Who profits?

I spent eight hours in boring lectures of orientation today. But about five minutes of my day made it all worth it.
Four months ago during my practicum I had cared for a 20-something Mexican man who was here illegally working for a construction company. He was involved in a car accident in which he was in the luggage carrier of a pick up truck. He was ejected from the vehicle and suffered a multitude of injuries. I don't remember them all. The most significant was a spinal fracture which left him a parapalegic. He did not any speak English.

A local church flew his wife in from Mexico to be at his side. I used translators and my VERY limited Spanish to communicate with them. For several weeks I watched him improve from being on complete life support to an awake, alert and oriented patient. My hospital does not deny care and is a not-for-profit organization.

The staff in my unit was divided in their feelings of sympahty. Some thought we never should have helped him since he was illegal. Others made remarks about how sorry they were for him. Some were apathetic only thinking of their paychecks. One even said that, "If he'd been in that wreck in Mexico he'd be dead. Why should we pay to help him?"

All I could think was what would happen to him? He had little, if any money. No insurance. No friends. And he could not even talk to his nurses and doctors. This would pose problems for any patient. But a paraplegic?! He will never walk again! He needs rehab and a wheelchair and someone to help him bath and toilet and move...for the rest of his life.

I finished my practicum never hearing what would become of him except that the local Spinal Rehab facility was denying him care because of his illegal alien status.

BUT TODAY I learned that my hospital fought the system :) I asked a discharge nurse if she knew about my patient and she beamed in response stating, "I'll tell you that one. It's one of the good stories."

The spinal center "did us a favor" and took him to rehab. My hospital bought him a basic wheelchair (because anything nicer would be stolen in Mexico) and flew him and a clinical technician who speaks Spanish to Mexico after his recovery. The tech assessed his home and helped him settle in to his new lifestyle. She ate dinner with his family and then came back to Georgia. I cried (yep, in front of the whole orientation class) when I heard this.

I've said for awhile that I never want to work at a hospital that can deny a person care. And yes, it's sometime a pain, because the chest colds that clog our EMERGENCY rooms slow us down, and the drug seekers getting high off my tax money are easily enabled. But then something good happens. Someone is helped. And the profit to the patient and staff far outweighs the monetary loss.

therapeutic: adj. ~of or relating to the healing of disease. ~having a good effect on the body or mind, contributing to a sense of well-being.

Well, if you are a nurse, nursing student, or nursing instructor you can just skip over this posting. You, like me, probably remember your Psychiatric Mental Health Nursing instructor standing before you stating that she is going to teach you to communicate like a nurse. "Communicate?" you're thinking, "didn't I learn that when I was two?". Not only do I have to memorize hundreds of new medical terms, relearn how to wash my hands, wear a stupid white uniform, and pretend like I know how to give a shot, I ALSO have to learn how to communicate??? AGAIN?!?!

Before anyone panics, this whole therapeutic communication thing will turn into, like most other things I've learned in my life, not as big of a deal as it seems. Sure, they say you are never allowed to ask "Why?" (it's not your business anyway). You can never lead an answer, "You don't smoke, do you?" And you must never ever ask a yes or no question, "Are you in pain?" Because none of those things would provide you with sufficient information and of course they would be devestatingly untherapeutic, and hey! We're nurses right? That means we are nice people and even if that isn't true we must make people think we are nice people by speaking sweetly and of course, therapeutically.

Now, do you really ever consider those things when you've got a 5 year old screaming that he wants his mom or an 89 year old nursing home patient telling you that she needs to pee, when in reality she has had a foley catheter for three days? Of course not. You are more concerned about the old lady's urine output and the kid's broken arm than you are about what comes out of your mouth. Maybe that's good. Maybe it's not. But hey, it's truthful. And I think that's what therapeutic communication is all about anyway.