How Do We Prepare For Hospitals?
To forestall any delays, make sure you arrive with your medical insurance cards, your personal data in hand, your list of medications and any doctor's orders that were given you by your physician or surgeon.
I've been in a small collection of hospitals since my first heart failure diagnosis and in only one did I find fault with their admissions procedure. The hospital is located in an area where I "hideout" during the summer months. Even getting a blood draw there is a tedious experience with inefficient bureaucratic redundancy, one that would challenge Mother Theresa. Even now when I go there for a blood draw, I have to check in by signing a form, wait in a chair for about five to fifteen minutes, (even there are no other patients waiting) then be led into an enclosed booth where I go through the very same paperwork that I've been through dozens of times before. It's tedious, expensive, time consuming, and wasteful. They even have a completely networked computerized system available to them, yet they still go through that "first day's" check in procedure as though they'd never left the world of pencil pushing spreadsheets. The lab technicians by the way, are excellent. So we have a mix in some hospitals. The way I prep for this one is have all my records in hand, ready to hand over. It saves maybe a minute or two but it also saves some stress.
At my favorite lab, I sign a very short form and bingo, into the lab for the draw and out within minutes. That hospital lab knows how to keep records and how to keep their patients happy. It is not an HMO, either.
But that's the bureaucratic side of a hospital.
This essay is not meant to disparage or challenge hospitals but instead to prepare you for the variations you'll find. We all have our own feelings about whether the idea of going into a hospital is
frightening, or uncomfortable, or whether it creates anxieties or any level of stress. So, here's my list for things to think about when you first check into a hospital, or later when you have to return. This list assumes you're not on an unplanned emergency run. We'll discuss that later.
- 1. Ask your doctor why you are going to the hospital. You want a specific answer, not a general hand-waving "Because it's necessary."
- 2. Explain to your family first what you are doing and why you have to go in. Tell them you're okay with it, whether you feel you are or not. Loved ones can suffer great stress if they aren't clear on what's going on. Often those concerned about you can pass their angst on to you and make you a bit too uncomfortable with your upcoming surgery. In many instances, only we know how we feel, and only we should be making the decisions concerning surgery or no surgery.
- 3. Do not be scared off by stories of thousands of people dying in hospitals or coming out with major staphylococcus infections or that your particular procedure is so hairy the others don't want you to do it.
- 4. If you aren't given a list of what to take to the hospital with you, then call the hospital. Most have staffs or volunteers who will guide you.
- 5. Make sure you have someone who can help after check-in as well as during. Make sure your hospital friend is an extrovert to the point of being able to ask questions, even to challenge something they might not trust. Neither one of you has to know much about hospitals. It's you we are concerned about here. That's also why you want all your records at your fingertips.
- 6. If you have trouble hearing or want an audio record of what you are told or answers to your questions, then take along a small handheld recorder. Ask permission to use it when asking questions, explaining you need it for clarity and to review later. Some might tell you no, because of fear of lawsuits. In that case, you or your spouse or friend should write down the answers.
- 7. Make sure you take your medical cards, personal information, list of medications and any special orders or check in slips give you by your doctor or surgeon. Keep records including a living trust or your will all in one place, easy for your spouse or a family member or friend to grab and take to the hospital if you aren't doing it yourself. Include in this file your lab tests (at least your last few), X-ray reports and your records of meetings with your doctors. Access to these files at this writing are not all that easy for some hospitals or emergency rooms to locate.
- 8. If you are going for an overnighter or longer, do take your own toiletries. Your own slippers. Your own pajamas and a robe. You don't have to wear their hip long expository clothing if you don't want to. Take something to read as well, that is if you'll be conscious long enough. And don't forget your eyeglasses if you need them.
- 9. Take your cell phone if you have one.
- 10. Request a private room. If possible, insist on it. My theory is that privacy helps us to heal. There are some steps you can take to ensure you get the room: Check that your insurance covers a private room. Call the hospital before you go. Check in on time. If the above don't do it for you, call the doctor arranging for surgery and ask him to get it for you and if that doesn't work, then ask for another hospital if one is available in the area.
- 11. Take your own pillow if you sleep on it better. For a single overnight, forget it. They won't let you sleep anyway.
- 12. Don't pay for TV. Actually many hospitals today offer it at no charge. If you find yourself in a room with someone else, ask them if the TV is bothersome to them. Go ahead, turn it off, you can live without it. And if you don't like the distraction of flashing lights (scene changes) from their TV, let them know.
- 13. If you are having a heart ablation or right heart catheterization, or other surgery below your waistline, take along some loose fitting athletic pants or gym shorts. Just remember, take loose clothing for your trip home since you don't want to put a strain on any surgical entry points or stitching.
- 14. Take your medication with you. Some hospitals may want to confiscate it, but I don't tell them I have it. (I'm going to lead you astray here.) I learned once that it might prove important to take it even though I feet like a smuggler. During one hospital stay I was taking a serious medication and the hospital pharmacy was closed by the time the staff got my list. Frankly, I was amazed they didn't have a 24 hour pharmacist on staff, but it was a small hospital. I missed taking it that night and the next morning. Some medications must be taken on schedule; therefore you may want to provide your own backup if needed.
- 15. Don't take jewelry but do take a small amount of money unless you have a spouse or family member who can manage the money because they'll be with you a lot. The reason for the money (or credit card)? You may want someone to make a run to the gift shop for a magazine or a dropped toothbrush or even sneak a candy bar. (Don't use anything that comes close to your face after it's been dropped on a hospital floor.)
- 16. Take home a copy of your discharge papers and summary of your stay including any records that you might still be sick or have an infection or other pending challenges.
- 17. Take critical records with you when traveling or on vacation somewhere. Local hospitals or doctors may need those records asap.
Other Necessary Preparations We Should Take
When Maureen tumbled down a flight of thirty stairs at the Mondavi Theater in Davis, California (after enjoying a Willie Nelson concert), our experience from paramedics through checkout at a local hospital was extraordinary. We had both been treated in that same hospital before, her for cancer and for me it was an emergency run for sepsis. (Blood poisoning. See: Glossary) Each time, the treatment we received excelled our highest expectations.
We also learned that evening that sometimes the patients produce the complications. So, here goes.
When Maureen went down that night she was carrying a small hand purse. I didn't know it, but all she had inside was a very small hairbrush and some lipstick. She had left her medical cards and her cell phone at home. (I don't have a cell phone.)
- 1. Always carry your medical cards with you. You can not predict emergencies.
- 2. Always carry a list of your medications, along with their potency (5 mg, 10 mg, etc.), and your daily regimen.
- 3. Always carry a next of kin, or "who to call" in case of emergency card with you. Place it behind your driver's license.
- 4. A convenient way to carry all the above is to sign on with a service like Medic-Alert. (www.medicalert.org, www.alert-1.com, www.rescuealert.com, )
That complicated things for a while. However we got lucky because of some exceptional paramedics and a friend who just happened to be at the show as well. The paramedics worked efficiently, with compassion and worked a bit harder to get an okay for transportation to the hospital of our choice. Yes, you can choose, but you may have to pay for it if you're not insured.
Fortunately the hospital had all our records in their system. It worked out, however we'll not trust to such luck again.
What About Low Sodium Meals In Hospitals
As Billy Crystal said in his comedy special a few years ago, "Don't get me started."
So, What Can We Eat In A Hospital?
I've been on a 500 mg of sodium per day lifestyle since 1997. I've learned the nutrient levels of many foods and the sodium levels of practically all food, but not necessarily all processed foods.
Hospitals tend to serve processed foods and the last time I checked one served brined chicken, which in essence is a processed food. It also was topped with salted white sauce known sometimes as Béchamel (flour, butter, salt & milk). Hospital cafeterias generally buy their food supplies from restaurant suppliers. Nearly all restaurant suppliers deal with processed foods and ingredients, unless they also supply fresh produce, but most produce distributors specialize in just produce.
Selecting a low sodium meal in a hospital may prove frustrating to you if you are as adamant as I am about taking care of a chronic illness.
Hospitals aren't hotels so we really can't expect them to dish up what we want. They will send up to your room what they want to send, based upon their caterer type service.
Feeding hundreds of people with a variety of specific needs three squares a day is not an easy task, so erase any thoughts you might have of receiving unique attention concerning your breakfast toast or luncheon sandwich or dinner entrée.
It's not going to happen.
What I have learned in the multiple hospitals I've frequented (and from tales of other patients) is that many still believe 2,000 mg a day of sodium is the "safe" level for low sodium. It doesn't matter that that level is higher than the AMA and NIH recommendation of 1300 mg to 1800 mg a day for healthy people, depending on activity. Apparently, the arbitrary figure of 2,000 mg a day was established sometime around the year 2000 BC and that's what they'll stick with. Sometimes sarcasm works. My point however, is that I have not been able to find even a scintilla of research that mandates a sodium level of 2,000 mg a day for chronically ill patients who must lower their sodium intake. Ergo, I figure it's an arbitrary number someone pinned on a bulletin board once and it hasn't been taken down.
Although this is not intended to serve as a campaign to get the medical profession to change, it might appear as chastisement for not changing when all around them have changed. Personally I believe every hospital in the world should start looking into diets and the food and nutrients they serve as part of the cure, not just something for sustenance while a patient is "in hospital."
And that cure could also benefit the medical staff and non-medical staff who work for the hospital and eat in the hospital cafeteria. I haven't seen a cafeteria yet that served exclusively healthy food. Donuts, bagels, cream cheese, heavily salted scrambled eggs, fried chicken, bacon, etc. seem to be standard fare; it's almost like walking into Joe's Super Slop. I used to think Denny's was bad, but I as wrong. At least Denny's serves a low sodium breakfast and they're trying to please all kinds of dietary needs. Here's a news release from Denny's dated March 23, 2009.
SPARTANBURG, S.C.--(Business Wire)--
Denny's is once again putting their guests first by introducing their new Better For You menu additions. Denny's believes Better For You items will give guests additional meal choices that will complement Denny's current menu selections. "Denny's realizes that we must have options on the menu for consumers who have special dietary needs - low/no sugar, low sodium and low fat," says Michelle Thompson, Director Food Science and Technology, Denny's. "We will also be making selected adjustments to our main menu, adjustments that will in no way compromise taste or food quality."
In a hospital we're generally dealing with what might be referred to as a large in-house catering service, although in the hospital where I served time for my broken leg they used the local caterer who also provided meals to the airlines. Don't try to get what you want from that service. Worldwide, hospital food is not known as a culinary treat, so we assume we should accept it as is. But the big secret is that a lot of hospital food is not nutritious in that it does not supply the nutrients needed on a daily basis. For long term patients that could prove a major health threat.
As to getting hundreds of meals to the patients in a hospital, feel at least a little good hearted if yours arrives at mealtime.
I watched Scott Leysath, (See Chapter # in this book), serve up 300 meals one night to a crowd of duck hunters who met annually for a special event. One of our daughter's and I visited him at his invitation and watched how he prepared three hundred meals and got them to the tables practically simultaneously and still hot. He was so relaxed about it I thought he'd lost sight of his mission that evening.
But when the time came, all three hundred meals were served within five minutes and each dish had three different selections of wild game and each of those had it's own special sauce - along with vegetables. It was the most amazing display of cooking and serving organization I'd ever seen.
Hospitals can't do it his way, however; too many floors, elevators and hallways. But they generally manage to get them to you, still warm, and generally edible.
Here comes the caveat. In at least one hospital I was served meals that totaled over 2,000 mg of sodium per day even though the selection sheet advertised each meal as "low sodium." In that hospital I asked and was told they had not "added salt" to the meal. What they had missed of course was that salt was in all of their processed foods, in the bread and rolls, in the desserts and of course the entrées. If you have doubts about the meals you are served, express them. Get some attention. You might meet the registered dietitian if your hospital has one who manages the meal service. (Some do, some don't.)
My solution to this challenge is simple. The first things required are self-discipline, planning ahead, and insuring enough nutrients to get me through multiple stay days.
I take a larger than usual bag to the hospital when I check in. It's not a giant bag, just larger than would normally be needed. The bag contains my Dopp kit with toiletries, other items mentioned before, plus homemade flaxseed burger buns, bananas, apples, and other seasonal fruit if possible. On one visit I took a neat little jar of unsalted peanut butter with some of my own homemade wild blackberry jam. During one visit one of my daughter's brought me a low sodium steak dinner with all the trimmings. (Not bad for a heart patient.) And Maureen has "smuggled" in other great eats. During that broken leg episode she smuggled chocolate milk shakes in. Not a bad idea since we tend to lose a lot of weight in hospitals, but also because they were real milk and real ice cream which contain vitamins A, D, some iodine, and a lot of smiles. It can be done. And two good things happen. You eat happily and don't have to eat the hospital food.
If you don't want to be bothered with my method, then here's what to look out for on your tray. I would avoid the following:
You can enjoy or consume:
- 1. Any items with a sauce
- 2. Breakfast cereal unless it's Spoon Size Shredded Wheat. (A few Trader Joe's cereals are below 70 mg sodium per serving most all others are pretty high. Remember if you're adding milk that it ranges from 103 mg a cup up to 150 mg a cup.)
- 3. Salad Dressing other than vinegar and extra virgin olive oil
- 4. Chicken unless absolutely assured it's not brined.
- 5. Deli meats.
- 6. Tuna fish sandwich unless they assure you it's unsalted or no salt added and that they didn't use mayonnaise.
- 7. Toast (Usually made with a commercial bread.)
- 8. If on blood thinners, don't eat the grapefruit served (it's generally out of a can and interacts negatively with blood thinners).
- 9. Ground meat unless they assure you it has not been salted.
- 10. Pork (probably brined), or any other meat unless the fat has been trimmed off.
- 11. Hash browns.
- 12. Scrambled eggs (unless they assure you no salt and no cream used) Each egg has 70 mg of sodium without the salt.
- 13. Ham, bacon, sausage.
- 14. Pasta with sauce (the pasta is acceptable if cooked in plain water, but the sauce will be high in sodium).
- 15. Pudding. (Usually high with sodium)
- 16. Jell-o (Usually high with sodium)
1. Sealed apple, berry or orange juice in containers.
2. Container sealed cold nonfat milk.
3. Fresh fruit.
4. Unsalted poached eggs.
5. Lettuce wrap sandwich (if ground meat is served make sure they haven't salted it and that it didn't come to them salted).
6. Any other food they will vouch for as having no salt added and not made with processed (generally canned or frozen) ingredients.
Paying Attention When We Can Might Make a Difference
When I jumped out of airplanes at various altitudes (for the enjoyment of it) you can bet that I paid attention to the packing of my parachute or what we called the "small details). Back then we each packed our own chute. When we do that, we are lot more comfortable about jumping than if someone else packed it. Unforeseen events can happen however. And by the way, the phrase "It all comes out with the opening shock" came from parachute jumping. When parachutes were packed for jumping during wartime, some talcum powder was added to aid with the opening.)
When Maureen was days away from delivering our first child, she attended a jump contest I was participating in. She was tucked outside in the shade of a hangar, playing the game of chess with someone. After I left a plane at 7500 feet above her, I flew around and then passed through our preset opening altitude, someone shouted, "The Lieutenant's chute didn't open."
Indeed it hadn't. I had pulled on the D ring successfully but then inadvertently spread eagled for flight so well that I'd created a vacuum across my back where the pilot chute simply laid down. No air, no open. At about 800 feet off the ground I went for the emergency chute and then the main snapped open since I'd broken the vacuum when I reached down.
However, when the voice on the ground bellowed out my apparent malfunction, Maureen didn't even look up. Instead she grabbed her queen, put it into a new position and told her opponent, "Checkmate."
Everyone there got a big kick out of that. I even hit the target dead on and won a trophy although at the price of bruising my coccyx. That's our tailbone, which tells you how I landed.
Even in the finest hospitals we can run into bumps that set us up for surprises and some could even become more severe than my jump. It can be something as simple as being under or over-dosed on medications. Or it could be something potentially a bit more major like a prep nurse marking the wrong area for surgery (which has also happened to me). Usually care given for proper medications works well in hospitals, but sometimes systems develop problems. When we are conscious however, we must also serve as our own watchdogs. For instance after the prep nurse put a big marker pen "X" where it didn't belong I very tactfully asked, "Why there?" She glanced up, frowned, reread her paperwork and then apologizing wiped that mark off and put the correct one on.
There are some things we might be experts at and others when we truly need help. Don't let your ability to understand Eintein's Theory of Relativity get in the way of your lack of knowledge concerning your physiology. Being in a hospital pretty much makes the statement that we need help. However, that help might have to come from us as well as the hospital staff even though we aren't the nurse or doctor. When medications are brought to me I look at them carefully instead of just rolling them out of the ubiquitous small cup in which they arrive. That practice has served me well. More than once I've had a nurse administer a medication and then just moments later another come in with the same dosage of the same medication. The medication's procedure must be adhered to. For one event it was my Coreg (carvidilol). It was to be taken every 12 hours, not every twelve minutes. Speak up though. I had to sort of get tough with that one. The nurse thought I was nuts. He later apologized.
Bumps can happen in your doctor's office as well. But generally those aren't as threatening or intimidating as some bumps in a hospital. I still remember a visit to a doctor where I was put into one of those holding rooms. The doctor would be there shortly I was told. So I sat down and began to read the book I had taken along. (I always take a book to read when visiting doctors or when going for lab work.) Anyway, after three chapters I looked up surprised. "I've been here for an hour." So I went to the door and opened it. The assistant who had put me in there nearly fainted. "Oh my God," she blurted out. "I forgot all about you." Since then I don't let them close the door.
Back in the hospital we are often presented with unknowns and we find ourselves at the mercy of those we must trust. Let's face it; we aren't trained early in life to understand the goings on in hospitals. In fact, early on we probably develop a feeling that we'd like to keep such experiences at a distance.
Lab tests also demand your attention. If you receive a copy before you visit your doctor, please don't accept them as totally or completely accurate or frightening. If you've never had a lab test, then your first will be part of your learning process and your medical staffs may use those tests as a "baseline" for you. Always keep copies of all tests you undergo, whether blood draws or other lab tests. Keep a file. For blood draws, you'll be able to compare any changes that might take place. If you do notice changes that seem rather abrupt, call your doctor and ask what they mean. Also, if you visit one lab for a test and then a different lab for the same test later, you might find variations due mostly to the change in labs.
If you aren't getting copies of your lab reports, then call and get them and ask your doctor or doctor's staff to have them automatically sent you each time, either via FAX or mail or you're lucky, E-mail.
For men, if you get a PSA every year, and suddenly one of them is much higher than the previous year, then ask your doctor if you can take it over again. Labs make mistakes, sometimes really big ones. I once had a PSA reading that was four times higher than my previous year. However, I had a very good urologist in charge. He said, "Well, I suspect someone out there feels good because they got your results and you have theirs." He had me take it over again and he'd been right. I've often wondered about the other chap, though. Why would anyone who gets a very low reading want to redo his test?
Lab readings of X-rays can be off as well. If you don't like the reading of your X-ray, insist on a second opinion.
What's All This Have To Do With Low Sodium?
As humans we seem to have a strong desire for survivability. We want as much out of life as we can get and are therefore always working to extend our lives. We marvel at people who smoke, drink, eat fat and salt and live to be a hundred.
Unfortunately for us, that's probably not going to happen. So, we have to work at it. And that means the whole package. After we are told to cut salt out of our lives, we learn that for the most part we are in charge and safeguarding our effort(s) becomes very important. The total package therefore, requires our attention.