Thursday, December 17, 2015

Future of Healthcare Scenario: TYRON 1

By Malone Smith 
CA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

As I try to keep my eyes open from the last 12-hour shift, my eyelids shut.

“Maybe I can get just five minutes sleep before the next rush,” I stated in my mind.

Eyes shut, I take in the sounds of the trauma wing. It’s like a gorgeous classical orchestra of sounds. Machines beeping, people yelling, monitors sounding and the television playing from Room 3. I can hear the president speaking about Tyron 1 virus in Europe. “Patient suffering extreme tremors, fever of 104 and rash on skin. Virus is morphing to mimic genetic material of patients.” “I wonder how they treat it?” I say to myself. “I’ve only treated…….”

“ Dr. Smith!” yelled nurse Kenny. I jolt awake, like at attention in the military. “I cannot seem to get my mobile lab tablet to work. The glucometer keeps getting jammed.”

“Try a new one Kenny or take blood the old fashion way,” I giggled.

I laugh because I remember the old days. Take blood, send the blood to the lab, and wait for results. That does happen at all anymore.

As I turned around I glance back at the television in Room 3. The channel has been turned to a local news channel. Below the screen flashes “BREAKING NEWS, Plane grounded at Hartford International Airport for sick passengers coming from Germany.”

I run into the patient room, turn the television up so I can be able to hear the television over the noises on the unit.

“Good afternoon everyone, I’m Peter White with WFSB news. We are standing at Hartford International Airport, where we have gotten word that a plane has landed due several individuals being extremely sick. I’m here with Jackie Woods a passenger from that plane.”

“Could you provide our viewers what was happening on the plane?” said Peter White.

“The individuals that were getting sick on the plane seemed to be fine when they got on the plane. All of a sudden the man sitting next to me started shaking. He said that it felt like he had a terrible fever. It looked like he was covered in a rash,” stated Jackie.

As I was watching the report my health tablet and wrist alert began to buzz and flash blue. We are getting those patients and it’s a code blue.

“What is a code blue again, Dr. Smith?” Kenny yells.

“It’s a virus code, to alert the doctors in the hospital to take additional barrier precautions,” I explained.

As the lead of the Trauma unit, I paged all of the infectious disease physicians, as well as everyone else on call to come down to the ER and meet at the nurses’ station in central pod.

I pick up the trauma phone not knowing what was going to be on the other side.

“This is Paramedic George O’Rouke calling in.We have 2 high-risk patients with fevers of 104.5, tremors, sweats and a rash. Patients are alert, on oxygen, have been given a dose of acetaminophen but nothing seems to be working. We are 10 minutes out.”

My brain starts working on overload. What could this be? I start going through possibilities in my head.

Within 2 minutes I have Dr. Paul Sydney (Infectious Disease), Dr. Mary Lopez (Infectious Disease), Kenny Peters (RN) standing in front of me at the nurses’ station.

“Dr. Smith, do you have any idea what we are dealing with?”

“Not sure, everyone. When the patients get here we need to do a thorough work up. Make sure to cross your T’s and dot your I’s. Please go put on your protective work gear. Dr. Sydney, take patient two and I’ll take patient one. Dr. Lopez please assist if needed,” I stated to the team.

Both patients arrive in the ER.

Patient 1 is transported to Trauma 1 and Patient two is transported to Trauma 2.

Both I and Dr. Sydney start evaluating our patients. First comes labs.

“Kenny, please get the mobile lab tablet and take both patients’ blood work,” I stated.

“Okay!” stated Kenny.

All of us are dressed from head to toe in protective gear. We look like space aliens. Blue Tyvek suits, gloves, goggles and face mask. It’s so hard to work in this equipment.

Patients are both full-body scanned by the mobile vital machine.  The scans will hopefully pick up temperature, detect virus or bacteria, and take heart rate.

As the patients are being scanned, I am receiving all of the blood work back on the patients. Fever is 104.5, it’s a virus, and patients are dehydrated. “Why is this machine not picking up what virus this is?”

“Doc! The machines are not picking up what virus this is. How are we going to treat this if it’s a virus that is not documented in this?”

“Give me some time to think about it. Get this patients hooked to fluids and push broad spectrum viral medications,” I told the physicians.

“Where did these patients come from?” I say to myself.

“Kenny! Where did these patients come from?” I ask.

“I believe they are US citizens coming from a vacation in Germany,” Kenny states.

“Germany????” I think to myself.

“Wait, I just saw something on the news about Germany. Patients being sick by Tyron 1,” I say out loud.

“Kenny, link the lab tablet to outside sources. I’ll give you the password to activate the World Lab Diagnostic in the lab tablet,” I yelled.

“Why, Dr.Smith?” Kenny asks.

“ I think that we might be dealing with a virus that has shown up in Germany.I want to see if World Lab Diagnostic has been updated by doctors over there. I want to see how they have been treating those patients!” I state.

“Oooooo, Okay” stated Kenny.

“Run the labs through the program and let me know if there is a hit!” I respond.

A few minutes later, Kenny comes running down the hall.

“Doc, we got a hit on the lab program that you said to run!” Kenny yelled.

“Good! What was it?” I eagerly asked.

“Tyron 1!” Kenny yelled. “ We don’t know how to treat that! That why the patients aren’t getting better. The meds won’t work unless they are specifically designed for them!”

“Kenny, talk to Dr. Sydney and ensure that the patients stay stable. I have to go ring a physician from Germany to see what they next steps are!”

I run down the hall and enter Conference Room three, which is locked for situations like this. The room is dark with a large television on the wall. It’s a huge computer. Health Information Transfer System! The system is a large physician network portal that allows for physicians to login, state what they need assistance with and it will locate a physician specialist that deals with that illness or disease.

I put my password in, upload the patient’s labs and guess on diagnosis. The computer brings up Tyron 1 virus. Please hold………

It seems like forever.

Connecting with Dr. Fredrick Viegen.

“Hello Dr. Viegen, I think I have two patients in my care with Tyron 1. What do you recommend as treatment?” I expressed with concern.

“Hello, Dr. Smith. I read through the labs, yes its Tyron 1! What you need to do is get blood from the patients and use your Viron machine to create two separate antiviral medications that are designed for each patient. The virus morphs to reflex genetic material. That is the only way you will kill it,” Dr.Viegen states.

“Thanks for all of your insight, Dr.Viegen!” I stated.

I rush to the lab where I run both of the patients’ blood through the Viron machine. Two vials of antibiotics are produced. One for patient one and one for patient two.

“Kenny, please administer the medicine to patient 2,” I stated.

I insert patient one’s medication into the IV line.

“Hopefully, this works,” I say to myself.

About 15 minutes later, I check the patients. Fever is down to 99.5, no shaking, rash seems to be fading! It worked!

Future of Healthcare Scenario: Joint Effort Success For All

By Ann Olson
HCA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

The New York newscaster blasted into my bedroom from my 3-D holographic projector at 5:30 am, which was set to awaken me from my typical deep sleep.  It had been a restless night since I was anticipating today.  The weather robot was predicting rain, and as I stretched in my bed, I began to allow myself to think about the day’s happenings, despite the threatening weather.  How could things have changed so much in the past two years?  I took a deep breath as Judy, my community coordinator had taught me to do, and felt an energetic charge go through my body since I was able to breathe that deep breath, without any discomfort, chest pain or shortness of breath.

Judy continued to race in my head, reminding me to use my positive internal voice and I started the mind mantra we had practiced.  I’m 63, I still have CHF (Congestive Heart Failure) but I feel better than I did than when I was 60!  I have worked hard, and have the support to help me do what is important to me.  I can control what I can control, and it’s making a difference!   I rolled over and having finished my morning pep talk, I started to let my mind ease into what brought me to this special day.  What I was going to wear for the awards dinner?  My JESFA (Joint Effort Success For All) wellness team, as well as other State wellness teams, would all be at the event.  “Just tell your story,” Judy guided me over our remote call device yesterday. “Stories make a difference!  It will inspire others to hear that by taking control and advantage of what the JESFA wellness team offers, you gained control of this disease instead of it controlling you!”  I slowly emerged from my cocoon and rehearsed my three talking points in my mind as I walked into the bathroom – Judy’s coaching, SMART phone game, JEFSA collaborative team.

After rehearsing in the shower, I came back in the bedroom to hear the President’s “Breaking Point Address” – his daily morning health message broadcast on every news station.  What were the chances that he would be talking today about the national contest for the state wellness teams that reduced premature deaths and disability due to chronic diseases like mine?  I felt the butterflies in my stomach get a little more active when I allowed myself to think that our group might be getting the Governor’s award today, and that would put us in the running for the national award!  Getting back to reality, I moved over to the desk in my bedroom to my SMART phone, to start my daily JESFA game.   I turned on the encrypted wireless connection and got on the scale, put my finger on the sensor and got ready for the Jeopardy like question game, to play and then get my score.  I only needed 10 more points to the win the free JEFSA You-Ride packet that I wanted.  I wanted the JEFSA You-ride packet so I could get to my granddaughters dance recital in NH.  As I waited for the score to tally, I recalled that I couldn’t have gone to the recital 2 years ago, in the state I was in.  The recital was one of my goals that Judy helped me identify to motivate me to get control of this condition.  As I felt good thinking about that, the phone game rang with score bells and I got the last 10 points to reach my goal!!

Thinking of food, I looked at the clock and decided I better get dressed and eat breakfast, so that I’m not late.  As I tied my last shoe, I moved a little faster when I remembered that it was the first Monday of the month, and I could have an egg for breakfast today!  As I walked quickly into the kitchen I remembered Judy agreed I could still enjoy an egg once a month.  The phone rang and I answered it while fixing my plate.  Only 15 minutes till my ride for work arrived, so breakfast moved quickly, I grabbed my gym bag and followed the regimen to go down the stairs.  I saw the car waiting out front, and moved quickly to head off to work.

I was in my office just five minutes when my boss came in because he received a call from the corporate office.  Since the company was a JEFSA member, they were hoping to get their incentive because of their successful work / life wellness program, if JEFSA won the award.  Before I knew it, the company “Move It” music streamed in, and my group headed to the activity center for our 15 minute exercise routine.  I remembered how stressed I used to feel before the company designated this time and was reminded of Judy reminding me of stress toxicity.  A deep breath was welcomed, as I headed to lunch and then back to the office to finish the day.

My boss came by promptly at five, to head out to the dinner together.  We were busy in conversation as we walked in, and I saw my JEFSA team gathered by our table.  As I walked up to the table of eight, I was still amazed that mine was the story they wanted to share!  Judy immediately came over to us, and since our corporate CEO couldn’t be there, and she introduced my boss to the pharmacy director, the food collaborative president, the transportation coordinator, the housing manager and the physician lead.  I summoned my inner voice as I felt a surge of emotions emerge.   Of the clients with the JEFSA team collaborative, and the other 3 team collaborative in New York State, I was chosen to share my story.  Thankfully, my big thoughts were humbled when the Governor arrived and he was led to his table in the front of the room.

Following dinner, I was mesmerized when the New York Commissioner of Health and Wellness started the program.  He congratulated each of the teams for improving the State’s chronic disease data that they made available through the national health information exchange (HIE), and then highlighted other initiatives.  I was amazed to learn that New York was selected to continue work on innovations to alleviate chronic disease overall.  He described a scanning device that was in its final testing phase to identify risk for diseases at birth, and annually, similar the annual mammograms earlier this century.  With that information, combined with socio-economic analysis and customized DNA pharmacologic medicines, he reported that the results are promising to eradicate chronic disease altogether.  I couldn’t help thinking that I should have been born 60 years later!

As I was lost in the thought of how different my life would have been, I realized that the Governor had been introduced.  He presented statewide statistics on the positive chronic disease outcomes including reduced overall health costs, hospitalizations, mortality and disability, while promoting consumer satisfaction.  He congratulated all of the collaborative, and mentioned that the national winner would be announced that evening.  The Commissioner thanked the Governor and began to introduce me.  It was hard for me to hear him tell my story of how sick I had been; what bad choices I had been making before I was able to be part of the JESFA team.

As I got on the stage, I felt empowered.  The words came easily, as I described my community coordinator Judy.  I explained that our calls and her coaching and coordination, helped me identify what I wanted out of life; what I needed to do to get control of my disease came easily after that.  As planned, I had the crowd laughing at how I tried to win my SMART phone games and how the incentives helped me to cure myself!  I talked about how JEFSA facilitated my housing, helped my company join and offer a health friendly company, recruited participating food and pharmacy distribution centers, and arranged for the transportation You-Ride program so I could make all of my appointments.   But it was when I told my stories – of achieving my goal to being able to get to my granddaughters recital, and wanting to still be able eat my eggs, that the crowd was truly moved. Because JEFSA educated me on my disease and my control, listened to me and helped me through its diverse team, I explained that I would stay on this track of recovery.

Well – we won the state award and now I’m waiting to hear about the national award.  While I know that national success will be hinging on the SMART phone technology, the comprehensive HIE, the collaborative team, the outcome statistics and the cost savings, I am grateful to know that the story matters.  My story, the patient’s story is the one that matters most of all.

Future of Healthcare Scenario: Abandoned

By Paula Pike
HCA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

Born in 1960, I never imagined I'd live past my 80th birthday, let alone 60 years of marriage to my beautiful bride, Anna.  Life had been good until I was diagnosed with Parkinson's disease in 2025.  After a battery of tests in April of 2025, Dr. Arbeteen, a respected neurologist in New York City, handed me my death sentence.  In an effort to manage my symptoms and delay the progression of disease, Dr. Arbeteen prescribed a daunting medication regimen along with physical therapy.  The disease responded poorly to the pharmaceutical management, if at all, and my spirit was saddened by my dependence on others.

Parkinson’s is a horrible, progressive disease robbing my wife and me of our independence.  Now, Anna is burdened with complete responsibility for my care: she bathes me, feeds me, repositions me, and changes my diaper.  It is a degrading position to be in and one I despise.  Recently I became unable to walk, imprisoned in a hospital bed in our living room; the place where we celebrated birthdays, anniversaries, and holidays now houses my motionless and expressionless human shell.  My wife is ill herself, suffering from coronary artery disease and a past myocardial infarction.  I love my wife, but to be honest, she hasn't been the best caretaker of her physical self.  She gained 50 pounds over the last five years adding to her already moderately obese frame.  My Anna is frequently out of breath and I wonder whom the good Lord will take first; secretly, I pray it is I.

Looking back, Anna and I enjoyed the finer things in life.  “Baby-boomers” they coined our generation!  Anna was involved in many equal rights for women activities.  She studied law at Columbia and passed the bar her very first attempt.  She quickly moved from associate, to junior partner, to partner at New York’s largest law firm, Skadden, Arps, Slate, Meagher & Flom.  My Anna was a go-getter, she worked long weeks and long hours; which is what I assume resulted in her increased stress level, hypertension, and myocardial infarction at age 50.  I too worked in New York City as a stockbroker on the New York Stock Exchange.  My hours were really no different than Anna’s, which is why I think we never had children; we were always so busy with work and advancing our careers.  We were not the only childless couple in our friendship circle, the days of filling a home with children and a stay-at-home mother was a thing of the past.

As I reflect on our lives, I wonder what it would have been like to slow down a little and have a family.  At least now, in my final years of my diseased life, I might have had the benefit of one of my children to care for me rather than my ailing Anna.  My friend, William, has advanced dementia.  He is a prisoner in both mind and body.  He has two children but both have their own lives and careers outside of New York.  Unfortunately, William’s wife died twelve years ago and his children moved him to a retirement village on the East Side.  Even having children, William lacks available family caregivers leaving him to be cared for by the retirement village staff.  Thankfully the dementia has robbed William of his memories and he doesn’t long for his son and daughter’s companionship and presence.

The caregiver pool for the aged is quickly evaporating; the government’s Medicare program went bust about a decade ago leaving those of us 65 and older to participate via additional taxes to the universal health care plan.  My entire working life my paycheck was robbed of thousands of dollars to pay for Medicare benefits that I had only briefly received.  Now, additional taxes on my retirement income are redirected to the national universal health plan.  Thankfully, Anna and I had managed to “sock away” a good-sized nest egg, so the $5000 monthly premium isn’t such a financial shock and burden.  Even so, the healthcare system leaves my Anna to care for me without assistance of a companion, home health aide, or nurse.

Today, I awaken to the wet, gargled cough of my sweet bride.  Her myocardial infarction weakened her heart’s functional ability and every so often she has these flair ups of congestive heart failure.  Usually, an extra dose or two of her Lasix pill reverses the fluid overload but today this isn’t the case.  She sits in the recliner next to my hospital bed and puffs into her breathing machine, which delivers medicine directly to her lungs.  I am scared for her and for me.  I watch her chest rise and fall deeply and deliberately and I pray that the medicine is able to reverse her shortness of breath.  It’s 9AM and she hasn’t changed my soiled undergarments from the night, brushed my teeth, washed my body, or fed me my breakfast.  My stomach growls but my Anna cannot hear it over the noise of her breathing machine.  I am scared.

Finally, the medicine delivery has completed and Anna opens her electronic health record chart and begins to enter data for the community on-call nurse to review.  She places her forefinger on a pad to the right of the screen and instantly her blood pressure, pulse, and oxygen saturation are recorded.  She then stands for a moment on a glass scale that records her weight (a measurement of fluid overload).  Finally, she records the medicines she has taken this morning; within minutes she receives additional instructions form the community nurse on next steps to control her exacerbation.  Anna glances my way and produces a small smile as to assure me that everything is going to be all right.  I am scared.

My Anna is a strong woman and she cares for me despite her own afflictions.  Anna promised me the day we married, “to care for me in sickness and in health” she says with a smile.  She gets up from her recliner and begins our daily grind that puts additional strain on her heart and spirit.  First, she uses a Hoyer lift to move my stiffened corpse to an oversized tub.  Thankfully, the machine does most of the work for Anna.  There is a track built into our hardwood floor that moves the Hoyer along a stated path and places me in this tub.  The water disintegrates my soiled undergarments and then, like a car wash, my body is scrubbed.  As the tub drains, hot air is forcefully blown on my body and the Hoyer lift moves me back to my hospital bed of fresh linens that Anna has so carefully prepared while I was in the tub.  As part of the health care plan, meals specifically designed for Anna and I are delivered to our home.  Anna pops mine in the convection oven and then feeds me.  Every spoonful is placed gently in my mouth, allowing sufficient time for me to chew and swallow (although it is a dysphagia pureed diet, and there really isn’t much chewing involved) all the while my Anna is joyfully humming.

Just as I finish my last bite, the electronic medical record laptop alarms, reminding Anna to repeat her battery of data collection for review and next steps.  My stoic Anna talks back to the inanimate object, “I’ll get to you when I’m finished here”.   Anna always puts herself last.  She dabs by mouth with a soft, white napkin and takes the dishes to the kitchen.  She returns with an ultrasonic toothbrush, brushes my teeth and combs what is left of my silver grey hair.  All the while my Anna is joyfully humming.

I hate the burden I have become on my Anna and yet, I am thankful that I have her to care for me.  If I didn’t have Anna, what would have happened to me?  I am scared.

The electronic medical record laptop alarms just a little bit louder this time.  “All right already”, my Anna replies in disgust.  She dutifully sits in the recliner and repeats the data collection steps.  She receives new instructions from the community nurse.  She looks at me and rolls her eyes, mumbling “for the love of Jesus”.  If I had the ability to raise my eyebrows, as if to question what she meant by that, I would…but I can’t as the Parkinson’s stole that from me too!  My Anna gets up in a huff, and retreats to the bathroom to the pharmaceutical closet, I can hear the door unlatch and I wonder what the community nurse has recommended.  If only I could call out and ask, but my words are always garbled leaving me and Anna frustrated that she cannot understand what I said or need.  So instead, I lay there, motionless, listening.  I hear a loud noise.  I envision my Anna on the floor.  I cannot even mouth any words.  My heart begins to pound, I feel sweat forming on my brow and begin to drip down the sides of my face.  I cannot move my fingers to my face to wipe the sweat away as the Parkinson’s has left me motionless.  I listen and hear nothing.  The house is silent.  I am scared.

Future of Healthcare Scenario: Falla

By Luwan Durant
HCA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

Hello, my name is Falla Roberts. Currently, I’m sitting in a hospital bed thinking about my life… I will be in the hospital for a while because I became septic from a wound infection after an appendectomy. The doctor says I will be here at least two weeks. I’m happy in a sense because, I’ll have a warm bed to sleep in, hot meals three times a day, snacks at my convenience, and I’m able to take hot showers five times a day if desire to. I’m living the life! On the other hand, I’ll turn 50 in five days. I really didn’t want to spend my 50th birthday in the hospital. So, April. 9, 2040, I’ll be celebrating my 50th birthday in the hospital. Upon admission, the staff in the emergency room had to throw away my three bags of belongs because they were infested with bugs. They called them bugs however, I called them my friends. The only friends I had these days are gone. I’m in tears just writing about them. I know they’re just bugs, however, I felt safe around them. They did not violate me, I controlled them; they did not control me. I wrote about them in my daily journals which are now gone with my belongings.

I’m happy my hospital room is equipped with a laptop, an interactive TV, and I love the little robot that comes in the room when I push the red button for help. I asked the robot for a pencil and a lot of paper so I can write down my thoughts while I’m here because I’m not a big TV person. I have not had a TV in five years, I have no clue on what I like or dislike. The robot informed me of the laptop available in the tray table. This robot is awesome! It’s so helpful. I really like that it has no ulterior motives. Hmmm, I think I like it more than the bugs.

Until my appendectomy surgery, I have not been in the hospital since I had my last child in 2015. Things have really changed in the hospital setting.  My admission nurse asked me to go to the patient portal on the laptop to answer a lot of questions in reference to my social life.  Initially after reading the first few questions, I was reluctant to answer the questions because I remembered grandma’s saying “what goes on in my house stays in my house”. After sitting in the room awhile thinking… I thought, I do not have a house so, I do not have to hide anything. I went back on the patient portal and answered all the questions. There were questions relating to housing, food, access to medication, transportation, family background, and also questions on my safety.

The safety question awakened some very bad memories. I grew up in a very strange environment. I was molested from the age of five to 13. I told my mother and my grandmother about it, they stopped me from going to the family member’s homes that molested me however, we never addressed or discussed it after that. As a teenager, I was walking down the street one day, a total stranger grabbed me, pulled me close to his car and raped me in broad day light after he finished; I walked home as if nothing happened. I never told anyone about this.

The question about a support system brought back bad memories too. I was living in an abusive marriage for 27 years. Five years ago, I said enough is enough. My kids were grown and finished college, I packed my bags while my husband was at work. I left the west coast and moved back to the east coast. Until a few years ago, I kept in touch with my children. For the past five years, I’ve lived in a mobile shelter park. The shelter park was great, I had three roommates. Two of them worked at a local Food Mart and the other roommate and I worked cleaning mobile homes at the shelter park. After my appendectomy surgery, I made a mistake and fell asleep with my door unlocked, I woke up to one of my roommate’s boyfriend sitting on the foot of my bed. My roommate was in her room sleeping at the time, I told him I would scream if he touched me. He left my room and I did too that night. I’ve been living under a bridge for the past five weeks prior to being admitted to the hospital for this really bad infection.

Wow, I’m glad the patient portal asked those questions. It really felt good to open up and write about the past versus writing about the bugs. While I was writing, a face popped up on the screen with an icon that says “Click to start a live conversation”. I clicked the icon, a brief summary of the person I was going to talked to came up. To my dismay, this woman’s life story was similar to mine. The woman’s name is Sandra, I signed all the consents for Sandra to read my information. Within minutes, Sandra and I were chatting as if we knew each other our whole lives. Sandra signed up to work for this company called “Adopt a Friend”, a non-profit organization that uses the information in the patient portal to match them to a person with a similar story. This company is similar to, the owner says, the concept generated from her experience on in her biography.

Sandra holds a degree in social work, a field she went in after dealing with her own social issues to be able to help someone else. We talked for about an hour and a half. Sandra promised she would send me information to read to keep me occupied during my hospital stay. On the patient portal, there is an instant message link, I can instant message her at any time and she or one of her colleagues will get back to me immediately if it’s emergent or within 24 hours for non-emergent issues.

Sandra sent me the following email the next day:
Hello Falla,  
There are 46 million Americans who live in poverty and are measurably less healthy and have far worse health outcomes than the rest of the population. You are one of the 46 million and I was once one of the 46 million only three years ago. Like you, I was linked up with “Adopt a Friend” during a hospital visit. My friend’s name is Theresa. Theresa helped me to get off the streets, back in school and working. I’m hoping I can do the same for you. I do not know if you know but there is a shelter called the “The Safe Place” for abused women. I will send you the link so you can take a virtual look at the shelter and the programs the shelter has to offer. Theresa referred me to “The Safe Place,” as well. I lived there for about 18 months before getting my own place. You have three kids but I have five. The counseling I received in “The Safe Place” played an instrumental part in rebuilding my relationship with my family. I know this sounds like a lot. However, I want you to know if it can happen for me, it can happen for you. I and my colleagues at “Adopt a Friend” will be with you every step of the way. 
Your new friend,
This letter from Sandra had me in tears. The little robot, my nurse and my tech came in my room to see what was wrong with me. A few days ago, they came in my room because they heard me crying about missing my bugs. So, the nurse began to apologize for the staff in the ER throwing away my belongings. I stopped her immediately and told her, “No need to apologize, I’m happy they threw away my belongings.” The nurse, the tech, and the robot seemed puzzled. The robot’s eyes lit up with yellow question marks. I explained my experience with Sandra. I also explained how having access to the laptop and the patient portal changed my thoughts on life and has given me hope for a brighter future. I hate that Sandra had the same experience that I had, but it’s good to know I’m not alone and there is hope. The nurse and the tech joined me in shedding tears, and the robot’s eyes lit up with red hearts.  Upon leaving the room, the nurse told me there was a discrepancy with my name. I apologized and told her Falla was an alias I made up, meaning “failure” in Spanish. My real name is Michelle.

Oh my, this was all a dream…. I wish it were real. I have the tendency to let my imagination get the best of me when I’m writing. It looks like I’ll be back on the streets when I’m out of here.

Future of Healthcare Scenario: The Importance of Established Medical (and Circadian) Rhythm

By Cara Ann Cama
HCA:507.90 Organizational Innovation, Creativity & Change Management in Healthcare
Post University

Linda scanned her fingerprint onto the visual TimePad to clock out and Terapio4, her robotic nurse assistant, retreated to the nurses’ station to await its next assignment. The night shift was about to begin. The hospital floor was silent with the exception of the occasional squeak from a Terapio tire. Linda took one last visual scan of the periphery as she yawned in exhaustion and hopped into her Ford InstaTraveler to head home.

Terapio4 met with its fellow robotic health assistant models to prepare for room rotations. Once assembled together, the captured EMR records from the prior shifts streamed from the database within the Terapios via iCloud network into online patient charts. Red flags for urgent patient matters popped up instantly on all of the on-call staff’s tablets for review. A few minutes later Terapios dispersed to administer medications, assist in patient mobility training, take vital signs and track patient urine output levels.


Linda removed the cafpatch from her arm to cease administration of caffeine into her system. Her limbs and eyes instantly grew heavy as the fatigue set right in. She stretched her arms up high and relaxed with a deep sigh. As she rubbed her knuckles into her bloodshot eyes, she headed over to the REMopedic. Linda placed the sensors on her forehead to register the necessary sleep cycle based on her cognitive function level and stepped into her pajamas. The double shift she had just worked drained her mentally and physically. Terapio4 was a great assistant, but the complete dependence on nurses for medical procedures and patient relations placed a lot of stress on Linda.

Before hopping into her REMopedic, she asked Siri for her social updates. A holographic screen appeared before her with touch sensitive applications. Linda selected an option that opened up to a live video streaming of the hospital floor she worked on . Patient dissatisfaction lights outside the doors were all off, indicating the Terapios were in control and on top of everything. She pushed away the hologram and snuggled herself into her REMopedic capsule to begin her circadian rhythm. The tanning bed-like structure folded over and an aerosol mist of melatonin filled inside. Linda’s muscles began to stiffen and her heart rate increased as her blood pumped faster within her. Her lungs caught an automatic and soothing rhythm as she entered into REM sleep. The expedited alternations between REM and deep sleep allowed for all the necessary biological benefits of sleep to occur in only half the time. REMopedics were staples in health care provider’s homes— especially nurses struggling to keep up with the demands of a physician-less world.


An elderly patient from Brazil entered the hospital with complaints of fever, body aches, and a rash. Terapio4 approached the patient with attempts to register the patient, but being unfamiliar with the technology differences from her country, she could not communicate.  Terapio4 attempted to comfort the patient, but the 65-year-old patient hit the machine with her cane and began to scream. Terapio retreated to the nurses’ station and tele-contacted all on-call professionals for assistance.

Linda’s tablet lit up with red flags and vibrated until it fell from the bedside cabinet onto the floor cable unit disconnecting the REMopedic. The sleep cycle was disrupted mid-REM and a bright light entered the unit waking Linda suddenly. Groggy and irritable, Linda was confused with what was going on. She pushed open the REMopedic and grabbed her head as a migraine shot through her frontal lobe. Linda grabbed the used and practically empty cafpatch from the night before and placed it on her arm. She began to focus a little and scanned the room as her eyes met the still vibrating tablet. Her eyes sore from lack of sleep, she opened her holographic video stream of the hospital to see multiple Patient Dissatisfaction lights illuminated. Linda quickly dressed and ported back to the hospital.


Terapios scattered from room to room to assist and reassure patients that there was no threat and the screams from the Brazilian patient were not of concern. Linda was met by Terapio4 with a debriefing on the patient. Linda quickly approached the patient who was now visibly shaken and wrought with concern. Attempting to comfort the patient, Linda held her hand and escorted her into a private room to talk. The patient calmed down and was able to tell Linda about her symptoms of fever and body aches. The pounding headache still resounded within Linda as she attempted to evaluate the patient.

Linda was used to dealing with apprehensive elderly patients and accounted the chaos to unfamiliarity with the changes in technology. Looking forward to heading back to sleep, she diagnosed the patient with Influenza, and suggested rest and Tylenol.  Too exhausted to port back home, Linda opted for an empty on-call room. She rested her eyes for a brief nap.

Several hours later Linda awoke feeling recharged. She freshened up and reviewed her cases from the night before. Terapio4 greeted Linda and alerted her that the Brazilian patient was still there. Curious, Linda decided to check in on her. She peaked into the waiting room to find the patient stiff, cold and shivering. Linda extended her hand to the patient and as she went to shake her hand, she noticed a large rash on her wrinkly forearms. Linda asked if the rash was new and the patient told her no, but it was getting larger.

Sleep deprivation resulted in Linda failing to elicit the rash symptom. Paired together with her recent travel from her home country of Brazil, the patient was actually suffering from a case of Dengue fever. Now a serious exposure risk to the hospital, and a heightened carrier risk via Terapio4, this patient should have been quarantined immediately. With her limited cognitive abilities and depressed immune system due to insomnia, Linda, too, contracted the infectious disease.

Medicine requires a rhythm and established structure for all patients. Addressing patient concerns through comprehensive medical interviewing exhausts the chief complaint and any other patient concerns. However, nothing can be done for others if providers are not caring for themselves first. Providers have a personal responsibility to ensure they receive adequate amounts of sleep as to not put the lives of others in danger.