My friend Joy was an indomitable trauma nurse. She never minded taking on the most challenging patients. She and I worked together in the ER for six years, and no amount of blood or guts could scare her off. When EMTs brought in a gory-looking accident victim, Joy was always the first one in the room, cutting off the patient’s clothes, taking vital signs, starting IV fluids, connecting monitors, noting injuries… The only thing Joy hated was paperwork.
One night, discussing work over dinner and a few drinks with Joy, I asked, “The way you move your critical patients along so quickly is fantastic. What’s your secret?” Joy smiled, lowered her eyes and shrugged. “When things get crazy, I just don’t chart,” she said. I was speechless. Wasn’t that against policy? My charting rate was 100%, even if I had to stay over without pay.
Joy may have worked at whirlwind speed, but she had a softer side. Her previous experience in nursing homes had taught her the importance of being gentle. Shunning paperwork bought Joy time to show solicitude. In fact, I wish she had been my pleasantly confused mother’s ER nurse after she fell and hit her head.
My 94-year-old mom frightened easily, like many Alzheimer’s patients with visuoperceptual difficulties. Joy would have sat down beside her for a few minutes, taken her hand, and comforted her. Instead, the doctors and other staff hammered her with questions and didn’t assign a sitter to keep her calm. My mother, who had no behavior problems, misperceived their actions. Feeling threatened, she hissed at and tried to bite the nurses. So they medicated her with an antipsychotic and tied her down. While this solved their immediate problem, my mother suffered as she fought against the Posey vest and wrist straps.
After my mom was discharged from her 32-hour hospital stay, I obtained her medical record. It ran to 91 pages, or 2.8 pages per hour. As I read page after page of repetitve information, I wondered how much time it had taken to create this much detail and whether the staff had focused too much on documentation and not enough on quality time with my mother.
Sadly, my coworker Joy died a while ago. She probably figured out how to get into heaven without filling out the proper paperwork. Or maybe one of her patients told St. Peter to move her to the head of the line.