Delivery of Care
Letter from Miriam
The ability to survive requires a measure of politeness, of listening, and a recognition that kindness is the key to all human endeavors
Photo by Richard Asinof
The patient's bleak view of care at the Miriam Hospital.
By Richard Asinof
Posted 2/10/25
The inside look at the health care delivery system in Rhode Island, from the patient’s perspective.
What are the best ways for patients’ voices to be heard and listened to? How do we reward the caregivers for their hard work and their initiatives? How do we tell the narratives of the workers who have spent their careers caring for people in Rhode Island? When will kefir and yogurt be available for consumption by patients in hospitals?
We are in a crisis mode when it comes to independent local journalism, given the ability of wealthy oligarchs to control content and messaging. One nurse complained that she felt it was hard to find the content of stories about what was happening. The pandemic stretched our resources to the breaking pont; we are still in prolonged recovery. Another CNA a born and bred Rhode Islander, spoke of her desire to read books, which led to a delightful conversation about several authors.
Good people will find each other, I believe. But it helps if there is a place to allow them to meet and interact without those who exploit social media platforms to sell their products — if you ever order a product online, you are doomed to receive an endless array of come on’s to buy products.
Good people will find each other, I believe. But it helps if there is a place to allow them to meet and interact without those who exploit social media platforms to sell their products — if you ever order a product online, you are doomed to receive an endless array of come on’s to buy products.
PROVIDENCE — I am currently ensconced at Miriam Hospital, having been admitted on Thursday, Feb. 6, after a harrowing night at the Miriam ER. There were no rooms available, and so I was placed on a cot which way too short, my legs hanging out over the end of the cot, for roughly 6 hours.
Negotiating placement in a hospital bed when none are available would test the most cooperative of patients.
My vital signs are all good at this point, and the immediate priority seems to be to get me placed at a rehabilitation facility.
There is irony being a health care reporter and recognizing that all my knowledge does not translate into the ability to impact my outcomes, to any degree.
I will have a lot more to say about all of this in the next few editions, but right now, I wanted to express my gratitude to my friends, family, and colleagues, who have been extremely supportive.
Have you now, or have you ever been, a patient in an overcrowded ER?
The way in which we take care of each other is a measuring stick for our society and our culture.
Depending on the kindness of strangers is a trait that requires a measure of understanding of our ability to keep an even keel in a stormy world.
The Miriam.
The nurse on the 5 a.m. shift was insistent that I be weighed by standing up with a walker and using the scale, although the bed is equipped with a weight measuring device.
The nurse on the 5 a.m. shift was insistent that I be weighed by standing up with a walker and using the scale, although the bed is equipped with a weight measuring device.
I insisted that there be two assisting me to get out of bed after a night’s sleep, because my legs were weak.
Her black jersey proudly proclaimed “Lifespan,” even though the corporate entity was now called Brown University Health.
When I asked her about her jersey, she explained: “We’re Miriam.” Whatever they say on top, it doesn’t matter, adding that the jersey was old but she couldn’t afford new clothing. “We’re Miriam.”
All the nurses and CNAs talked about how happy they were to be working at Miriam, as if it were the workplace destination of choice.
They all had work t-shirts proudly proclaiming “TMH,” The Miriam Hospital, with images on the back, including one that said, “Go with the flow,” with an multi-colored image of a heart.
Clearly, there was a sense of camaraderie, the knowing looks of a team that likes to work together.
My roommate, a truck driver, is busy snoring away, bringing smiles to the nurses, and I told the story sbout how in 1997, when my wife, my son and I were in California, visiting her brother, we were asleep, and my wife, a very light sleeper, elbowed me to ask that I stop shaking the bed.
I protested that I wasn’t, but no matter, she insisted: the bed was shaking. We were both right; the bed was shaking, but I wasn’t doing the shaking. It was an earthquake. The nurses laughed, with a knowing nod of their heads. They knew the difficulties of partners sleeping together.
There was a big rally outside in Providence Saturday, protesting the country’s swerve toward fascism under the new President. A group of eloquent speakers addressed the nation’s plight.
Thankfully, Steve Ahlquist was there, reporting on what was said, allowing me, in a hospital bed at The Miriam, to listen to what was being said. Reporting like this is both brilliant and dangerous to the powers that be. (See link below.)
No one talks politics or health care, although the nursing staff, like the patients, are starved for conversation. Outside the snow is swirling.
The nurse goes to the Dell computer which uses Epic to record all the patient’s data and complains that the machine is slow warming up. “Must be the snow,” I suggest. She laughs.
Right on cue, the corporate logo of Brown University Health appears, over an image of the Newport Bridge. Welcome to Rhode Island, but really, the data heartbeat of The Miriam.
The plastic toothbrush is made in China, the mouthwash by Medline, the toothpaste is "sparkle fresh,” also a Medline product.
The most important survival item is your phone, and the battery charger a key lifeline for contact with the outside world. I can follow in real time the results of any tests that are run, often before the results are reviewed by providers. This was how I found out that I had “abandoned screws C7 “ that were revealed in a CT Scan on Tuesday, January 28. (See link below, "Dancing with refrigerators.”)
Defective products?
My foli catheter was a Bard product; the first item was defective, which required my nurse to remove the defective catheter and put in a new one; she called me a trooper, and anyone who has two catheters installed knows why.
Her black jersey proudly proclaimed “Lifespan,” even though the corporate entity was now called Brown University Health.
When I asked her about her jersey, she explained: “We’re Miriam.” Whatever they say on top, it doesn’t matter, adding that the jersey was old but she couldn’t afford new clothing. “We’re Miriam.”
All the nurses and CNAs talked about how happy they were to be working at Miriam, as if it were the workplace destination of choice.
They all had work t-shirts proudly proclaiming “TMH,” The Miriam Hospital, with images on the back, including one that said, “Go with the flow,” with an multi-colored image of a heart.
Clearly, there was a sense of camaraderie, the knowing looks of a team that likes to work together.
My roommate, a truck driver, is busy snoring away, bringing smiles to the nurses, and I told the story sbout how in 1997, when my wife, my son and I were in California, visiting her brother, we were asleep, and my wife, a very light sleeper, elbowed me to ask that I stop shaking the bed.
I protested that I wasn’t, but no matter, she insisted: the bed was shaking. We were both right; the bed was shaking, but I wasn’t doing the shaking. It was an earthquake. The nurses laughed, with a knowing nod of their heads. They knew the difficulties of partners sleeping together.
There was a big rally outside in Providence Saturday, protesting the country’s swerve toward fascism under the new President. A group of eloquent speakers addressed the nation’s plight.
Thankfully, Steve Ahlquist was there, reporting on what was said, allowing me, in a hospital bed at The Miriam, to listen to what was being said. Reporting like this is both brilliant and dangerous to the powers that be. (See link below.)
No one talks politics or health care, although the nursing staff, like the patients, are starved for conversation. Outside the snow is swirling.
The nurse goes to the Dell computer which uses Epic to record all the patient’s data and complains that the machine is slow warming up. “Must be the snow,” I suggest. She laughs.
Right on cue, the corporate logo of Brown University Health appears, over an image of the Newport Bridge. Welcome to Rhode Island, but really, the data heartbeat of The Miriam.
The plastic toothbrush is made in China, the mouthwash by Medline, the toothpaste is "sparkle fresh,” also a Medline product.
The most important survival item is your phone, and the battery charger a key lifeline for contact with the outside world. I can follow in real time the results of any tests that are run, often before the results are reviewed by providers. This was how I found out that I had “abandoned screws C7 “ that were revealed in a CT Scan on Tuesday, January 28. (See link below, "Dancing with refrigerators.”)
Defective products?
My foli catheter was a Bard product; the first item was defective, which required my nurse to remove the defective catheter and put in a new one; she called me a trooper, and anyone who has two catheters installed knows why.
As fate would have it, I bumped into the same nurse on my next adventure being admitted.
Miriam should be very proud of the quality of its nursing staff it employs, having recognized a defective device. She deserves an award.
I have been given my notice that I will be discharged and sent to a rehab facility within the next 24 hours; from a list I have chosen 5 and this morning, another five.
Make no mistake, the health care system has a formula for how long you can stay in the hospital before being transferred to rehabilitation; the calculators are humming overtime. It's 48 hours.
Make no mistake, the health care system has a formula for how long you can stay in the hospital before being transferred to rehabilitation; the calculators are humming overtime. It's 48 hours.
Time to travel.
It’s Super Bowl Sunday, and I am being transferred to a rehabilitation facility around 5 pm today, having reached my limit at Miriam before discharge is mandatory.
It’s Super Bowl Sunday, and I am being transferred to a rehabilitation facility around 5 pm today, having reached my limit at Miriam before discharge is mandatory.
The hospital delivery system in Rhode Island is a true Rhode Island industry, one where the forces of equity and inclusion and opportunity are thriving, if the sampling of staff who cared for me is representative — nurses and CNAs were almost exclusively Rhode Island born and bred, or recent immigrants from Cape Verde, or older women who have pursued their careers in nursing.
It is clearly an industry that can lead to more prosperity, if the leadership of Attorney General Peter Neronha in seeking to improve the system is followed, and health care does not become a plunder machine for private equity.
Patients are often left out of the conversation; and so are the providers. No corporate logos or pr campaigns can replace the human interactions.
What does a nurse do who encounters a defective folio, recognizes the problem, and corrrects it? How is she rewarded and recognized?
The reality is that all of us are getting older, and we will need more care, not less, as we age. Pushing staff to the breaking point will not yield the results that profit-making private equity financiers seek. As I was leaving, an RN asked, when I commented how busy things were, "Did you notice how many code blues there were?" which indicated a patient's heart failure.
I am just one person, who despite all my knowledge of the health care industry, found it difficult to navigate. There is no excuse for tests that identify problems being ignored — the “abandoned screws at C7” in my case. I only learned about the findings because I could scan the results on my app on my phone in real time.
It may turn out that many of the problems I encountered in my health conditions can be traced back to the abandoned screws. Stay tuned.
