A Little Pushiness Goes A Long Way

This week one case in particular really made me proud, and brought my patient to happy tears.
October 5, 2023
Pramote Polyamate/Getty Images

We each take care of five patients at a time in my Med/Surg unit, and I almost never bring these stories home, but this week one case in particular really made me proud, and brought my patient to happy tears. I’ll tell it carefully to avoid violating HIPAA:

Monday – I arrived, got my 5 patients, and 4 of them were on isolation for different things (1 Herpes Zoster, 2 Pseudomonas and 1 COVID). It was the COVID case that wasn’t adding up. She was here in respiratory distress, apparently with a bad case of COVID, testing positive when she arrived. But in her history, we knew she had COVID very recently in August.

I’ve had COVID twice in a short period of time. You can also get a rebound case, with or without taking Paxlovid. However, I felt reasonably confident that if I were to check, the hospital COVID test would be a PCR, not an antigen. The PCR is so sensitive that it could still test positive well after the virus and contagion has left the body. So I checked, and as expected it was a PCR. So I went to work.

First I spoke with the doctor, who is a wonderful friend of mine, and he fully backed up my suspicions, and agreed that automatically keeping her isolated for COVID made less than zero sense. So now that I had his support, I had to work on the hospital and their red tape, because they were automatically enforcing a 10-day isolation for her throughout her stay. And although family can visit isolation rooms now, it certainly prevents many from wanting to do so. Worst of all, it prevents any of the members of the care team from going in and out of the room with immediacy. It’s an arduous process donning and doffing your PPE each time. The patient’s already unpleasant experience is thus far more miserable and…isolating. I was highly motivated.

Tuesday – Knowing the doctor fully backed me, I complained loudly (and probably obnoxiously) that this woman’s isolation was likely inappropriate. When I was given pushback that this is hospital protocol, reacting to her positive test upon admission, I said that the hospital should recognize that I understand COVID more than most, as they literally had me giving the seminars on the topic back in December of 2021. I hated pulling that arrogant “do you know who I am” card, but I cared more about the patient’s well-being than my own perceived image that day. I spoke to the right higher-up doctor/administrator, who also fully agreed with me, and on the phone he got us all permission to handle this my way. I was given the green light.

I then got my patient an ANTIGEN test ordered. Shortly after, in a moment of victory, it was NEGATIVE. I then was able to order a full removal of her isolation, and entered my patient’s room and told her, and gave her a hug and showed her how easily and quickly we could now tend to her, even leaving the door open. She called her family, and by the end of the day about 15 family members were filled in the room and she was overjoyed, though still feeling physically awful of course.

The COVID from August was highly relevant, as it had created a nasty case of pneumonia in her lungs, and sure enough she began treatment for that, and by the next day she was starting to stabilize, and eventually took a few steps and sat in a chair. When I said goodbye to her that night, she cried and gave me hugs. Although I can’t know for certain how her medical journey will end, I do know that a little pushiness made a huge difference.

Boaz Hepner works as a Registered Nurse in Saint John’s Health Center, and provides health education to the community at large. He grew up in LA in Pico/Robertson and lives here with his wife Adi, daughter Natalia, and son Liam. He helped clean up the neighborhood by adding the dozens of trash cans that can still be seen from Roxbury to La Cienega. He can be found with his family enjoying his passions: his multitude of friends, movies, poker and traveling.

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