HOSPITAL CARE: A CAUTION

TORMENT

Torment is the best word I can find to describe an overnight 12-hour experience that I endured while a patient at the University of Virginia Hospital, in Charlottesville, in May of 2012. Only after nearly three years am I able to share this story calmly and without disruptive emotion.

The written records of the time tell the story. The first, THE COMPLAINT, is a letter of complaint addressed to the hospital officials. The second, THE RESPONSE, is a set of notes by my son, who received the hospital’s response by phone because they said they were unable to put it into writing. To my knowledge, no further action was taken other than an alleged reprimand to the responsible staff member.

We know that hospitals lose many lives through mistakes in treatment or failure to prevent the spread of infections. I have no idea how much these involve abuse as described here. As reported by the Charlottesville Daily Progress (December 23, 2014), the U.Va.Medical Center faces penalties for relatively high rates of hospital-acquired conditions such as infections, ulcers, clots, and injuries from a fall. In my own experience, my health declined steadily for three months after surgery, while the doctors told me to drink more water, until another hospital diagnosed and treated my problems as pneumonia, hypothyroidism, sepsis, dehydration, excess coumadin (an anticoagulant or “blood thinner”), and conjunctivitis.

The purpose in telling this story is to share an important lesson: Such things can and do happen in hospitals. The only apparent remedy is for family members or other advocates to accompany a patient who is too weak or confused for effective self-defense. The advocate must be familiar with what constitutes torment, and with the patient’s rights. Even though it is difficult to arrange stays beyond visiting hours, that is needed because torment can occur at any time of day.

One might visualize a time when hospitals provide truly conscientious advocates for patients who have none of their own, or when they might at least provide closer inspection of staff performance.  But, aside from technological advances, real progress in medical care is extremely slow.

THE COMPLAINT

Letter of complaint

Shortly before my discharge from the U.Va. Medical Center on May 17, 2012, I met with Jennifer B. Kane, Patient Relations Representative and Marcia White, RN, MSN/MHA CCRN, MA, Manager, TCVPO, University of Virginia Medical Center. I described the events of the night of May 13th, about which I wished to lodge a complaint. I was advised to put this account in the form of a letter to Ms. White. This would give her a basis for investigation, and she would inform me of the results of that investigation.

The resulting letter, dated May 19, 2012, and addressed to Marcia White, follows.

 

JAMES R. BURNS
Waynesboro, VA

May 19, 2012

Marcia White, RN, MSN/MHA CCRN, MA
Thoracic Cardiovascular Post-Operative ICU Manager
PO Box 801444
Charlottesville, VA 22908-1444

Dear Ms. White:

I am an 85-year old retiree who recently underwent open-heart surgery, follow-on heart surgery, and emplacement of a pacemaker at the University of Virginia Hospital. I was most pleased with the successful results of the surgeries and the skillful, careful, and sensitive levels of treatment furnished by the surgeons, other doctors, and all staff members who took care of me throughout my ensuing stay — with one single exception. I must lodge a serious complaint about the treatment I received from one nurse, whose name I understood to be Dwayne, who handled my case for about 12 hours the night of Sunday, May 13.

That Sunday night was my first one awake after remaining under anesthesia through the previous two, which had followed two consecutive days of surgery. I was extremely tired and restless. Despite an initial error in recalling the year we were in, I do not believe that I was confused to any serious degree. I occupied a model of bed that several members of the ICU nursing staff later identified as uncomfortable and likely to promote restlessness. I recall tossing restlessly during the first hour or two with Dwayne, and thereby disarranging the bedcovers several times, and I recall once pulling off the glowing red finger clamp used to measure blood oxygen content.

Dwayne promptly grew hostile, said that I was being irresponsible for my health, that I was extremely uncooperative, and that I could not be trusted. He asked me why I had bothered getting heart surgery if I wasn’t going to protect the results. He quickly and surprisingly worked with an assistant to install restraining mittens on both hands. I told him I simply could not endure this confinement, and I asked him to remove them. After the mittens had remained in place about an hour, I began trying to remove one and I soon succeeded. He then quickly overwhelmed me and installed thongs tightly binding each wrist to opposite bedrails, spread-eagle fashion. This situation continued through the rest of Dwayne’s work shift, ending about 8:15 am on Monday. Total restraint time was close to 12 hours, and I do not recall any intervening periods of relief. I was coughing incessantly during most of the 12 hours. Dwayne said the coughing was good for me.

The following photos show the visible evidence of this ordeal that persisted until they were taken on Thursday, but the bruising was a minor matter compared to the physical and emotional discomfort that persisted through the period of restraint.

DSC00535                  DSC00533

This experience stands out as the most relentlessly brutal medical procedure that I have ever received in my lifetime. It remains my opinion that, if restraint were intended either as punishment for my “misbehavior” or as a means of teaching me a lesson, its duration was far out of proportion to the nature of the offense; and that if it were critically necessary to stop health-endangering motions permanently, then at least an attempt should have been made to follow shorter-term restraint with something else, ranging from two-way discussion to injection of a consciousness-lowering agent. I recall, in fact, that both these steps were taken – not as attempts to end the situation – but as steps followed quickly by abandonment while restraint continued long afterward. I noted long periods of abandonment under restraint, avoiding any opportunity to discuss the problem or further to resolve it.

Rather than relying entirely on my own memory to assess this event, I would appreciate any extracts from your records that would help me assess what went on, such as:

  1. Names and titles of any additional persons involved in the case that were present during Nurse Dwayne’s assignment, indicating whether in supervisory, advisory, collegial, or supportive capacity toward Dwayne.   .
  2. Medications or other treatments attempted, and indication whether these were successful, or failed, or involved repeated attempts.
  3. Any application of balm, relief, repair/recovery from treatment effects, or independent checks by others regarding need for same.

I am confident that each of the other nurses serving on my case after Dwayne would give positive feedback about my responsibility and cooperativeness in medical matters. I am also quite sure that my Internist, Dr. S.A. Tatar and my cardiologist, Dr. R.S. Gibson, both of whom have known me for many years, would give equally favorable witness on such matters and would also provide highly positive comments on my character, sense of responsibility, and trustworthiness when involved in matters of medical stress.

I am deeply grateful for your attention and assistance in this matter.

Sincerely yours,

James R. Burns

Copy to:
Jennifer B. Kane, Patient Relations Representative
Patient Relations Department
PO Box 800678
Charlottesville, VA 22908-0678

THE RESPONSE

Results of investigation 

On May 31, The ICU Manager conveyed the following message in an email to Mr. Burns: “It took some time for me to review the chart and to talk to everyone involved in your care, so I apologize for the time it has taken for me to get back to you. I will try to call you tomorrow afternoon to discuss.”

Jasper Burns (James K., son of James R.) replied on June 1, saying, “My father asked me to respond to you. He does not feel that he is up to a phone conversation with you about something so important to him. He is afraid that he will not remember what you tell him or be alert enough to ask the pertinent questions.

“Perhaps you could email the information to him or call me instead.”

In the late evening on or about Saturday, June 2, The ICU Manager spoke with Jasper by telephone. She indicated that she had been trying all day to put the results of the investigation into writing, but without success. She found it repeatedly necessary to delete the items she had written. It was agreed that the matter would be handled by phone with Jasper, and that took place several days later. Jasper’s notes on the conversation follow.

Summary of a conversation on or about Friday, June 8, 2012 between Jasper Burns and Marcy White, Manager, TCVPO University of Virginia Medical Center.

The ICU Manager was following up on a complaint filed by James R. Burns concerning his alleged mistreatment while in the University of Virginia Hospital TCV ICU by a nurse named Dwayne during a 12-hour period from May 13-14. Mr. Burns had undergone open-heart surgery on May 11, and follow-up surgery for continued bleeding on May 12.

The ICU Manager stated that she had spoken with everyone involved. She said that her conclusions after discussing the matter with everyone were that significant nursing and physician errors were made while Mr. Burns was under Dwayne’s care. These errors included the following:

  • Contrary to hospital policy, no physician authorized the prolonged close restraint that Mr. Burns was subjected to, extending over a period of approximately 12 hours. The restraint was approved by the “nurse practitioner”, or “LIP”, rather than a physician.
  • Dwayne should not have encouraged Mr. Burns to cough and breathe deeply as narcotics were being withheld and weaker painkillers (e.g. Tylenol, Toradol (if kidney function was adequate) had not been prescribed. Coughing and deep breathing would have been very painful under these circumstances.
  • The ICU Manager expressed the opinion that pain management should have been “more aggressive”.
  • A delirium assessment should have been done before any decision regarding restraints was made – this did not happen.
  • Inasmuch as Mr. Burns was subjected to restraints for 12 hours, a sitter should have been assigned to observe his condition and comfort.
  • Nurse Dwayne should not have “scolded” Mr. Burns for disarranging his bedclothes and being restless.
  • Greater attention should have been paid to Mr. Burns’s dry mouth.

When informed that Mr. Burns continued to remember his ordeal and had experienced vivid nightmares about it after leaving the hospital, she said that she regrets this very much. She suggested that, if Mr. Burns has difficulty getting over the trauma, he might consider attending a “Mended Hearts” support group meeting.

The ICU Manager stated that Dwayne was reprimanded for his actions while treating Mr. Burns, and that Dwayne “feels terrible” about the distress that Mr. Burns experienced and continues to experience.

James K. (Jasper) Burns
June 12, 2012

 

ENAMEL AND METAL ARTS: X

More Boxes, Dishes, and Mementos

This is one of a series of postings about enameling and art metalwork. It is based primarily on my work in the 1980s. I am not a master of these arts, but I hope this fact will be an advantage in communicating the basics, in simple terms, to readers who are not already familiar with them. The series is not intended to instruct in procedures, but solely to impart an appreciation of the art forms involved.

*        *        *

The story of a boy riding on the back of a dolphin dates back to ancient Greece. I have never done the research to form an opinion on whether this has actually happened, and when. Nevertheless, we know that dolphins are intelligent creatures, and that on occasion they have been both friendly and protective towards people. I like to believe that the picture below depicts a true event, and that it could occur in modern times as well as in ancient Greece. Which is why the boy is clothed in swim trunks.

BoyDolph1

 The enamel is on fine silver and is mounted on the walnut lid of a box with a walnut base and sides of enameled copper. Sterling silver inlays in the wood carry the wave theme beyond the enamel.

In the open box, the dark amber counterenamel on the copper siding can be seen. The edge of the copper is covered with a channel wire of sterling silver.

BoyDolph2                    BoyDolph4

*        *        *

The next box shows the sad face of a clown who suffers among the symbols of joy and comedy at a circus. The mood is inspired by the scene in Leoncavallo’s opera Pagliacci, in which the clown sings Vesti la Giubba, as he dresses for the show while mourning the love that was stolen from him.

 Clown-03               Clown-04
*        *        *

The box titled “Nantucket” was commissioned by my sister-in-law as a memento, a gift to her partner in real estate, upon their opening of a new development named and fashioned after the theme of Nantucket.

Nantucket           Nantucket(2)

*        *        *

The music box Portofino is a memento of a happy honeymoon there. It was commissioned as a gift for the young bride on the occasion of their first wedding anniversary.

Portofino MusBx2                Portofino MusBx1-06

*        *        *

Another music box, showing here a glimpse of its inner workings, is designed on a Russian theme in keeping with its music.

              RussMscBx2        RussMscBx3
RussMscBx1

*        *        *

Wooden dishes provide another attractive setting for enamel pieces. The dishes are normally produced on a wood lathe. I also had success in using a much less expensive machine, called the Bowl Crafter, in which the wood is turned slowly while the blade of an electric router does the cutting. One dish below shows bobwhites in the field; the other portrays the cottage of Anne Hathaway, born in 1556, who married William Shakespeare.

 XI d BobWhite1-08               XI d Hathaway Cott  04 (2)
*        *         *

Many items were commissioned as gifts to commemorate some special occasion. Most were simple pendants similar to those shown previously. Several of the boxes shown above were likewise mementos. Some of the more unusual items are shown here.

This simMeditationple dome-shaped circular design was specified by the customer as a birthday gift for her fiancé. She was precise regarding the proportions and the colors. It was essential that the red circle reflect light well because he would be gazing into it for purposes of meditation. I complied by including a small circle of gold foil beneath the red enamel. I wondered, with a silent chuckle, just what it was that was being represented here. I soon found out, when she brought me a book on Yoga meditation. It showed exactly the design I was following, as an instrument for meditation.

Meditation 2

 

Several days after I gave her the completed work, she returned in tears. She had an inscription engraved on the silver back, and the birth date was wrong. I could have made a new bezel, but I first suggested a less costly approach: I gave her the exact thickness of the silver, and asked her to consult with the engraver; he could possibly grind away the old inscription and engrave the corrected one. That apparently worked, for I never heard about it again.

*        *         *

The next piece illustrated the blue and white symbol of a local hospice. It was presented as a retirement gift to a lady who had worked there for many years.  XI HospiceRetir -08

*        *         *

One day a young fellow brought me a single cufflink. He had proudly worn it ever since inheriting it from his grandfather. Now he had lost its mate. Could I duplicate it? Well, I was willing to try the complex design, called Blue Wisteria. It would involve the Champlevé technique, tracing the design with resistant asphalt paint, and then etching the remainder with a mordant. But I didn’t think I could match the exact color of the enamel, or the texture of the gold plating, apparently from some industrial process. I suggested replacing both cufflinks to ensure a good match. And so I did, and so the young man went off, content with the thought that he’d done the second best thing, next to not losing the cufflink in the first place.

BlueWisteria2 4

*        *        *

XI Rejoined-14Finally, a memento celebrating the remarriage of some close relatives. After 36 years of a good and fruitful marriage, with three grown children, they divorced.   One year later, there was a happy remarriage that lasted the rest of their lives. The enamel piece was made by a team effort. I came up with the design concept, my son Jasper developed the precise design, and my wife, Jaquelin, a novice enamelist, performed the actual work. The enamel is presented in a box-type frame.

After both of the couple had died, I received the following note and picture from their daughter. It is a response like this that fully rewards an artist or a writer, and instills a pressing desire to continue the work.

“I’m attaching a photo of the small altar I created in memory of my parents. The wood box contains mementos, letters and two small keepsake urns containing some of Mom and Dad’s ashes. I’m sure you recognize the cloisonné piece you created in celebration of their reunion when they remarried; it’s now in a place of honor and I treasure it.”

Freund Altar Rszd

(Photo courtesy of Jaqui Freund)

*        *        *

Enamels decorated the weapons of ancient Mycenaean warrior kings. They adorned important religious objects such as reliquaries and chalices throughout the medieval period. They made superb gifts fit for the most highly honored royalty, such as the Fabergé eggs of the Russian czars and their families. And throughout three millennia, enamels have furnished brilliant and richly colored jewelry for both men and women.

The simple pieces shown in this posting show that enamels can well express celebration and joy over everyday human experiences.

ENAMEL AND METAL ARTS: IX

High-Firing Experiments

This is one of a series of postings about enameling and art metalwork. It is based primarily on my work in the 1980s. I am not a master of these arts, but I hope this fact will be an advantage in communicating the basics, in simple terms, to readers who are not already familiar with them. The series is not intended to instruct in procedures, but solely to impart an appreciation of the art forms involved.

*        *          *

The lead-bearing enamels that I used gave interesting, surprising, and often beautiful results when fired at high temperatures, about 1,800 degrees Fahrenheit, on copper. (This contrasts with normal firing temperatures of 1,400 to 1,500 degrees.) Transparent enamels often gave unexpected colors and lusters. For example, a pink enamel called tea rose produced a brilliant gold with bright metallic luster. An example of this is shown below in the Celtic Wreaths enamel, previously introduced in part VI.

 XII CeltWreathsEnam

Also, many opaque types of enamel became transparent during high firing, and led to still more colors, always with a metallic luster that is not well rendered in the photographs.

A desk pen set illustrates results of an experiment using both transparent and opaque enamels on the familiar eagle design.

EagleHiFire-12 (2)                    EaglePenset-11 (2)

The experimental piece shown below was an attempt to portray the lights and colors of Paris on a summer evening. Its shortcomings in definition and form, a frequent casualty of high firing, are partly balanced by the richness of color and luster.

Summer Eve-05c

The fictitious scene of a harbor at sunset takes full advantage of the warmth and brilliance that are easily produced by this technique.

Sunset-18                   Sunset-08 (3)

All of the pieces shown here are basse-taille products. The low relief was etched in copper by a mordant and then covered by enamel, built up to a flat or gently curved surface.

High firing was a fruitful area for experimentation. It was the scene for many advances of the art in the 1980s, and the subject of many workshops. In this context, my own experiments barely scratched the surface.

 

ENAMEL AND METAL ARTS: VIII

Design with Nature: Birds

This is one of a series of postings about enameling and art metalwork. It is based primarily on my work in the 1980s. I am not a master of these arts, but I hope this fact will be an advantage in communicating the basics, in simple terms, to readers who are not already familiar with them. The series is not intended to instruct in procedures, but solely to impart an appreciation of the art forms involved.

 *        *          *

As I became more adept at the techniques of enameling, I began to feel daunted by the power of the art form. It offered tremendous opportunities through freedom of proportion, rich colors, and its ability to emphasize line work. Using such features, I realized, was subject to principles and rules that I had not studied beyond the first year of high school, and had never really grasped.

Anxious to learn quickly, I reasoned that most of these principles and rules probably expressed the preferences that nature had instilled in us long ago. Nature, then, was the arbiter of what was artistically sound. My starting point would be to prepare realistic images of natural subjects. Abstraction could come later. I began with birds.

Which was better to start with than the bald eagle? I sensed that nature would not only guarantee the artistic soundness of this image, but would also add a touch of drama reflecting the personality of this fearless hunter. It worked reasonably well, both small (on cufflinks) and large (on a box lid).

 

EagleCfflnks2-06 300

Eagle Lect 14 300

Other species followed in short order. Feeling more comfortable about choice of color, I began taking small liberties with what nature had provided. In some cases, a realistic pendant or brooch might be accompanied by more abstract smaller accessories like earrings and cufflinks.

Bird 1 Pend 300      Humbird 1 Pend 300      MiscBird1-06 300

Of the two pairs of “button” earrings shown below, the pair on the left reflects elements of numerous bird images; on the right, the enlargement of a small detail of a butterfly’s wing.

VIII. MiscBird3Earr 300

VIII. Swallows Feeding Lect 17 300        VIII. MiscBird-03 300       PenguinPnd-07 300

Again, the penguin image on the pendant is a source for abstractions on the first pair of accompanying earrings. Hummingbird images are caricatured on the second pair. In the third pair, the avian origin is mostly lost in abstraction.

PenguinEarr-06 300            Hummbrd Earr-04 (2) 300

VIII. Champleve1-09

Finally, we present a “copy of a copy” of nature. The ancient Athenians used a wise owl to represent their patron Athena, goddess of wisdom and war. And so they used an owl to decorate their silver tetradrachm, considered by many to be the most beautiful of all the coins ever minted. Here is a rendition of the coin in enamel. It was made by the basse-taille (low-relief) technique; relief was obtained by embossing a thin sheet of fine silver.

VIII. Classical Owl tetradrachm 300