Nobody really wants to be in the hospital, especially not you, the patient. Even the employees would probably rather be somewhere else, relaxing, than at work. Whether your stay comes unexpectedly or is long-planned, and whether you are the patient or accompanying a loved one, it is likely you will have the occasion to spend a night at the hospital at some point. A little behind-the-scenes knowledge can empower you to feel less fear, frustration, and pain, and to make sense of the apparent chaos going on around you. You can avoid hassles, and you may even be able to decrease the length of your stay.

What to Bring to the Hospital (and What Not to Bring)

If you have the luxury of planning your hospital stay in advance, you should make certain to bring a list of all the medications you take at home, including medication name, dosage (milligram amount), and number taken daily. In fact, if you take a lot of medications at home, it is good to carry around a list of them just in case you need it in an emergency, and keep it updated. You should also be able to provide a list of medications to which you are allergic, if any. You will be asked for your compete medical and surgical history, so if it is too extensive to memorize, a list of prior illnesses and hospitalizations written on a piece of paper or card can be very helpful.

Though you may need insurance cards and documents when you come into the hospital, there are very few personal items you will need while staying on a hospital floor. In fact, you will be encouraged to send some items home with a family member, such as any money, jewelry, or other valuables. If no one is available to take them home, you may keep them in the hospital safe, or sign a waiver that states that the hospital is not responsible if they are lost.

In general you should not bring your home medications to the hospital, but rather a list of them. Since the staff cannot know for certain that the medications in the bottles are what you say they are, hospitals prefer to send you medicines from their own pharmacy. If you don’t have a list of home medications, you can bring the bottles to the admitting nurse, allow her to document them, and then send them home with a family member. Only in the case that you take a very rare drug (that is essential to your survival) might the staff ask you to keep your home medicine there, just until the hospital pharmacy is able to order that drug for you.

You can keep your glasses, dentures, hearing aid, and watch with you if you need them for your comfort, but be careful with them. If you must leave your room without an item of value to have a procedure done, give it to your nurse to lock up until you return. Never leave a pair of glasses, dentures, or a hearing aid on a food tray! It may be picked up without your knowledge and be lost forever in the cafeteria garbage before you know it’s missing.

What to Expect During Admission

During admission, you will be given a hospital gown and box of supplies, usually your own water cup, tissues, soap, toiletries, and other necessities. You will be expected to remove your clothes and put on the gown, for the ease of the staff who will be examining you and performing tests. Hospital gowns are open in the back but can be tied. If you plan to do a lot of walking outside your room, sometimes you can request a second gown to put on backward and tie in the front, for more coverage. If you are cold, you can wear your own robe over your gown, except during procedures. Sometimes, if you have your own similar, loose-fitting gown, you can wear that instead of the hospital gown. If the room temperature is not right, you can request additional blankets or have the thermostat adjusted.

If your hospital has both single and double rooms, you may be assigned a roommate even if you wanted a room to yourself. If this happens, ask the charge nurse if you can be placed on the waiting list for a single. One may open up before you’re discharged.

Shortly after your arrival, a nurse or nurse aide will come to check your vital signs (blood pressure, pulse, temperature, and breaths per minute). A nurse (usually a registered nurse, or “RN”) will perform a complete head-to-toe physical evaluation, then ask you what may seem like an endless list of questions about your medical history, lifestyle, and current symptoms. Even though you may have told this to your doctor or an ER nurse before your arrival on the floor, it is essential that your admitting nurse have this information documented, so please be patient.

What Happens Next: Your Doctor’s Plan

Doctors and nurses know that fear adds to pain and pain to fear, and the fear of what is going to happen to you in the hospital can be eased somewhat by knowing what to expect. Your admitting nurse will have a list of orders, written to her by your doctor, stating his initial plan for you. She may read you the list. If not, don’t be afraid to ask what you’re in for. Initial orders will include the following:

• Diet. If you are not “NPO” (which means nothing to eat or drink, usually because you are about to have a procedure done or have a gastrointestinal problem), you will receive three hospital trays a day. If you are on a “regular” diet, then you can eat normally, and usually food brought from home is okay, too. You may be on a restricted-calorie or low sodium diet, in which case you should stick to the foods on your tray, since the calorie count or sodium level in the foods has been calculated for you. If you are diabetic, you may be sent a snack also. It is important to stick to your diet, and not to eat anything if you are “NPO.” If you do eat when ordered not to, your procedure will have to be postponed, and you will probably have a longer hospital stay. You should be able to select from a menu of choices for your meals each day, in the form of a slip of paper that you mark in the morning. If you don’t fill it in, the cafeteria will decide for you. If there is a problem with your meals or you are still hungry, don’t wait until too late in the day to mention it to your nurse. The cafeteria may close after dinner, after which you will be limited to food available on the floor, which may be only juice or milk and crackers.
• Activity level. If your activity is “as tolerated,” you may move about freely, but you should still be cautious if taking a medication that makes you drowsy. It is always better to call for assistance than risk a fall. Your activity level may be “with assistance,” in which case you should push your nurse-call button if you want to get up. If you are restricted to “bed rest,” there is probably a good reason, and getting up will affect your safety.
• Intravenous line (IV). Whether or not continuous IV fluids are ordered, most hospital patients will at least have a “saline lock” or “heparin lock,” basically an IV with a stopper that nothing is flowing into at the moment. The part of it that remains in your vein is not a stiff needle, but a flexible plastic catheter, so it cannot cut you after it has been placed. The rationale behind having it is that if an emergency should occur and you need medication, IV access is readily available so that no time is lost. While pills must go through your stomach and be slowly absorbed, IV drugs take effect immediately. Your IV will probably be changed every few days, depending on the policy of your hospital. It will also be flushed according to policy, which means that a nurse will push in a water solution to make sure that it stays open and functional.
• Consults. Your primary care doctor may have requested that some specialists come to see you about your particular problem.
• Medications. Your doctor may order that your home medications be continued, which is why having a list of them is so important. On the other hand, he may want to put you on a completely different regimen. Though you might be quite satisfied with your home medications, you must remember that they may change during your hospital stay. You might take some medications through your IV in the hospital that you took as pills at home. You may go home with orders to stay on the previous medications, or to change to new ones. If you are concerned about this, discuss it with your doctor. Hospital medication times are scheduled by the pharmacy. If you are not happy with the schedule, you may be able to change it by talking to your nurse.
• Intake and output. Your doctor might want a strict record of how much fluid you take in and how much you put out. If so, you can help your nurse by informing her of how much you drink while she is out of the room. Your urine may be measured from a bag if you have a catheter. If not you may have a urine “hat” which fits on your toilet if you are female, or a specially shaped urine jug if you are male. Your nurse will measure and empty it for you, so you should save it for her, and inform her if it is too full rather than emptying it yourself, to allow for better measurements. Some patients are embarrassed about leaving urine out, but rest assured that your nurse is not squeamish about urine at all, and would much prefer to have a good measurement. In addition, she can examine the urine for its color and character, noting any sediment or blood, which provides good information about your health to your doctor.
• Labs. Your doctor can obtain a wealth of information about your health from a sample of your blood. For this reason, you will probably have blood drawn on admission by a phlebotomist from the lab, who will come in carrying a big box full of tubes. This “vampire” may be the first person you see each morning, since labs are generally drawn early so that doctors can examine the results when they begin their rounds. The phlebotomist is looking for your biggest, easiest vein, usually the one on the inside of your elbow. (This vein is not the preferred vein for your IV because people bend their arms so frequently that the plastic catheter becomes obstructed and bent, but it is fine for the phlebotomist, whose goal is to get in and out as quickly as possible.) Though you may wish it, blood cannot be drawn from the IV you already have in your arm. In addition to blood samples, your doctor may also want a sample of your urine or sputum (mucousy spit), or a swab of any wound you have.
• Tests and Procedures. You may be scheduled for tests by other departments of the hospital. Some of the tests you will be transported to by wheelchair or stretcher, and some of the tests come to you. You may be scheduled for EKGs or radiological scans. You may also have orders to undergo surgery, which will be discussed extensively with you beforehand.
• Respiratory. Many patients are ordered supplemental oxygen and/or breathing treatments, usually supplied by a respiratory therapist.
• Other Nursing Orders. You may need a urinary catheter, telemetry unit to monitor your heart, or other device or treatment, which will be explained to you by your nurse.

During your hospital stay, your doctor will visit you every day, and he will probably write new orders each time he sees you. It is very helpful, if you are able, to make a list of questions and concerns to discuss with the doctor when he comes, since it will be more difficult to contact him for answers after he leaves the hospital floor. Also, it may be hard to predict what time the doctor is going to arrive. Though your nurse can tell you what time the doctor usually comes in, the doctor will rarely give you an exact time, and don’t be surprised if he is early or late!

Dos and Don’ts While in the Hospital

DO:

• Ask questions. The more you know about your treatment plan, the less stressed you may feel.
• Point out anything that doesn’t seem right. If you think something is wrong with your medication schedule or your IV, or if anything in your room is beeping, tell your nurse. Something may need to be repaired. Also, though generally very competent, hospital employees may make mistakes just like all people do. It never hurts to ask.
• Tell your doctor about all the symptoms you are experiencing as early as possible. If you wait until discharge to tell him you’ve been having chest pains, you might wind up staying an extra day for a cardiology consult.
• Know that death is listed as a possible risk on every consent form. The hospital wants to protect itself from litigation no matter what happens. It doesn’t mean death is very likely to occur.
• Call your nurse for pain medication early, before the pain gets too bad. Since she is likely to have several other patients with needs, it may take your nurse awhile to get to your request.

DON’T

• Don’t ever smoke in the hospital! The most important reason is that there is an oxygen source in the wall of every room, and oxygen combined with fire causes explosions! There will be a smoking area just outside the hospital door. If you cannot take yourself there and have no family to help you, a nurse aide may take you down, but she is obligated to complete her other duties first. If you cannot travel without an oxygen tank, then you cannot smoke at all, because of the risk of explosion. Also, don’t spend too much time outside smoking, because you might miss tests, medications, or doctor visits, which could lengthen your hospital stay.
• Don’t push the buttons on your IV pump or other equipment. You could give yourself a lethal dose of medication if you alter the settings. Also, resist the temptation to keep silencing a beeping pump or to turn it off yourself. Call your nurse instead. If it is beeping, there is a problem. If it isn’t fixed, you may end up with an IV site gone bad and have to be restuck, or you may get behind on your medication schedule and end up having to stay longer to finish the course. Do not unplug yourself from the pump to remove your robe and plug it back in yourself. This leaves you vulnerable to bacteria that might enter the system when it is unplugged.
• Don’t expect the technicians who perform your tests to give you immediate results. Technicians are trained to take good pictures, not to read them. Final results must come from radiologists and other doctors, and even your nurse is limited as to what results she knows and can share. Doctors may take a day or two to get back with results.
• Don’t expect everyone who enters your room to know your complete medical history. Hospital staff members with limited responsibility to you know little about you. Keep in mind that even your nurse reports to duty only about half an hour before taking patients, so she has a limited amount of time to learn about several patients from the previous shift nurse. Nurses cannot possibly read your entire chart before coming to see you the first time, but if you have the same nurse over a period of days, she will become very familiar with your situation. The person who knows you best is your doctor, and even he needs his notes.
• Don’t take any home medicines while in the hospital. They may interact with your hospital medicines, which puts your health in jeopardy.

What to Expect at Discharge

The only person in the hospital who can send you home is your primary care physician (PCP), the doctor whose name appears on your armband (or his partner). Though specialists and hospital staff can recommend or approve your discharge, only your PCP can order it. Therefore, he is the person you should ask about discharge.

You should know that you are not a prisoner in the hospital, and you are free to refuse any treatment or leave at any time. However, you may be asked to sign a form that states you are leaving against medical advice (AMA). Beware that if you leave AMA, your insurance company may refuse to pay your bill. Also, your health may be at risk if treatments aren’t completed.

Once discharge is ordered, your nurse will bring you a form with your doctor’s instructions and explain them to you. You may need to limit your activities for awhile or change your diet or medication regimen. If no further orders are pending and your ride has arrived, she will remove your IV and send you to your car in a wheelchair. (Even if you can walk, hospitals prefer you leave by wheelchair.) You will have a list of instructions and a phone number to call should you have any other questions.