During my surgical internship, we had a formula for identifying when patients were ready for discharge from the hospital. If a patient “looked good, felt good, and was wearing the clothes he wanted to wear”, that patient was ready to go home.
The year was 1985, a different time in health care. I can’t imagine too many docs today trying to apply a similar set of criteria. Insurance companies would have a fit. The physician would be labeled by peers and hospital administrators as non-scientific, evidence-lacking.
Too bad. The criteria were pretty darn good, from a clinical perspective. For days, a patient could be bed-ridden, food tray untouched, face filled with that pasty look. You’d stop by in the evening, hoping to hear of some improvement, only to learn from the patient’s nurse or a family member that nothing was different from the morning. “Maybe tomorrow will be better,” you’d opine. Then tomorrow morning, sometimes surprisingly, there the patient would be, sitting up in the bedside chair, complaining about his hospital gown, trying to get one hand into his own shirt over an i.v. while swiping at an uncooperative eyebrow or patch of hair with the other. You would stand there and review the objective pieces of information. You’d align that data with the expected timeline for recovery. But you already knew how this was going to turn out. If the fellow passed the discharge screening triad by mid-day, he was usually going home.
I thought about those criteria this morning when I awoke at five AM with a headache bigger than the space available inside my skull. This isn’t right! I yelled internally. Day 4 of feeling like crud, looking like Flat Stanley, and wearing sweaty pajamas. This isn’t right. I’d had enough, was unable to sleep because of coughing and unable to be upright for any amount of time because of general flu yuck. I was tired of it all. Sick and tired of it all.
Angry, I made myself crawl out of bed and stumble to the kitchen for some fluids and a dose of ibuprofen that I knew would just upset my stomach. Then I retraced my steps back to bed and some compressed pillows. And more waiting. Waiting to recover.
That’s when the surgical team from 1985 rounded on me.
“Day 4 of admission for influenza,” the intern stated wearily. He didn’t look at me, clearly disappointed that I’d not done better overnight. “Body aches are improved but he has a headache the size of Texas, worsening sinus congestion, intractable coughing, and persistent temperature instability. Limited oral intake too.” The guy’s tone of voice belied a certain cynicism at his patient’s interest in making progress.
Everyone else nodded. They all stared at my pajamas. That meant one thing: I was going nowhere. Which was fine because nowhere was how I felt. I felt like plain old nobody going nowhere. “Try to sleep,” the intern advised. Then off he and the others went.
Not again, I told myself. I’m not disappointing that intern again tomorrow morning. Today would be the day! Today I would turn the corner. Sure, my body replied. It reminded me of my hacking cough, booming headache, and surliness of stomach post-ibuprofen. Ready by tomorrow. Yeah. Whatever. I drifted into a state of uncomfortable non-sleep. By expected clinical course, I should have been up and about this morning. By the criteria of appearance and clothing selection, I was stuck in illness.
However, a few hours later, I’m up. I’m not better, but I feel ready to be better. I need to be ready to be better. So I shave. Then shower. Then wash some clothes. And then I put on something other than pajamas. And I sit somewhere other than semi-propped up in bed.
Being sick stinks. I’m lucky though, and I know it. Because this flu illness, no matter its temporary ugliness, is likely going to pass, either later today, tomorrow, or the day after that. Many other patients aren’t so fortunate. Too many people have chronic conditions that either challenge their daily routine or flare regularly and repeatedly, disrupting anything resembling a normal course of life. These folks don’t have the choice of whether or not to wear the clothes they want to wear. Every day, they just have to wear those clothes, look the best they can, and try to balance things so that they look and feel as good as possible on as many days as they can. They have to become warriors for their health.
We understood a little something about warriors in 1985. While there weren’t as many patients living with chronic conditions back then as there are today, there were still plenty of bad things, such as cancer, that gave people good reasons to be and stay sick. Sure, we could cut out some badness, or bypass blockages, or perform other temporizing procedures. But the clinical toolkit was more limited than it is today. So we let time and the warrior-nature of people help. We didn’t want anyone going home before they were ready, not because of insurance DRGs, hospital length of stay statistics, and readmission rates. We didn’t want our warriors to unnecessarily suffer.
Maybe that’s why we watched for reliable signs that recovery at home would be better than care in the hospital. One of the best signs? You guessed it: the patient choice of wardrobe. Once someone put on her own clothes, she was usually ready to take on the challenges of healing outside the sleep-interrupting patterns of a hospital surgical ward. Once someone was inside his own shirt and pants, we didn’t want him spending a day longer in the hospital than was needed.
I don’t know how I’ll be feeling during the next rounds from my imaginary hospital team. My head still feels oversized and my sinuses are still under pressure. But I’m looking better, at least one person has told me, and I’m no longer sitting in bed. I’m also wearing the clothes I’d wear if I wasn’t sick with the flu.
Maybe tomorrow’s my day.
Ugh! Praying today’s the day. Feel better