If you have a major surgical illness, you will no doubt require hospitalization. When you go to the hospital, you will be better oriented and less perplexed if you acquire some insight beforehand and know what to expect.
You are not going to the hospital for a vacation. There is a definite purpose for your being hospitalized, and in recent years the tendency has been to make the hospital stay as short as possible. Never fear that you will be sent home before you are ready to take care of yourself and assume your daily duties, but the days of long convalescence in the hospital are gone. It has been found that long periods of rest in bed after an operation are more harmful than good in many cases, and unnecessary time off work is often the most expensive item for the patient. Also in recent years the demand for hospital beds has been far exceeding the supply, and as rapid a turnover as possible is necessary so that all may be served. Plan on making the most of your hospital stay, but do not labor under the misconception that you are going on a hotel vacation to lie back and be served.
The best preparation you can make for your hospital stay is to free your mind from worry about problems both at home and at work. Try to arrange your affairs so that you will not have to worry about them during your absence. You cannot expect things to run as smoothly while you are away—you must expect some minor problems—so try not to be upset on hearing of them. Your job or business will be waiting for you when you return, and in just a short while you can have things functioning normally again. Your children may have to stay with neighbors, but in most cases they are thrilled with the brief change and fare just as well as they would have at home. Oddly enough, while worrying about the problems you left behind never seems to solve them, somehow difficulties always seem to work themselves out. If you are worried, make certain that the problem is worth worrying about and not just a trivial thing. When a real problem arises and you cannot get it off your mind, tell it to your doctor. He would rather try to help you solve it than have you try to fight it by yourself. Or, if you would rather, ask your minister or priest or rabbi to call on you. If he cannot find a material answer readily, he can help you to utilize the Resource which never fails.
There may be several people you will want to notify that you are going to the hospital. If you have not had time or if you have forgotten anyone, mention it to the nurse, and she will make any necessary telephone call for you. In all cases, it is wise to notify your church, as the church delights in sending both callers and remembrances. Do not neglect to tell your employer where you are.
YOUR HOSPITAL ROOM
Hospitals provide private rooms, double (semi-private) rooms, and wards. In the private room you will be the only patient but may have to share a bathroom; in the double room there will be one or more other patients, and in the ward there may be several others. Of course, the rate for each is different. The admitting clerk will attempt to honor your request for the type of room you desire, but you may have to settle for something else if that type room is not available. You will not be
able to pick the specific room or bed you want, as patients are grouped into certain sections of the hospital according to their illnesses, in order to facilitate nursing care. In some cases the physician will specify the type room he wants his patient to have.
In almost every hospital the admitting procedure is different, but the admitting clerk will direct you. In all cases it is your doctor who arranges for you to enter the hospital. He will tell you when to go to the hospital, and when you arrive you should report directly to the admitting clerk. If you are able, you will be asked to provide certain information about yourself and then you will be directed to the nurse in charge of the section where you are to become a hospital patient. If you are not able to do this, or if you come to the hospital by ambulance, an aide will take you directly to your room, and the required information may be obtained at your bedside or from a relative.
If you have any jewelry or other valuables with you, ask the admitting clerk to put them in the hospital safe for you. She will give you a receipt.
After you have been given instructions about your room and about preparing yourself for bed, the nurse in charge will call your doctor to notify him that you have been admitted and to receive tentative orders from him. In some cases sealed orders from the doctor are brought by the patient or are left by the doctor before the patient arrives. These orders become a part of your chart.
Your hospital chart concerns one patient only —you. It is made up of several sections. The first page is a face sheet, which is supplied by the admitting clerk and gives general information about you. Your full name, address, nearest relative, religion, doctor in charge, and any other data about you which may be needed throughout the course of your illness—all are recorded on the face sheet. A doctor’s order sheet provides space for your doctor to write all orders concerning you. A graphic sheet gives all readings of your temperature, pulse, and respirations at regular intervals, in the form of a graph. This is a most important page in your chart and is referred to frequently by the attending physician. Nurses’ notes are kept on specially designed pages to give a detailed running account of everything that pertains to your case. All your medications and the time they are given are recorded; your activity and your complaints are described; your diet and how well it is taken are noted, and notes on your elimination are recorded when necessary. A complete medical history and physical examination are recorded by your doctor or a hospital doctor on pages provided for this purpose in your chart. There are also sheets for doctor’s progress notes wherein the doctor describes regularly your hospital progress. Report slips from the laboratory of tests done on you are pasted into your chart in a section provided for such information. Tissue reports from the pathologist and x-ray reports from the radiologist are separate sheets inserted into the chart. If you undergo an operation, a detailed operative report is placed in your chart. This is usually dictated by your surgeon immediately after the operation. There is also an anesthetic record sheet.
There may be other pages to your chart, such as consultant’s reports, special diet sheets, intake and output records, and any other data concerning your case.
You can see that your chart presents the complete story of your illness; nothing is omitted. However, never fear that your confidence is jeopardized. No one has access to your chart while you are in the hospital except your doctor, the nurses, and the hospital doctors. There is one exception: in some hospitals medical stenographers are utilized to take dictation from the doctors. Naturally they must have access to the charts, but they are sworn not to divulge information. In no instance is a chart to be seen by patients, nurses’ aides, orderlies, technicians, or other hospital employees.
After you leave the hospital your chart becomes the property of the hospital registrar for safe keeping. The registrar, who is a record librarian, files your chart and prepares a cross index according to names, diagnoses, operations, complications, and other pertinent data. This cross index is for study of professional service by the records committee, which committee is composed entirely of physicians, and they serve to maintain high professional care. They review groups of charts from time to time to analyze the standards of professional practice in the hospital.
The only other person who may review your chart is your doctor or a doctor who treats you subsequently. If a physician treating you at a later date at another hospital wants information about your present illness, he may write to the record office and the record librarian will prepare a case summary from your chart for him, but this again is in strict confidence.
Thus, your chart is not only the treatment log of your illness while you are in the hospital, it also becomes a permanent record for future reference. Your chart will be valuable to your doctor in your future illnesses, in many cases, for it is kept on file indefinitely.
YOUR DOCTOR’S ORDERS
While you are in the hospital your doctor is in complete charge. He is responsible for your care, and every medication and every test is ordered by him. In most instances the physician in charge has authorized the hospital doctors to write orders on his patients, but this is the only exception to your doctor ordering everything in your case, and all major decisions for treatment rest with your own doctor. For exactness, each order is written in your chart, and the nursing staff executes the orders.
In most hospitals there are standard tests which are routinely performed on all patients. These include a urine analysis and blood cell count, and in some hospitals a chest x-ray picture and other blood tests are taken. But all other tests are ordered by the attending physician.
The doctor must include everything in his set of orders. The initial orders will be many, but they will be modified by subsequent orders from time to time when the physician sees fit to change medications and procedures as the patient’s condition changes. The doctor must designate the professional service on which the patient is to be placed; he will indicate the privileges of the patient, such as bed confinement, bathroom privileges, limitation of visitors, and so on; if there is a special position the patient is to assume in bed, the doctor will specify it; nursing instructions for care other than routine must be noted; any physical care required such as ice packs, light cradles, or special baths are designated; the diet the patient is to have will be specified, and if a special diet is necessary the physician will write the prescription for it in the doctor’s orders; if fluid intake is to be controlled, this will be shown in the orders; any special attention to be given the patient’s elimination will be noted. All laboratory procedures and special tests the doctor desires arc ordered. All the medication the patient is to have is written down by the doctor with specification as to dosage, method of administration, frequency and time to be given, and the duration such medication will continue. This includes specific therapeutic medication as well as supportive medication for pain, sleep, and so on. No medication can be given without the doctor’s orders.