Cascade Hospital Entrance
| ER | ICU/Ward | Trauma
|
Cardiology | Forensics
| Genetics | Infectious
Disease | Neurology | Obstetrics
| Oncology | Orthopaedics
| Pharmacy | Psychiatry
| Surgery | Toxicology
| Miscellaneous | Hospital
Emergencies
Last updated October 10, 1998
The Cascade Hospital is a resource website designed specifically to help FANFIC and other FICTION WRITERS who want to make their stories more medically authentic. It is NOT for people seeking answers to personal medical questions -- that is a job for your private physician.
Being a patient in the
ICU and Wards
Okay, you've gotten Jim or Blair out of the ER or surgery. They're stable. Now what? They go to the ICU or the wards. What's it gonna be like for them? Here are some general things to help you out.
Please read the Sentinel and Medical Disclaimers.
ICU vs. wards
Hierarchy of a teaching hospital
Nursing
Vitals
In's and Out's
IV fluids
Medications
Pain medicine and other drugs -- Visit
the Pharmacy!
Do I stick 'em in the ICU (Intensive Care Unit) or the wards?
Depends how sick they are. In the ICU they can be hooked up to more machines and have one-on-one nursing care. If they've been really sick and just had a big emergency surgery, they probably belong in the ICU. If they're unconscious or unstable, they probably belong in the ICU. After a day or so when they get better, you can move them down to the ward where they don't need a nurse watching them all the time.
Hierarchy of the doctors in a teaching hospital
I thought I'd put this section in because in the pilot of The Sentinel, it appears that Jim went to a teaching hospital because he asked Blair (disguised as Dr. McCoy) "are you the intern or what?" Basically, most large hospitals serve as teaching institutions to train new doctors, and each level of training is called a different name. It can be confusing to most people who aren't familiar with the medical field. You start out at the bottom of the pile as a medical student (most people do four years of regular college, then four years of medical school). You usually get to go into the hospital in your 3rd (junior) year and start seeing patients under the supervision of everybody else, because you know pretty much nothing (at least it feels that way). Medical students can't write any orders without having a resident or attending co-sign them. You do two years (your junior and senior years) of clinical training, then you graduate with an M.D. Then you select a select a specialty of your choice (internal medicine, pediatrics, ER, Ob/Gyn, surgery, whatever) and start what's called a residency, which is specialized training in that field. Residency can last from 3 to 10 years, depending on what specialty you go into. Most primary care residencies are 3 years (medicine, pediatrics, family practice), while the surgical residencies are longer. Anyway, while in your residency years you're called a resident (creative, huh?). A first year resident is often called an intern or junior resident. After your first year, then you get to be called a senior resident and supervise the newer residents and medical students on your team. After you finish your years of residency, you take your specialty boards and get certified in your specialty. Now, you're a real doctor, not a doctor-in-training. If you stay at a teaching institution, then you're on top of the heap and your title is the attending.
Any nurses reading this, please accept my apologies if I get anything wrong here because I'm not a nurse.
The nurse's job is to care for the patient and follow the orders the patient's doctor has written. This involves checking vital signs, dispensing medications, helping the patient with tasks like eating, walking around, and being comfortable. Unlike the doctor, a nurse is readily accessible and nearby the patient 24 hours a day. Nurses also change dressings, make sure the patient's IV is working, and alert the doctor if the patient needs something or is getting worse. They also often function as a very important emotional support and informational source for the patient and family.
Vital signs: this means taking the patient's temperature, blood pressure, pulse rate, and respirations (breathing rate). In the ICU where patients are sicker, there's one nurse for one patient so they can have the closest level of supervision. Nurses may take the vitals as often as every 15 minutes in the ICU; if the patient is stable, then it's every hour. On the ward, the patients aren't as sick, so the vitals are done every 4 hours (or maybe less often, like every 8 or 12 hours).
I's and O's: Doctors also often request that the nurse measure the patient's "I's and O's", or intake and output. This means keeping track of how much fluid the patient drinks and how much fluid the patient gets intravenously. And even more fun, you have to measure everything that comes out, i.e. urine. For guys this usually means going in a urinal (lots of fun for the patient) if they don't have a foley catheter in them. If they've got a foley, the nurse just measures it when they empty the bag. For ladies without a foley, they usually have these lovely bed pan things to go in if the patient can't get out of bed (Ick) or sometimes they have these plastic "hats" that can go in the toilet and catch the stuff. Aren't you so glad you're reading this? The whole point of this is that it helps to know in sick patients if they're getting enough fluids (not getting dehydrated), because if they're not, it could keep them from getting better.
IV fluids: Nurses keep the patient's IV in working order and "hang" all the fluids the doctor wants the patient to get. "Hanging" fluids means putting the bag of saline (or whatever the fluid is) on the IV pole and connecting it to the tube running into the patient's arm (IV). They also set the speed at which the fluid flows into the patient, which the doctor specifies.
Medications: Nurses make sure the patient takes all the medicines the doctor wants them to have. There's three basic ways they do this: give the patient pills, give them a shot, or give them something through the IV (of course there's always suppositories, but we'll save that for another time).
If it's an IV medicine (the method if the patient is very sick and/or can't take anything by mouth, or the drug just doesn't come in pill form), the nurse may inject the medicine into a rubber "port" in the IV tubing designed for drugs. Or the medicine may come in a bag or bottle which gets "hung" like other fluids and infused into the patient through the IV over a period of time.
A shot's pretty self-explanatory. Most shots are given in the upper arm, not the buttocks like people like to say. That's because there's a danger of poking the sciatic nerve when you inject in the buttocks, which can be very painful and very bad.
Pills are really easy, and most patients like these better. The goal is to convert the patient's medicines to pills so they can go home. It's possible to arrange for a patient to get IV drugs at home, but that requires a home nursing visit and special lines, so you don't do it unless it's really necessary.
Doc, I need something for pain!
Most Blair and Jim-bonking I've read in the fan fiction requires pain medicine! (Poor guys.) Visit the Pharmacy for lots of info on pain medicines and other commonly prescribed drugs in the hospital.