Communication for Patient Safety
Frank

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Frank

Frank was looking more tired and withdrawn as he lay flat in his hospital bed staring at the four white walls surrounding him.  His nurse had gone in to give him some medicine when she realized he was not himself. Inquiring to see that he was alright, Frank told her while fighting back the tears that his first round of treatment was unsuccessful. Only minutes ago the Oncologist sat at his bedside informing him of the latest results, and asking how he would like to proceed with his care.  Frank had commented before on how he appreciates a “direct approach”, and would rather be “told straight” what is happening.  He just wasn’t ready for that.

Frank had been so optimistic throughout his past eight weeks in hospital and believed that he would fight this.  A minor set back was all it was and to Frank there was only one decision on “how to proceed with his care”. It was simple in his mind, “you just keep treating until the cancer is gone”. As he said at one point regarding treatment,  “it has to work, cause I’m not ready to die”.

Frank had recently retired and his wife of 43 years left her job early to support her husband once the diagnosis was made in May that he had a rare blood cancer.  Frank had been a pretty healthy man throughout his life and never needed to be in a hospital or be treated for any significant illness, so this experience was something “strange and unusual” to him and his family. Frank speaks of the initial phase of the “journey” to be a bit of a blur.  He recalls receiving a telephone message from the medical centre asking him to come in for an urgent appointment.  He knew he had blood taken during a routine physical examination a couple of months before, but thought little of it.  Despite the “urgency” of the appointment, Frank left the office with little information and a great deal of worry.  Although he credits his family physician for recognizing there was something wrong, it “felt like a lifetime waiting for the test results to come back”.  Frank didn’t know what to expect, or who would follow up with him once the results were in.  He reports that time being very difficult for him and his family because they were not sure how to proceed with their lives. He knew that it was out of his family physicians scope of practice and he had to put his trust in another person/ system that he had yet to meet.

Although fear was at the core, Frank put on a positive front and tried to “go with the flow” so to speak. He recollects meeting the Oncologist for the first time and appreciating his direct approach.  Frank was given the diagnosis and told what treatment would be best for this particular cancer. Frank wanted to know all of his options and the physician took the time to explain the different types of treatments. He also mentioned that some patients have sought a second opinion and he was not adverse to that if he so chose.   There was a reason why Frank was told to schedule a day for the appointment because he was seen by so many people at that first session.  He recalls being introduced to many nurses, medical students, a dietician and a social worker all of whom he says were “very kind, but it was a bit overwhelming”.  He was given a big binder with information and told to review it and bring it to his appointments so that he can add business cards and any new information.

Overall, Frank speaks of a “good experience” with the hospitals and the staff involved in his care, “not to say the process was seamless, but I felt that there was a genuine concern for me and my situation.  Coming from a rural community two hours from Kingston made it more of a challenge for Frank and his family, especially the first few appointments at the Cancer Centre. Fortunately, he had help from his many family members and community for drives. He wondered how other patients managed when they do not have the supports in place.

Frank mentioned that he found there were some communication gaps from the time he was sent from his medical centre to the inpatient unit where he would stay for 40+ days receiving cancer treatment. When he arrived at the Emergency Department, he was moved around so many times within that unit he said that the physician had little knowledge of his situation and reason for admission. The Oncologist that had arranged for the admission was supposedly off.  As a result, Frank was telling the many different staff members that came walking through his “curtain” his story and explaining every symptom, test and treatment he had up to that point “over and over again”.  One minor mistake that led to other problems throughout his stay was the fact that the transfer record had his Father’s name on it.  Frank’s father was named Francis and so, until the staff was continually corrected, Frank was greeted with a “Hello Francis”.  It took a trip to the dialysis unit that was not part of Frank’s treatment to get the unit to respond and have the name corrected.

With most hospital stays, it is uncommon to be kept in the room you were initially given.  For Frank, he adapted to the few moves, but usually “at a cost”. It was one move in particular that had him “traumatized”.  Frank reflects on the night where he had been woken up from a deep sleep and abruptly told that he had to move to another room without any explanation (despite his inquiry). He was “dumped” into the overcapacity room where there was not a single window, a musty smell, and an old flickering light tucked away in the corner.  Frank felt deserted and despite his pleas and family advocating for a change in room, he stayed there for five days.  To him it felt like an “eternity” and the “absolute worst place”. He said he may as well have been “put in the morgue”. 

Eight weeks have passed since Frank has slept in his own bed, walked the dog as he did every morning and sit with a hot cup of coffee sharing sections of the newspaper with his wife Anne.  He missed these simple pleasures immensely and no longer took them for granted.  Frank was able to express these thoughts among other deep emotions he had with the social worker and spiritual care.  He said that he worried so much for his wife and family and didn’t want them to be burdened with what he felt was a “fragile state”.  Frank mentioned being so thankful for the many kind, caring and compassionate professionals, and in particular felt a connection to the lady who came in daily to clean the floors and take out the garbage. He said she exuded happiness and brought joy to his day with her contagious laugh and sense of humour. 

Given the latest results of his Cancer treatment, Frank is certain he wants to continue, but he needs to determine how far he will proceed. His initial Oncologist said he would welcome him seeking an outside opinion from another Cancer expert from Toronto, but the one he had seen today was less inclined to refer him and advised Frank that they have reviewed fully and believe the treatment offered to him is all that can be done.  With mixed messages, Frank pondered. The nurse who recognized he could use a listening ear asked the social worker to see him.  It was decided that a family meeting would be most beneficial to everyone involved, and most importantly, Frank.  After having some time to reflect and express his thoughts. In Frank fashion, he used humour to lighten the mood, and questioned the social worker, “Don’t they say Retirement is supposed to be the best years of your life?...  I guess I’m proving them wrong eh”? 

 

 


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