Showing posts with label hospital. Show all posts
Showing posts with label hospital. Show all posts

Monday, July 25, 2016

The Zuckerberg: Space Does Matter

Hello everybody!  I am one new to the group and just wanted to introduce myself.  I'm originally from Massachusetts, currently a Bay Area Internal Medicine Hospitalist with a 2 year old daughter, siberian husky (mini) and techie hubbie.  Hope to contribute some entertaining stories.  The following is something I wrote last month after we moved into our new hospital. 

            The ‘space’ can make a difference.   I had already spent two years working as a physician/hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges.  Fast forward to the end of May 2016 to one my first shift working in the new building … Zuckerberg San Francisco General (ZSFG/The Zuck); change had never felt so good.
            I walked across the bridge connecting our old building to the new ZSFG which consisted of expansive windows and white beams that outlined the hall. It was a sunny day in San Francisco, and I was able to witness it for once.  At the entrance there was a quote etched into the wall  “Be the person who touches the lives and hearts of people. Be a positive light to others as you put a smile on their faces”.  I found myself taking a brief pause and a smile was taking form and there was no stopping it. 
            Onwards I trudged, only to be greeted by a security officer who looked at my badge, and then said ‘Good Morning Doctor’.  As I stepped off the large steel elevator onto the 6th floor, different routes presented themselves; I was warned about this and the likely confusion that would ensue. Nonetheless, the room numbers were highlighted with San Franscisco themed unit names like “Mission Dolores” and I walked to the zone I needed to get to.  The heavy blue doors which were often manually opened were now beige and badge activated, opened by a mere hand wave.   This might sound trivial given that its 2016, but let me emphasize that it is not.  The design of the building was doing work for me instead of me pushing my way through everything.  
            Now came the real test…how were the actual work floors and units.  What struck me immediately was the lack of noise; it was completely quiet! A brief instance of panic set in and I thought, ‘ Oh my god, I’m on the wrong floor…. Is this the morgue’ but no, I was exactly where I needed to be.  As I walked further around, there was a spacious work station with an lcd screen showing patient room information and nursing assignments with call numbers. 
            The time had come to finally enter my patients’ rooms.  I knocked and then with ease opened the door only to find my patient sitting in bed comfortably with the most spectacular backdrop of the city I had ever seen. The room had ceiling to floor windows that beautifully displayed San Francisco at its finest, and the sunlight poured in.  I sat down at his bedside, and began to go through my assessment and learn about his concerns.  Usually at this point I would be raising my voice to overcome my patient’s neighbor who was either watching television, or talking to others in the old building.  The rooms had no natural light, so lights always had to be turned on, which was of course bothersome for many as some patients were sleeping, and others were not.  The rooms were also filled with walkers, trays, and other medical equipment that were strewn about as there was minimal space, and it became an obstacle course for staff, patients, and family whenever anyone moved about in the room.    Now with this all gone, feng shui was in full effect.  I reviewed the plan with the patient, and calmly exited the room.  As I entered the next patient’s room, similar exchanges and observations happened.  With my mind unburdened by the environment, I just focused on the subject at hand.  My patients too were not being set off by surrounding stimuli; they now had peace and quiet.
            I finally ended that morning with some downtime in one of the new provider rooms to start the lovely exercise of completing my documentation, and again I was struck by the silence.  It was like a library where I actually had the space and time to think about what I was doing.
            Noise and chaos was often the defining feature of our intense environment, and as faculty and staff, we perfected our ability to deliver high quality care to our troubled and sick patients despite our surroundings.  Now with ZSFG, San Franciscans along with our many generous donors have contributed to a building that has shifted the mileu of our work environment.   My patients now have a space that truly honors them in tough times and gives them the space within which to heal.  As a provider, I now have the space to work more seamlessly and to think and reflect on my work.  Of course our space is not perfect, but you have to start somewhere right? So let the healing begin…

Friday, May 27, 2016

think zebras, not horses

Hi MiM aficionados,

I'm ZebraARNP, and I'm so pleased to be the first non-physician contributor here! I'm a nurse practitioner in a big hospital in a big city. I've been an ARNP for about 8 years now, and I've spent all of those years in oncology. I can't imagine doing anything else, to be honest. I live in the 'burbs with my wife, to be known here as The Wife, and our three kids, to be known here as Jaybird, Hedgehog, and Egret. More about the family in my next post.

The other day on rounds, as my team was heading out to see our first patient, we encountered a large group of petite Filipina women, dressed in the green environmental services uniform provided by the hospital. Our team greeted the group then as we passed them my (tall, white) attending said to me "They're so cute, they're all so short!" At the same time in my mind I was thinking "Dammit, they're all people of color..." and I felt a wave of...disappointment? Sadness? Irritation? Hard to find a word to describe the exact feeling. I'm not even sure that the two (white) MDs with me even noticed that the ENTIRE group of custodial staff we encountered was Filipina. All that my attending appeared to notice was that they were "cute." Sigh.

The flip side of the above experience is when I see another African-American/multiracial ARNP/PA/MD in the hospital. In those moments, time slows down, music starts to play...(Chariots of Fire, in case you're wondering. It's ok to click on it..) I want to run up to them to see if they're actually real!! Should we hi-five? Cheer? OK, no. Maybe next time...

For such a big city (although <10% African-American), and such a big hospital (>300 beds), there is a dearth of African-American professional staff. Over the years I have been mistaken for kitchen staff, janitorial staff, nursing staff, but more than that people have often looked genuinely surprised when I explain my role on their healthcare team and what I actually do on our team (admissions, write orders, take first calls from the RNs re patient issues, etc). And my point is not that any of the above mentioned jobs lack importance at all; my point is that no one assumes that I have the job that I have and mostly that they express surprise at my actual position. Food for thought. That surprise? It doesn't feel very good on my end.

Always check your assumptions....because we all have 'em. Women as surgeons. Men as nurses. Someday I hope that female surgeons, African-American physicians, male nurses, etc--I hope none of that even raises an eyebrow.



More about me, since I'm a newbie-->
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ZebraARNP is an oncology ICU ARNP with three children- school aged twins (girl, boy) and a preschooler (girl). That brief sentence vastly oversimplifies the amount of joy/pain/money /insanity/Band-Aids/love/maniacal laughter it requires to raise three human beings; it’s a doozy sometimes. Anyway, this is ZebraARNP's first public/non-academic/not Facebook writing experience, or writing that isn’t a daily progress note of a critically ill oncology patient. ZebraARNP is married to a pediatric SLP who isn’t in fact really that interested in oncology but who has acquiesced to the fact that she will indeed continue to learn about it (or at least listen to random factoids) year after year simply out of love for Zebra. Dinner time conversation in our demographically complicated yet still shockingly quotidian suburban home (interracial lesbian marriage, anyone? Can someone say “intersectionality” ten times fast?!) may or may not include how much CPR was done that day, palliative care conferences, cdiff vs VRE, who did well on his/her math test (or who did not), who will go grocery shopping next, what MRSA is, what exactly IS pus made of, what actually happens when you die, arguing over who gets the last muffin/cookie/etc, reviewing hematopoiesis, and questioning whether kid # 1, 2, or 3 really did wash their hands after using the bathroom. When ZebraARNP isn’t at work or with kids, she enjoys gardening, chicken keeping, reading books (or the NY Times), and wasting time on her iPhone (oh the Amazon app…)…and not being at work or with the kids.