulling over this scenario, that the Inspector turned to Annie and spoke.
“I have a question, please, Miss . . . sorry I can’t see your name badge, it’s flipped over.”
“I’m Mrs. Brown. Sorry, it just got twisted.” Straightening her name badge, she thought she heard a sigh from the manager organism.
I’ll just make something up but I won’t say ‘I don’t know’, no matter what.
The inspector leaned towards Annie slightly and in a muffled tone asked,
“Where is the restroom?”
Maybe it was the molten lava of anxiety which over-whelmed her, but Annie couldn’t suppress a little chuckle. That wouldn’t have been too bad, but as the molten lava flowed, a chuckle grew, then a small volcano of laughter appeared out of nowhere. As she chortled away, she happened to meet the inspector’s eyes. He didn’t seem to see any humor in the situation, she observed, as his brows furled and his lips turned down, the beginning of a frown. Annie looked up to the amoeba organism of managers. Some had their mouths open in a silent scream, while others seemed blank with shock.
Annie pulled herself together enough to say to all in general, “I’m sorry. . . it’s just I was so scared there would be a question I couldn’t answer and that wasn’t on the answer card here (she pulled out her card held it high) and to be asked where the BATHROOM is. . . well, I don’t know, it just was funny to me and. . . ”
No one else joined in the merriment and she realized things were actually going rather badly. There seemed to be nowhere to go from here but down. She gently took Einstein’s arm and said softly, “Here, I’ll show you.”
For a moment, it seemed the organism of managers would actually accompany the poor man into the bathroom, but they stopped just before following him in.
Annie bowed her head, partly in prayer and partly to avoid any eye contact, as she swerved around the managers, turning the corner to see Christine, who still stood in her “chief sergeant” pose--silent, but in control.
“Chris, I don’t think they are coming back here.” (spoken in whispers as the managers were still in earshot).
“What were you doing, Annie? That looked really bad.”
“Yeah, I know. I guess I just got too nervous.”
“Well, you messed up big time. You should have seen the looks on the manager’s faces. That was about the worst thing you could have done, laughing at the poor inspector having to use the bathroom.”
“Chris, I . . .” Annie had learned by now, some explanations were better not attempted with Christine. Plus, she was starting to feel a dark brain cloud approaching, a forecast of one of her depressions, which could easily progress from doubting her ability as a nurse, to questioning her ability as a functioning member of the human race. Sometimes, emergency chocolate intervention could help.
“Chris, let’s go to the snack bar. I’ll treat.”
The chief sergeant and soldier headed down the hallway together, no words needed, chocolate being part of the universal language of friendship and healing.

MEMORANDUM

STATUS: ROUTINE
TO: ALL NURSING UNITS
FROM: ADMINISTRATION, AND NURSING VP

CONGRATULATIONS TO ALL DEPTS. WE HAVE JUST RECEIVED NOTIFICATION THAT ONCE AGAIN WE HAVE PASSED THE JACHO INSPECTION WITH FLYING COLORS. THERE WERE VERY FEW AREAS NOTED FOR CORRECTION. THANKS FOR ALL YOUR HARD WORK.
NOTE: ALL RESTROOMS ARE TO BE CLEARLY MARKED WITH SIGNAGE BOTH OVERHEAD, AND ON THE WALL ADJACENT TO THE ENTRY DOOR. MAINTENANCE WILL BE ON ALL THE UNITS DURING THE NEXT MONTH TO DO THIS. PLEASE BE SURE THEY ARE DIRECTED TO ALL RESTROOMS TO BE MARKED. THANK YOU.
********
A busy afternoon in Day Surgery. Annie sat at the desk, picked up a chart and began scrolling down the computer screen looking for a matching name. “When will they ever decide to go completely EMR? Now all we have is duplication; part paper and part computer, making an alien-kind of mixture, a recipe for making mistakes and missing things.” She sighed loudly and could already hear in her mind Chris’s answer to Annie’s complaints.
“Not my decision, or yours. Deal with it.”
Just then Chris’s shouting erupted from down the hallway. Annie surmised or hoped the patient was hard of hearing.
“MR. JAMES, WHEN YOU COME FOR YOUR SURGERY TOMORROW, BE SURE TO GET HERE ON TIME. THAT’S AT 6:00 AM SHARP, OK?
Mr. James shouted back, ”WHY THAT EARLY, NURSE, MY SURGERY DOESN’T START TILL 7:30?”
Annie decided not to stay for the rest of this conversation and left for the waiting room desk.
“Mrs. Lewis, please.”
“Mother, come on that’s you. It’s the nurse”, a middle-aged woman was speaking loudly to an elderly lady next to her. The elderly lady in response jumped up with a surprising energy.
“Well, let’s go, we don’t want to make the nurse wait on us.” And with that, large flowery handbag over her arm, she zipped past her daughter and made fast time to Annie standing by the desk.
“Hi, Mrs. Lewis? I’m Annie Brown, one of the nurses. I’ll be asking you some questions and assessing you, if you’d like to come on back.”
“That’s what I’m here for, Mrs. Brown.” And she led the way, Annie and Mrs. Lewis’s daughter trailing behind.
“Mother, slow down please. Sorry nurse, she moves faster when she’s nervous and I guess she must be a little up tight today.”
“Oh, no problem. It’s great that she has all that energy for someone her age. It says here she’s ninety, is that right?”
“She’ll be ninety-one in two months and she’s already excited about her birthday party. The church ladies are giving a ‘gay nineties’ birthday party for her,” her daughter said with a touch of wistfulness in her voice. I only hope I live as long and am as healthy as she is, in spite of some problems along the way.”
By this time, they had reached the pre-op desk, and Annie led them into pre-op room two, settling Mrs. Lewis into the recliner and her daughter into the straight chair that barely fit beside it. Mrs. Lewis was gently patting her hair in place, as if it had become mussed in her hurried walk down the hallway. She had fire engine red lipstick on, but it seemed to fit her bright demeanor. Annie noticed that she had hosiery on too, dressed for Sunday morning church. Her daughter looked more frowsy and unkempt, jeans that had a ragged edge to them and no lipstick at all in contrast to her mother.
“I’ll begin with a few questions about your health, Mrs. Lewis. Do you have any heart problems?”
“No, my heart is just fine. Oh, it skips a beat every so often, but I wouldn’t call that a problem, would you?”
“No, Mrs. Lewis, at 90 you . . .”
At this point the patient’s daughter interrupted.
“Mother, you had heart bypass surgery, remember?”
“Of course, I remember, May. I still have my marbles, you know. But the doctor told me that fixed my heart. Don’t you remember that?”
“Well, of course, he fixed it, but you don’t have bypass surgery unless you have heart problems. Right, nurse?”
Annie did not want into the middle of this discussion. There were more questions to answer and she didn’t want to make enemies with either side.
“I’ll just make a note of the bypass surgery.”
Little harrumphs from both parties indicated to Annie that neither side liked her answer.
“OK, now. How is your blood pressure? Any high blood pressure problems?”
Mrs. Lewis gave a look of triumph towards her daughter.
“My blood pressure is completely normal. You can check it for yourself,” she said holding her arm extended in invitation.
“I’ll do that in just a moment, ma’m.”
Once again, the daughter cleared her throat and spoke.
“Mom, you have high blood pressure. That’s why you are on medicine. Nurse, she takes Altace for high blood pressure.”