Tuesday, January 10, 2017

The Disappearance of Darkness

Before PACUs there were recovery rooms and yes they were nocturnally
illuminated by 15 watt nightlights and nurses penlights

Over countless millennia,  human behavior has been influenced by the 24 hour cycle of sunlight and darkness. Evolution has imprinted our nervous systems with the notion that daylight is for vigilance and night is for peaceful rest. Fooling around with nature's rhythms produces an unpleasant emotional response. Just ask any night nurse how they feel leaving the hospital when all the daylight personnel file in all bright eyed and bushy tailed. I used to feel nauseated after working nights and the bright sun provoked a throbbing headache. Hospital patients don't feel well to begin with and keeping them up all night with bright lights adds fuel to their emotional distress.

Modern hospitals are brilliantly illuminated inside and out at night. The brightness of the helipad can be seen from miles away. Florescent lights bombard halls and patient rooms with artificial daylight 24/7. This photon bombardment is definitely NOT patient centered.

One local hospital here in Pittsburgh actually had signage (don't get me started on hospital signs) offering eye masks to patients. Just ask your local friendly nurse for one if the bright lights prevent you from sleeping. Maybe they should be also be in the ear plug dispensing business. There is certainly minimal resources contributed to promoting restful sleep. I guess this is one more attempt to force patient participation in their care. "No.. we cannot dim the lights at night so here is an eye mask to cover your face with." said the caring nurse.

From personal experience, I can tell you hospitals do not promote restful nights for their patients. I don't know which was worse, the bright overhead lights or the nurses clip clopping around in their noise producing clog footwear. I believe they are called Danskos, but a more accurate name would be Decibels for all the racket they produce. Old nurses valued quiet footwear. There  was nothing like a well broken in pair of Clinic nursing shoes for stealthy moving around at night.

Old school hospitals were serious about patients getting their rest. Sleep was actually recognized as an important element for the patient's recovery. At night the hall lights were dimmed by a switch at the nurse's station so they were barely on. All areas occupied by patients contained one tiny night light that was louvered and close to the floor. Nursing personnel all carried flashlights or tiny penlights and these were only switched on at the bedside when providing care. There was a cache of tiny 15 watt bulbs at every nursing station. Darkness was an important commodity.

I have been attempting to write about something other than operating room tales, but it's difficult to shift gears at my age. So here I go again with a story about lights out in the OR.

There was an unusual, but very good vascular neurosurgeon that I occasionally worked with. After clipping and removing a potentially life threatening aneurysm from cerebral circulation his routine orders were for the circulator to turn off all overhead lighting for a full 2 minutes. He asked the nurse to carefully time the lights out interval, but by instinct, he could tell exactly when 2 minutes were up.

His explanation for this practice was that the brain was housed in the light tight cranium. He wanted assurance that there would be no occult bleeding in the dark intracranial cavity after he closed everything up. If anyone questioned this practice he always said in a haughty, judgmental voice that he was doing this based on empirical evidence. I guess his point was that this trick seemed to work, but there was no science to back it up.

I always thought that after having a brief lights out interval, the surgeon's eyesight was more acute and sensitive to any bleeding after the lights were fired back on. Anyhow, his trick seemed to work. Nurses see some whacky things!

Thanks for reading my foolishness.

4 comments:

  1. I had to laugh... the stepdown unit associated with our ICU DID offer ear plugs to patients!! No masks, though ~

    Me, personally ~ I have NEVER been able to sleep in a hospital, not even when I was 10 years old!!

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  2. As a patient, sleep is very elusive for me too. It's another story when working as a nurse. Late at night, I think that I fell asleep standing up a few times. At least in the OR, bright lights kept me awake. Dr. Slambow used to swear by dunking his head under cold water at the scrub sink when tired. I tried the dunk trick, but had too much wet hair to deal with. Dr. Salmbow was bald.

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  3. From Denmark ... i think you at FABulous :))) Love your stories - and reminds me of a "different" more patient-centered" time .....
    regaurds ...

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  4. It certainly was a very different time. Nurses were much warmer and fuzzier when there were few real cures for illness. If we could only combine today's technology with yesteryear's caring it would be a perfect world. Thanks for commenting.

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