In May, for one week, I sat daily at the hospital bedside of a dear friend who was trying to recover from a formidable bedsore and two surgeries related to her hip fracture. She was thoroughly exhausted and depleted from the frequent surgical check-ups, thrice-daily wound dressings, every-two-hour turning of her body, vital sign monitoring throughout the day and night, and persistent attempts by perky rehab specialists to get her back on her feet.
"All I want is some rest," she would plead. "Can't you tell them I need sleep to get better?"
Sleeping in a hospital? Resting a worn body that needed deep healing? How could I convey such radical concepts to the hospital staff?
Everyone knows that an overnight stay in a hospital is supposed to serve as a universal stress test, offering each patient a total-body check-up (and at no additional cost!). The searing overhead lights flicking on whenever nurses enter the room are a terrific means to assess a patient's state of arousal and primitive nervous system.
The monitoring alarms that beep ominously for no "apparent" reason throughout the night -- they actually enable the psychological assessment of a patient's concern for his own life and death. Being awakened to take routine medications at all hours of the night explores a question about that patient's capacity to adapt to disruption and chaos -- important coping skills for anyone burdened with serious illness. And perhaps it goes without saying, but those boisterous staff discussions in the hallways -- the ones between 2 and 6 in the morning -- they're meant to test a patient's hearing and sense of humor.
Do we really want to forgo all these patient benefits that accrue from disrupted sleep in hospitals?
It's been taking a long while for health care administrators and medical professionals to wake up to the possibility that "hospital culture" can harm patients when it treats them as around-the-clock checklists. It also treats them as tasks that must be divvied up among staff according to the artifice of their shift hours, not the hour of a patient's need.
My depleted friend's request for restorative sleep sounded thoroughly sensible. On her behalf, I asked the staff if we could minimize disruptions to her sleep by coordinating various interventions at lengthier intervals. Maybe dress her wound at a time of turning her. Coordinate medications with vital sign collections.
I received several polite nods. A few raised eyebrows. Some sympathy for my old friend. But, consistently, I also received an explicit message that went something like this: Are you crazy? Your friend is in a hospital! She's on our schedule!
Well, so much for the original meaning of "hospital" signifying hospitality extended to guests. Instead, as both a physician and patient, I was reminded of philosopher Ivan Illich's view that "Modern medicine ... isn't organized to serve human health, but only itself, as an institution."
Indeed, it's stunning that only last week did we see the first study ever published to critically examine the routine practice of nighttime vital sign monitoring on medical wards. Researchers of the study in the July 1 issue of JAMA Internal Medicine pointed out that the hospital tradition of collecting vital signs every four hours had been perpetuated since 1893 without convincing justification of its value.
Meanwhile, evidence had accrued that sleep disruptions were highly prevalent among hospitalized patients (yes, formal studies were funded to corroborate this), and sleep deprivation in general had been associated with several unhealthy outcomes: impaired wound healing, diminished immune function, elevated blood pressure, heightened stress hormone responses, depressed mood, memory impairment, heart problems, and delirium.
Those researchers found that fully 45 percent of nighttime vital checks on medical wards might not be, well, "vital." Instead, they were sleep-disruptive interventions performed on low-risk patients with greater chances of being harmed than helped by the checks. The researchers suggested that more strategic vital sign collection may "improve patient experience and safety in hospitals."
Only a year ago did another study -- which included two authors of the aforementioned publication -- report on the objective measurement of noise and sleep disruption on a typical medical ward.
Published in the Archives of Internal Medicine, the study demonstrated that usual hospital noise levels in patient rooms were too loud. The authors concluded they were "markedly higher than recommended levels and associated with clinically significant sleep loss among hospitalized patients."
It seems that in our fact-driven era, we've become too overzealous in needing to articulate the blatantly obvious with data. We too often prioritize collecting quantifiable information about patients, over eliciting and attending to their actual experiences.
Still, I am inspired by the trends to seek major grant funding for a study of my own: whether middle-of-the-night bedside serenades by volunteer bagpipe brigades seriously interfere with the quality and quantity of patients' sleep.
Of course, I won't know the answer until I complete that study. In the meantime, I will use as guidance this sage wisdom offered by Florence Nightingale in 1863: "The very first requirement in a hospital is that it should do the sick no harm."
Kate Scannell is a Bay Area physician and the author, most recently, of the novel "Flood Stage."