While Steph was at Baptist-Lutheran Hospital
for minor surgery, among the many pricks and pains and tests, she was tested
for Methicillin-resistant Staphylococcus aureus (MRSA). Not sure why they
tested her — maybe they tested everyone, or everyone who was scheduled for
surgery. Her test results came back positive.
We didn't know what MRSA was, and
I'll wager you don't know either. It's a stubborn, difficult-to-fight infection
that originated from hospitals. Which makes sense, I reckon — put a whole bunch
of sick people in the same building, and you're concentrating the sickness,
maybe inventing some new sickness. It used to be called "hospital-acquired
MRSA," but it's moved beyond hospitals — now you can get MRSA anywhere.
To recap, then: MRSA is not
something you want, and you can get it anywhere, but you're especially susceptible
in a health-care setting. Bear that in mind when you’re visiting Gramps in the
hospital after his gout surgery, or your wife and newborn child in the maternity
ward.
Steph never developed any symptoms
of MRSA beyond testing positive at Baptist-Lutheran. MRSA was never mentioned
as a factor in any of her subsequent illnesses or hospitalizations. We're not
sure she ever even had MRSA; the test results could have been a
false-positive, which certainly happens. MRSA was not a diagnosis she had to
deal with in any normal way, like the flu or diabetes or any other illness you
can think of. But just testing positive for MRSA was a little like carrying
leprosy.
Once you've tested positive for MRSA,
just once, you're always on the MRSA list. Every time Steph was admitted
to any hospital for the rest of her life, her room was always and immediately labeled
as "MRSA isolation."
What does that mean? A special sign went
onto the door of her hospital room, announcing MRSA isolation procedures.
Doctors, nurses, and all other employees were required to "gown up" before
entering Stephanie's hospital room, which entails wrapping a lightweight protective gown over their clothes and tying the string in the back; putting a
mask over their face, and gloves over their hands. Upon leaving the room, these
masks and gloves are tossed into special "isolation trash," and the lightweight
gowns go into a special "isolation laundry" bin, to be washed,
sanitized, and later re-used.
Stephanie was hospitalized many
times, so we grew accustomed to the slow but annoying rustle of these
almost-plastic gowns, as staff gowned up before entering the room — the
doctors, the nurses, the technicians, the guy who's going to wheel her down the
hall for an x-ray, the guy who's bringing her pills, the next guy who's taking
her temperature, the woman who's bringing her breakfast, the nurse's aide who's
bringing her a glass of water, the lady who's there to draw blood samples, the guy
who's emptying the trash and washing the sink, the technician who's going to
fix the TV, and often, me.
There were many, many
violations of this protocol, however. Gowning up takes time, but hospital staffers are
frequently overworked and thus in a hurry. Countless times, doctors, nurses,
and others entered Stephanie's room without donning the required
protective gear.
And what about me? Sometimes I was
required to gown up before entry, gown up after I came back from the mens'
room, gown up after I'd gone for a walk down the hall, or to the cafeteria for
a sandwich. But just as often the staff considered me and other
visitors exempt from the isolation rules. Whether visitors were required to gown
up seemed to depend solely on the nurse's mood and persnicketiness.
Ponder for a moment how
many times people go in and out of a single hospital room over the course of the
day — it's many, many times. One day I kept count, and more than 250 times someone (not including myself) stepped inside Stephanie's "isolated" hospital room.
With that many people coming and
going, it's unlikely that the "isolation trash" and "isolation
laundry" bins are being emptied often enough. In practice, the bins were often
full and overflowing, so used and discarded gowns piled up on
the floor. These piles were frequently kicked out of the way by visiting
staffers, or by me — but the gowns don't cover anyone's legs below the knee, so
every kick effectively violated the isolation, and contaminated someone's
britches and shoes.
Psychologically, it just screams
"untouchable" to the patient. Steph sometimes complained that she
felt like she was in The Andromeda Strain, a sci-fi movie where patients
are kept behind glass and doctors wear rubber suits to protect from
contamination.
Every employee's photo-ID badge was
clipped to their shirt, which was hidden behind the gown, so when someone gowned
up and stepped into the room we couldn't guess whether it was a doctor or a lab technician, unless he/she announced their name and job title. Even if a
particular doctor or nurse had seen Stephanie a dozen times already, Steph couldn't recognize that person when he/she stepped into the room, because
everyone's face was always behind a mask.
It's MRSA isolation, but the key concept isn't MRSA, it's isolation. Whenever Stephanie was hospitalized — which is to say, whenever she was most frightened, most weak and most worried — her care was provided behind masks, gloves, and gowns that made everyone a stranger, every time. It's difficult to establish rapport, or respect, or any reasonable doctor-patient relationship when the patient can’t even recognize the doctor.
It's MRSA isolation, but the key concept isn't MRSA, it's isolation. Whenever Stephanie was hospitalized — which is to say, whenever she was most frightened, most weak and most worried — her care was provided behind masks, gloves, and gowns that made everyone a stranger, every time. It's difficult to establish rapport, or respect, or any reasonable doctor-patient relationship when the patient can’t even recognize the doctor.
And lastly, riddle me this: Why was Stephanie's MRSA considered so dangerous at the hospital, but not worrisome at all when she had an ordinary doctor's appointment, or when she spent four hours at the dialysis clinic three days a week? Nobody wears a protective MRSA gown at any of those places.
Steph and I believed in science, and
medicine is science. We wanted to believe that MRSA isolation made sense, but eventually we concluded that it's simply counterproductive — bad medicine, and bad science.