We'll Take the Watch from Here

Although he uses the moniker only with tongue squarely in cheek, "Internet Sensation" Chief David A. Oliver of the Brimfield Police Department has created an engaging Facebook page that brings an international community of "crazy cousins" into informative, humorous, and thought-provoking dialog with those who serve and protect a small Ohio town (https://www.facebook.com/BrimfieldPolice). Now over 141,000 followers strong, Chief Oliver and the BPD offer fans a look at the inner workings of a department that is redefining what it means to be public servants. My mornings are not complete until I read the Chief's daily message, as well as any updates from the "Brimfield Triangle" and any Chief's "rants" or "babbles" that may have appeared in the preceding twenty-four hours.

A post that always touches my heart is a tribute to a fallen officer anywhere in the country. Chief Oliver notes what happened and links to a local news report, extends sympathy to the family, and bids his brother or sister in blue "Rest in peace," adding, "We'll take the watch from here." Having known and worked with many fine police officers over the years I can imagine a public servant not quite able to rest, even from the Beyond, without knowing that his or her watch is covered. I am grateful, and struck that a police chief in a little Ohio town thinks to offer that reassurance: "Your watch is covered; be at peace."

Why is it that we can't seem to cover our watches in healthcare, even when they span only the relatively small group of patients entrusted to our care in whatever setting we happen to practice?

"Maria" was an elderly patient of mine last year. She had heart disease, high blood pressure, diabetes, kidney issues, and all the degenerative processes that so often accompany advanced age. As she recovered from a complicated post-surgical course and neared the time of home healthcare discharge, her husband "Frank" was scheduled for surgery himself. He had been told to anticipate a five-day inpatient stay and then a period of recuperation at home that would last some weeks. His planning for this surgery included lining up relatives to assist Maria in his absence, however, I was concerned. In the many months I had seen Maria at home, no family ever had appeared. Greeting cards were displayed at holidays, and now and then Maria and Frank mentioned that someone had visited during the previous weekend, but these visits were infrequent, and no one had shown interest in Maria's health needs or offered to help with her care. So I wondered if they would step up to provide the level of support that she would need while Frank was away and later recovering. Fortunately Maria had enough ongoing issues with her various health problems that I was able to extend my visits to the time of Frank's surgery.

Frank was admitted to the hospital on Monday, for surgery that same day. He underwent a five hour procedure, and spent Tuesday in Intensive Care. Wednesday I was able to reach Maria at home and schedule a visit with her for Thursday, as Frank was doing better and she would not be going to the hospital that day.

My wait on their doorstep Thursday morning seemed interminable. Maria and Frank live on the second floor of a two-flat, and I wondered which family member was so slowly making his or her way down the stairs to admit me. Imagine my surprise when Frank opened the door, breathing heavily, a large surgical dressing covering much of his face and neck, and looking like he was about to fall over. He had been discharged home, alone, Wednesday, the day after leaving intensive care. "They didn't tell me it was going to be like this," he said, breathing hard and grasping the handrail for support. "And I'm supposed to take the bandage off today, but I don't know how. And what do I do about what's under there?" I asked if he had been given fresh bandages or other supplies; he said no.

Somehow Frank and I made it back up those stairs, after which he barely managed to walk several steps to all but collapse in a chair. Maria sat on the couch with her walker nearby, able to move about the apartment herself only with difficulty and certainly unable to provide physical assistance to him. No one else was there.

Frank was not my patient. I was not privy to his treatment plan or to information about his surgical procedure or hospital stay. There were no orders for home healthcare; Frank had not signed a consent for me to lay a hand on him or provide any kind of service. In short, his problems and needs were not my business. Or were they?

Certainly Frank's welfare was material to Maria's, and she indeed was my patient. Perhaps on that basis I could justify a bit of emergency assistance. But ethically there was no question what needed to be done, orders, proper referrals, legal consent forms, or not.

"Frank, would you like me to help you with that bandage?" I asked.

I don't know if the tears or the gratitude in his eyes were greater.

The details of his case aren't important now. The incision under the bandage was healing well and could be covered with a much more simple and easily managed dressing. I could tell Frank generally what to expect, how to take care of himself, what pitfalls to avoid, and what might happen that would warrant a call to his surgeon or, God forbid, an emergency trip back to the hospital. Maria was fine, well, as fine as an old woman with multiple chronic problems and a basket-case of a husband could be, and needed little attention just then. Whether family had risen to the occasion earlier in the week was a moot point: Frank and Maria had food and could manage adequately in their little home without any more trips down the stairs. They knew to call 911 in an emergency, and family or me for anything else.

But what had happened at the hospital?

The surgical team did its job on Monday, the critical care team did likewise on Tuesday, and Frank was handed off to a general surgical floor on Wednesday, determined no longer to be in need of inpatient care, and discharged home. Harsh as it may seem, that might not be unreasonable. Hospitals are dangerous places, with potential for infection of new surgical wounds and much bustle allowing for possible confusion of patients, orders, and needs. If a person does not absolutely need to be there, often it's best for him or her to go somewhere else. Insurance companies and hospital bean-counters wound agree, albeit perhaps for other reasons.

I wonder, though, if anyone asked Frank where he was going (home to a second-floor walk-up apartment), who was available to help him (no one), or if he understood, less than forty-eight hours after general anesthesia and with a load of narcotic pain relievers and other medications on board, what had been done, what he would need to do for himself, how to do that, how safely to maneuver about, what measures to take to build strength, and under what circumstances it might be necessary to seek help, or what that help would be. If anyone did ask those things, under those circumstances, I wonder what was wrong with that person's brain. Frank was an old man two days out of surgery and full of brain-altering drugs!

Frank was a Medicare beneficiary who qualified for home healthcare, yet no one referred him. I wasn't looking for more work to do; truth be told, I was looking forward to discharging Maria because their home was out of the way for me and I had tired of the extra driving. But I, or someone like me, would have seen Frank in a heartbeat. Two or three nursing visits and a session or two with Physical Therapy to see that he moved up and down those stairs safely would have done the job nicely. But it seems that when each hospital team finished its own job, it sent Frank to the next setting on his road to recovery and washed its hands of him. I do not believe there was one iota of malicious intent, and I'd bet money the hospital was busy and its workers harried, striving to do the best they could for the charges in their care, with little time even to think about consequences beyond the next "hand-off."

Yet even when a police officer dies, when his or her tour of duty is ended for the last time and there is no more work for him or her to do ever again, colleagues such as Chief Oliver and thousands of others step up to take over, ever mindful of the need to serve and protect twenty-four hours a day, every day, regardless of circumstances.

Healthcare providers could stand to take a page from the Brimfield Police Department and public servants everywhere, and not rest without knowing that when their work with a patient is done someone, an appropriate party receiving the "hand-off," has said,

"We'll take the watch from here."