Jessica
This interview took place in Jessica’s hospital room after multiple admissions for chemo, consolidation chemo and a blood infection.
Jessica is the kind of person who draws you in. She is warm and cheery, and has an easy smile, all the while belying the extremely tough road she has been walking for almost a year. Jessica is a 33 year old mom of two children, aged four and six. Jessica’s journey with cancer dates back to February 2009 when she ended up in the emergency department of her local hospital. Jessica had been struggling with chronic fatigue for the month prior to her admission. She thought she had the flu; her family physician told her it was ‘mono’ and she had to rest until it passed. The ‘mono’ did not pass, and she and her husband were becoming worried. Jessica got to the point where she was so weak and tired she could hardly stand, and so they decided to go to the hospital. After 14 hours in the emergency department, Jessica was finally diagnosed with Leukemia. Jessica talked about how difficult it was to be in the emergency department for all the preliminary tests; including a bone marrow test. She described being in a curtained cubicle with no sense of privacy. She was acutely aware of the other patients in the neighbouring cubicles who could hear what was being discussed at her bedside. During the bone marrow procedure she said she yelled out in pain, and someone in the next cubicle asked if she was OK. Jessica went on to say that sadly, minutes after her neighbour enquired after her wellbeing, he died. Jessica was shocked and very aware that the energy had changed in the department, as staff rushed to remove her caring neighbour’s body.
Once the remaining tests had been completed, Jessica was admitted to the cancer floor as an inpatient to begin chemotherapy. Jessica stated that everyone had been very kind to her on this floor. The nurses were personable and she felt they knew their job. Jessica also said she stayed on top of her treatment plan and progress, giving her a sense of control when in realty she felt her life had been taken away. Jessica’s husband was very supportive, as were her family and friends. The constant flow of medical people was at times frustrating for Jessica. She said she often wished for several hours of uninterrupted sleep, but that seemed impossible as there was always someone asking her questions, changing her IV, or taking blood. Jessica said her greatest struggle however, was being away from her children.
Over the next months Jessica continued treatment as an outpatient, and was back to being a full time mom. Unfortunately in October 2009 Jessica had a blood infection, and she had to return to the emergency department for six days. She said the first two days she slept, and felt her care was good. However the remaining four days, she said she felt forgotten. Her medication either did not arrive, or arrived late. She would not see anyone for hours. She had no immunity at the time which made her susceptible to infection but remained in the emergency department. Jessica also had to lie on an emergency cot for three r four days, before she got a hospital bed. In short, she said the experience was “terrible.” Finally after the sixth day, a private room was found on the cancer floor, and she was transferred. Jessica felt her care, from the time she arrived on the cancer floor, was wonderful. The nurses knew her from her previous admissions, and sympathized with her experience in the emergency department.
Jessica, after telling the story about her six days in the emergency department, said she did not want to complain, because she felt her overall care was good, specifically when transferred to the cancer floor. However, she said wanted to provide feedback to the hospital regarding her experience, so that perhaps other cancer patients in her situation would be treated appropriately. She felt that being at such high risk of infection, a transfer out of the emergency department should have been a priority.
Communicating Effectively for Patient Safety since Jessica had no immunity to infection, should she have been taken out of the emergency department immediately? Were the right people contacted with a view to getting her to a safer place?
Working in Teams - How could team work be improved in an effort to support Jessica and her family?
Recognize and Respond to and Disclose Adverse Advents – Jessica’s medication was either missed or came late. Who should have been paying close attention to her requirements?