Choosing your Hospital Buddy/Buddies:

Who should be your Hospital Buddy?  You should be accompanied by someone you trust to take accurate notes for you, someone who will speak up for you and question people when necessary, and who is able to put up with you when you are in a less-than-perfect-health-induced crabby mood.  It should be someone with whom you are comfortable sharing medical information.  It also should be someone with whom you have discussed your general medical goals and wishes, including what you would want done in a life-threatening emergency (if this person is not your legal medical proxy (someone to whom you have given the legal authority to speak for you in a medical situation if you are incapacitated), he must know who your legal medical proxy is and how to reach that person).  This person could be a spouse, partner, family member, friend, or a hired Hospital Buddy (there are private nurses available for hire, as well as trained non-nurse hospital companions who can especially be helpful overnight).

It is tiring, both physically and emotionally, for someone to be your Hospital Buddy.  Therefore, you might want to line up a few people, if possible.  This will enable people to take turns, so that everyone has a chance to get home (or to a local hotel) to shower (guests are not allowed to use patient showers), sleep, and attend to any other urgent matters.  If the hospital stay is only for a couple of days, then one person should generally be adequate.  If the hospital stay stretches beyond two or three days, it helps to call in the reinforcements, even if only for a few hours each day or a few overnight shifts.

When people to whom you are not close enough to ask them to be your Hospital Buddy ask what they can do to help, request that they help hold things together at home.  If your Hospital Buddy is your spouse or someone else you live with, ask a neighbor to take in your mail and take care of your pets.  If you have young children, have a friend, family member, or trusted adult babysitter stay with them so that your spouse can be with you.  Other help-offerers can be asked to bring dinner the first few nights you’re back in your house.  The more people you allow to help you, the less pressure you’ll feel like you’re putting on any one person.

My hospital has specific visiting hours.  Won’t the nurses kick my Hospital Buddy out?

What about visiting hours?  In general, most nurses are lenient about allowing people to stay beyond designated visiting hours, provided visitors are quiet and considerate of roommates.  With resistant hospital personnel, your best bet is generally a calm, well described explanation of how your/your Hospital Buddy’s presence is actually assisting the nursing staff (help with keeping the person comfortable, assistance with getting to the bathroom, bringing a person water, general psychological support, help remembering details when communicating with doctors, etc.).  Getting permission from your doctor is also extremely helpful, as it can help avoid objections from a later shift of hospital staff who might not be familiar with your Hospital Buddy system.

It is much simpler to have a companion stay overnight when there are private patient rooms.  In a private room, there is generally more space for a convertible chair or a cot.  When there is a roommate in the picture, there can occasionally be resistance from a roommate’s family or from nursing staff to overnight Hospital Buddies, and this is best dealt with ahead of time, with permission from your attending physician.  Make sure you address the hospital staff’s concerns (e.g. you will keep noise levels low, you will respect a roommate’s privacy, you will keep the cot/sleeping chair as out-of-the-way as possible), be as polite as possible to the hospital staff, and remember to thank them for accommodating your request.

Why is it even an issue to have someone stay overnight?  And why are there ever limits on visiting hours?

When you understand the objections to overnight visitors, and the reasoning behind visiting restrictions in general, you can easily address any concerns, and are much more likely to obtain the permission that you require.

The short answer to why you need to argue for overnight stay permission is that the hospital is trying to ensure a restful environment for all its patients, and visiting hours tend to be noisier than other times.  However, it is more complicated than that.  The information in the later chapters of this guide (in the section describing “The Places,” which is currently slated to be Section 4, but that could change) will help you to understand many of the factors that play into how a hospital functions, and you will be able to use this knowledge to advocate effectively.

If the person being hospitalized has memory difficulties, even when they are medically rock-stable, there should be a Hospital Buddy with them 24/7.

What about an elderly patient or a patient with memory issues?  If the person who is hospitalized has dementia, it is always best to have a companion stay in the hospital overnight.  It is very disorienting to wake up in a hospital, and many patients end up being sedated or restrained due to overnight confusion (Note: overnight confusion is sometimes refered to as “sundowning”).  The best way to prevent or minimize this is by having someone in the patient’s room at all times so that a companion may gently remind the patient where he or she is, help keep the person from getting tangled in any cords or IV lines, and help keep the person calm.  At night, the person’s Hospital Buddy can remind the person that it is nighttime, and that it is time to sleep.

Many times in a hospital, the nurses deal with “problem patients” (those who are awake and confused overnight, and who might fall from bed, pull out i.v. lines, or otherwise pose a danger to themselves), by rolling their beds down near the nurses’ station overnight.  While this allows hospital personnel to keep a closer watch on these people, it also means that the patient is kept in a light environment through the night, with people talking and walking around, which keeps the patient fully awake.  This contributes to a vicious cycle of a person’s having a disturbed sleep/wake schedule, worsening confusion and contributing to delirium.  It is much preferable for these people to have a Hospital Buddy available to stay with them in their room.

In certain circumstances, a hospital may have a “sitter” – an official person hired by the hospital – sit at a person’s bedside to verbally orient the patient when necessary, and remind the patient not to get out of bed.  However, there are not always enough sitters available for every patient who might benefit from having one, the sitter is generally not someone who is familiar to the patient (and thus may not be as easily able to calm the person, who is feeling confused and disoriented in an unfamiliar environment), and many rehabilitation and nursing facilities will not accept a patient who has required an official hospital sitter within the past 24 hours.

What’s wrong with using restraints and/or sedation? 

While these may, at times, be necessary to ensure a person’s safety, there are risks involved with their use.  A person may respond unpredictably to a sedating medication – older patients, in particular, may be more likely to become over-sedated, even with lower doses.  Physical restraints are generally unpleasant for the person to whom they are applied, and restraints may cause a person physical injury.  And again, there are many nursing homes and physical rehabilitation facilities that will not accept a patient who has required restraints in the past 24 hours, which can complicate a patient’s discharge from the hospital.  While a physician may determine in certain situations that the risks of sedation or physical restraints may be outweighed by the risks of not sedating or restraining a person, it is best to try to set up an environment in which those measures are less likely to be necessary.

Aren’t my doctors and nurses there to advocate for me or my loved one?  Of course, but they have many other patients to care for (your nurse usually has three to seven other patients, unless you are in the intensive care unit, and your hospitalist generally has 12 to 20 or more other patients along with you each day).  It is beneficial to your healthcare providers to have someone knowledgeable about you there.

So my nurses and doctors are busy.  What could my Hospital Buddy really do for me?  Do they really need to be there at all times?

Your Hospital Buddy can remind your doctor that the last time you had a fever and started seeing pink elephants, you had a urinary tract infection.  Or your buddy can point out to your nurse that normally you are quite sweet, and the fact that you are cursing at the nursing staff is a severe, sudden personality change, for which you should be medically evaluated.

Doctors arrive in patients’ rooms at random times.  Your Hospital Buddy will be able to take notes for you while you are napping or sedated – just make sure to scribble a permission-to-talk note for the doctor, so that your doc can speak to your buddy and fill him or her in on what’s happening.  As you write down your daily list of questions for your doctors, you can decrease the stress of worrying about missing your doctors’ visits when you know that someone you trust has that list and will ask and record the answers for you.  You can nap, when necessary, with peace of mind.

What about at night?  Again, it is always safest to have someone with you.  Your companion is there in case of emergency.  Occasionally there may be an instance when someone remains in the hospital simply because they are awaiting a procedure that has been scheduled, or are finishing a course of intravenous antibiotics, but otherwise are rock-stable, and then it may be reasonable not to have someone stay overnight with him.  However, when things are rocky, it is still preferable to try to have a companion.

Chapter 1 – Always Have Someone with You in the Hospital

This is possibly the most important piece of safety advice for a person who needs to be hospitalized.  This chapter explains why it is so important, what this person can do for you, and who this person should be.

No exceptions.  Well, very few exceptions.  A hospitalized person will benefit from having a non-hospital-personnel person with him or her at all times.  We’ll call this person your “Hospital Buddy.”  Like your swimming buddy at summer camp, this is a person you choose and who chooses you, who accepts the responsibility of looking out for you, who enjoys your company, and whose company you enjoy.  As a camp counselor would never let a person out into the lake without a buddy (they would have a person “triple up” with someone rather than let someone in the water alone), you should not allow yourself or your loved one to be in a hospital without a buddy.

Redundancy is routinely factored into systems to ensure safety.  If one safety measure fails, the backup measure kicks in.  Your car has brakes, and it also has seatbelts to keep you from being thrown from the car if your brakes fail to stop you in time to avoid hitting the deer that runs in front of your car.  Your alarm clock has battery backup.  Your house-wired smoke detectors have battery backup.  Your Hospital Buddy is your backup safety mechanism, and a hospital is simply not a place to be without backup.

I’m a perfectly intelligent, capable person.  Why do I need a backup?

As was mentioned earlier, a person in the hospital is either quite ill, or is undergoing something that has potentially serious side effects or complications.  A post-surgical patient may be groggy from anesthesia or from pain medications, and may very likely not be able to think appropriately.  Similarly, a sick person may very well not be in the clearest state of mind.  Chemotherapy can sometimes cause unpleasant reactions – exhaustion and severe nausea and vomiting does not put someone in the best frame of mind to absorb complicated medical information.  A woman who has had an uncomplicated pregnancy and has just delivered a healthy child may begin to bleed and may not be in a state to understand a potential need for emergent surgery.  Someone needs to be there in the hospital to cover for you when necessary.

If it turns out that there are no acute events requiring your Hospital Buddy to step up as your backup, then you will at least have had some company, and someone to bounce things off of when you had decisions to make.  It is never a waste to have had the necessary backup on hand.  If you make it home from the grocery store without an accident, you generally don’t say to yourself, “What a waste it was that I had my seatbelt on.”  Similarly, when you arrive at work on time, you don’t usually lament the fact that your alarm clock battery wasn’t used last night.  Your Hospital Buddy is your seatbelt, or your battery backup.  He or she is your personal advocate in a place where you may very well need an advocate.