Nobody Told Me It Would Be This Hard | Part 1: Executive Leadership in a Hospital Room

Speaker A: M welcome to suits and pajamas, where grace meets grit and ambition learns how to breathe. It was a little after 6 o' clock in the morning when my mom came over and woke me and told me that there was a problem in her apartment. I walk over to her apartment and I, uh, opened the door and water was everywhere. There was water across the bathroom tile, into the living room, on the wood floor, into her carpeted bedroom, into the closet. And much to my disappointment, I go down and there was water just pouring through the garage ceiling below. And I was trying to stand there and make sense of what I was looking at. I mean, I knew what it was. But then that's when I saw them. Two bath towels, completely soaked, lying in the middle of the floor. My mother had tried to clean it up herself. What she had done was she had been, unbeknownst, um, to David and I, she had been flushing food down the toilet. And so the toilet overflowed sometime around 5, I'm guessing that morning, maybe even earlier, frankly. But because her dementia has progressed so significantly, it never occurred to her to come downstairs and tell us. Instead, she tried to fix it alone. David and I spent more than six hours vacuuming up water, pulling back carpet, moving furniture, trying to save whatever we could. And to add to this, David was one day away from flying to California for a work reunion thing. And there we were, just looking at all this water on the floor, trying to do what we could to mitigate any damage. A few days later, the insurance adjuster came in and estimated the damage at nearly $27,000. Standing there that morning, I really thought that that was the crisis. I had no idea that three days later, after David had flown away to California, I had no idea I'd be standing in an emergency room being told that my mother's intestine was twisted, that part of her intestine and colon would have to be removed, that she'd wake up with a permanent colostomy, and that everything about our lives was about to change. Sometimes life doesn't announce the biggest storm. Sometimes it quietly opens the door and it lets you walk right into it. And so I welcome you all back to suits and pajamas. Over the last six weeks, many of you know that, uh, I've been a little busy. You've wondered where I've been. I've gotten emails, messages, comments, people asking if everything was okay because I had kind of gone radio silent, which is not like me. So not only was I not, you know, doing the podcast, I just really checked out from talking to a Lot of people. Because, um, I just had a lot going on. Because the truth is, everything really wasn't okay. I've spent the last six weeks literally trying to keep my mother alive. And I want to be honest with you, all about what that was like. Not the composed version, the real one. I was terrified. There were moments when she was in the hospital that I stood there alone at, uh, 2 in the morning and did not know if she was going to survive what was happening to her body. I was angry at the system that sent her home unresolved, sent her home with an unresolved diagnosis. And they sent her home on a Sunday. And then she was back in emergency surgery by that Tuesday. There were times I felt invisible in specific ways that caregivers feel invisible. Doing everything right and still feeling like no one saw the full weight of what was being asked. I didn't know what to do. At least not in the first hours, not in the first night. I was figuring it out as it happened. You know, building the plane while flying it at 6am at midnight and every hour in between. And that's the honest version. But here's what I realized. Somewhere in the middle of it all, I wasn't calm. I was leading. And there was a difference. Professionally, I'm, uh, a vp, responsible for governance, integration, operational excellence, risk management, IT security, et cetera. My career has been built around seeing what other people miss, Finding gaps before they become failures, questioning assumptions, building systems, holding organizations accountable. I coordinate teams, escalating when necessary, protecting ultimately what matters most. I've spent more than 25 years doing that inside corporations. I never imagined the greatest leadership challenge of my life wouldn't happen inside a building. Inside it. Well, it did happen inside a building. Let me take that back. It didn't happen in a boardroom and a conference table. It actually happened inside a hospital room. The organization wasn't a company. It was my family. The stakeholders weren't executives. They were physicians, nurses, case managers, social workers, rehabilitation facilities, insurance companies, Medicare, Medicaid, and a frightened 74 year old woman with stage 6 dementia who needed someone to become her voice. That's why this series exists, because advocacy is leadership and leadership belongs everywhere, especially where the stakes are literally life and death. And so this is part one of a three part series. And by the end of it, I'm going to give you something I wish somebody had given me. A repeatable framework for the day. Someone you love cannot speak for themselves, so you will learn to never be the quietest person in the room. Part one is going to be about the inside of the hospital, what they don't tell you when you check in. Part two is going to be the discharge cliff. That includes rehabilitation, Medicare, and the system that sends them home too soon if you let them. Part three is going to be the now what? Finding care, understanding costs, and making the hardest decisions you'll probably ever make in your life. Before I get in this story, I want to introduce the framework that kind of emerged from these past six weeks. Not because I planned it, not at all. Instead, it's because necessity built it. Six pillars. Every story I'm going to share maps back to one of these pillars. Pillar 1 observe. Pay attention to what everyone else overlooks. Watch. Listen. Patterns matter. Details matter. The smallest observation can completely change an outcome. I observed the NG tube was the wrong size before the doctor even considered it. I observed that the lab teams were ignoring the sign on the door. Observation saved my mom from unnecessary pain countless times. And I mean countless times that I'll share later. Pillar 2 question. Never confuse competence with certainty. Ask again and again. Some of the most important decisions in my mother's care changed because I asked one more question. And then one more question. Pillar three Document. If it isn't written, it might as well not exist. Names, times, diagnoses, conversations, promises. Everything. Documentation creates accountability. And I kept notes from the very first day, as did my family members who helped to take shifts. Those notes became the continuity the system's handoffs failed to provide my mom. Pillar four Escalate. Respectfully, professionally, immediately. You are not being difficult. You are protecting someone who cannot protect themselves. Those are not the same thing. Pillar 5 coordinate. You gotta coordinate healthcare changes every 12 hours. Your loved one does not. You become the continuity. You become institutional memory. You become the bridge between shifts. I built a family shift schedule because the hospital systems required it. Again, small things that I noticed told me my. My spidey senses tingled and told me we cannot leave mom alone. Not for a second. Pillar six Protect. Protect, protect. Protect the patient. And protect, protect, protect yourself. Because burnout doesn't help anyone. Neither does guilt. Neither does silence. And the caregiver who falls apart cannot advocate for anyone. So as you listen to this three part series, I want you to hold those six pillars because we're going to come back to them again. Pillar one, Observe. Pillar two question. Pillar three document. Pillar four escalate. Pillar five coordinate. Pillar six protect. So I'm going to start with what I've dubbed the first admission. And what they missed. My mom was admitted on a Friday. She Was diagnosed with a UTI dehydration. Mentioned, uh, they mentioned, uh, ileus, which was a slowdown of the intestine that can resolve on its own or it can signal something more serious. By Sunday, they sent her home with an antibiotic and no follow up on the ileus. They were merely treating the UTI because, as many of you know, with elderly people, UTIs are very common. So they just assumed that was the real problem. I had questions at discharge, but I didn't have the vocabulary to know which ones were the right ones to ask. The process moved really fast, and I didn't ask all of the questions that I really should have asked. And that is pillar two, failing. Not because I failed per se, but because the system had not given me the framework I needed to know what to question. By Tuesday, she was back. So discharged on Sunday, she was back by Tuesday. After a CT scan, it confirmed intestinal blockage. She had a twisted intestine. And they wanted to try a non surgical approach first, which meant putting a tube through the nose, down the throat, into the stomach with air pressure that might cause the intestine to unravel on its own. The doctor told me that I could step out, that I didn't have to be in the room when they did this, but I couldn't do it. I could not leave my mom by herself with her stage six dementia. She was already frightened. And I'm not gonna lie, guys, I was terrified to be in that room. It was so hard. And I get emotional now just thinking about it, because I was just as terrified being in the room as I was of leaving her in there by herself. She's at that stage where she can be kind of childlike in some of her responses. So I stayed. And again, even though every part of me wanted to be somewhere else, I stayed. So, um, the doctor attempted to insert the tube. It was obstructed. And he pushed. After a couple of tries, uh, at it, she begged them to stop. She. Her exact words were, please, no more. Please no more. It's like a child begging for the pain to go away. So that hurt in my heart, that part of me that was just hating hearing her being in pain, immediately turned to anger. I was so angry. And I wanted to say that plainly. I was angry in a way I have rarely been angry in my professional life or anywhere else, because I'm trained to manage my reactions. But in that room, watching my mom beg and watching the procedure continue, I, uh, was furious. I told him to stop. Simple and plain stop. And Then I asked with every bit of composure that I could hold, did they have a smaller tube? And the doctor looked at me, as a matter of fact, and he says, well, yes, I guess we can try that. So matter of factly, like that option had simply not been considered, like the procedure would have been continued, my mother would have been continuing to beg if I hadn't been in the room to ask. You can best believe, I have no doubt, if I was not in that room, they were going to continue to put that larger tube through her nose, down her throat and enter her stomach. And guess what? The smaller tube worked the first time. So please understand that is pillars one and two. Observe. Question. I observed that that tube wasn't working. I questioned whether there was another option. Those two actions changed what happened next. So mom had the surgery and it went a little longer than they expected because they found two different issues once they went in. And as it turned out, my mom was in the hospital for two weeks and I stayed with her every single night. I took the night shift, uh, and it wasn't because I wanted to. It was because within the first night I understood that night shift is a different institution. 42% of all hospital errors occur during night shifts. A 2026 shift. Uh, 2026 shift. A 2026 study found night shifts rotations directly increase medication errors and reduce nursing performance. And in a clinical audit, 100% of healthcare staff acknowledged fatigue related performance lapse. Every single person surveyed. Guys, these are systemic failures. But systemic failures land on patients and my mom could not protect herself from them. And listen, let me be really clear. This is not an indictment on doctors and nurses. It's more about the system. Because the system is what's failing. Not just the patients, but it's failing the caregivers as well. The nurses in particular. I have a real problem with the lack of support that nurses get. But at the end of the day, their lack of support and the systemic failures that are around, I can't let that be at the expense of my loved one, and neither can you. So please understand, one has nothing to do with the other. There are cases when there were some nurses that were better than others, no doubt about it. But that's in any profession. So I want to talk about now, like what protection looked like, at least for me, and how I felt and how I approached all of this. The night nursing staff kept presenting these full size pills for my mom. They were antibiotics. And anybody who's taken antibiotics, you guys know those things are huge. And she had just Come out of surgery. So her throat is swollen, it's dry because they stuck a tube down her throat and she was struggling and so I. They tried to bring her those full size pills and I was like, no, you need to split them. And they were trying to, like, have her take them anyway. I was like, no, no, no, no, hold up, hold up. You. You are not, you're not hearing me. She cannot swallow those whole. I said, fine, I'll cut them up if I need to. Well, they got snooty and they were like, no, we'll cut them up for her. So they did. They wanted to do them in halves. I said, no, you need to do them in thirds. Okay, fine. But she couldn't swallow them when they were trying to do it. So that's why I insisted on the three. So don't think I just said when I saw them automatically, don't. I saw she had tried to do it and it was hurting her. So. But, uh, here's the thing. Antibiotics. Uh, everybody knows you got to take them until you're done. So every night I was going through this with them. They were trying to still do the whole pill or doing half. So I kept having to ask them to split them. Now, the thing about the nursing shift, at night, they have fewer staff available, and that means the patient to nurse ratio is bigger. And so while your loved one may be dealing with something, they're off with another patient. Even when you hit that call button, sometimes there's a delay. And so for me, as I'm sitting there, I'm the one observing my mom's behavior. I'm observing what works for her, what doesn't work for her, what she struggles with. As a simple example, when they were trying to give her the pills, I told them, you cannot just give her the pill. You have to let her drink some water first to lubricate her throat, because again, it was swollen. She had just had surgery, for Pete's sake. So when they wouldn't, when she would have the water first, when she then put the pills in her mouth, they went down easier versus her waking up. No water in her throat. And they just try to give her this dry pill while she's taking water came. So that was number one, the other issue that I noticed. And this is why, again, please have someone, especially post surgery, and especially when your loved one is in a vulnerable state. Lab techs, the lab team always comes in between like five and six o' clock in the morning, right, to draw blood. They have to, because they're Trying to do it before the physicians come on for morning rounds. Makes sense. So 5 to 6am like clockwork, the lab team would come in. The problem is my mom has really tiny veins. And so this has always been the case. It's documented in her files like crazy. It's just very difficult to get a line on her. Like, even just getting the iv, they had to try multiple locations to try to get it. So the they. The lab team, the first night, they kept trying to poke, poke, poke, and the guy couldn't get it. And he had such an ego. I've done these for so many, so many times, for years. I'm like, the best. We have all that crap. And I'm like. And I. And I told him, it's like, I don't doubt that. I just need you to hear me. She's already dehydrated, and you're trying to draw blood on a line that I'm telling you already collapsed twice. But of course, he didn't listen. He tried. He tried. I had to tell him to stop. And then I requested a midline, because a midline is a specialized access line that is placed specifically to prevent repeated needle sticks. So again, my mom, childlike, getting poked anywhere from five to 10 times because somebody was insisting that they could do it, not caring that it was hurting her. So it got to the point on that second night after. And something told me after the first night of them doing this and not listening to me, that I definitely had to stay. Sure enough, and I'm not exaggerating, please believe me, every single night, over 14 days that I was there, the lab people kept trying to come in and draw blood on my mom. And I had to stop them every single time and tell them, no, she has a midline. And so then their little quip back was like, oh, so you're refusing us to draw labs? I was like, no, get the nurse so she can draw the blood through the midline, because the lab people are not allowed to do that. I learned that too. So I told them to get the nurse. And so the nurse would come in and draw the blood. So, like, day four, I'm like, can you guys just put a sign up? Because first of all, they're waking me up too. I'm not sleeping at all. You guys know what it's like at the hospital. They're constantly coming in that room. I'm exhausted. And never mind that I'm still working. So anyway, I'm at the hospital with mom from like, 9 to 8 in the morning. So 10, 11 hours every night I'm, um, with them, no sleep. So after a while I got frustrated and I just asked the nurses, can we put a sign up that tells the labs, the lab team, do not try to draw blood? Do you know they still tried, even with big sign on. And when I told them there's a sign up there. No, there's not. Yeah, there is. And I would have to literally walk them to the sign that they just passed. It was awful. It was awful, awful, awful. So all I was asking them was to draw the line, draw the blood correctly. And so that got really frustrating every night for two weeks. So please remember, pillar three, document. Pillar four, escalate. Pillar five, coordinate. Okay. So I documented all of this. I escalated to the nurse when I needed to, to come in and tell the lab people to leave. And the coordinate part came in what I'm about to share next. And that's the family shift schedule. My husband, my brother, my aunt, my daughter, we built a schedule the way you would build a work schedule. Because in essence, that really is what it was again, 10, 11 hours for me because I took the night shift. The remaining, you know, 12 to 14 hours were covered by rotation based on availability for the rest of my family. We coordinated like a team because the hospital's night systems required it. I had to be there. So it's not like we could leave her over the course of the night. And then there were like six of us to rotate, you know, every other day or something. And, uh, we were so coordinated. By the way, the nurses and the doctors said that they had never seen a family so committed to being a continuous presence for their loved one. They said it like it was a compliment. But I actually kind of received it as an indictment of a system where a family's 24 hour presence is deemed remarkable rather than expected for a patient who cannot speak for herself. And so here's what I want you to understand about those two weeks. Life did not pause. I still had to show up for work. I still had to answer emails. I still had to lead meetings, manage global initiatives, and perform my level, my, my perform at the level of my role. Right. That it required because the job does not adjust its expectations to your personal circumstances. Now, don't get me wrong, my company, the company I work for, understood. And so I did take like a couple of days off to really get like into a rhythm with my mom because it was just so unpredictable what was going to happen with her. So, um, it was a really challenging time. And while I Was still trying to show up for work. I was still showing up for my husband. He was covering shifts with me. But, you know, a marriage still requires that version of you that's not, uh, coordinating logistics and managing crises. Right. I have children, I have grandchildren, my little babies, um, that I still needed those calls with. Frankly, they got me through, um, but they still needed me in the ways that they always needed me. Babies don't understand. Where's Grandma? Right? Like, that's just important to me. And so the daily need that it doesn't announce itself, but the accumulation of it, when it goes unmet, it gets tough. My auntie Mom, I flew my aunt from New Mexico out too. And so we just became this collective of people who really made sure mom was good. But for me, the hidden cost of all of it was real and rarely counted between trying to figure out when I could grab a meal not from the hospital cafeteria, because I'm just there just was not appealing. But I lived at the coffee shop downstairs, um, dealing also still with the insurance, uh, claim for the flood, the water damage at the house. For that first week, David was in California. So I was really dealing with all of that. And by the way, so nobody thinks nefariously, my husband, he had offered to stay, but this trip had been planned for a long time. And it's where he gets his joy. And he also helps me with my mom all the time. I wanted him to get away for a while, so. And everybody who knows me knows I'm a very capable person. So I was able to, like, navigate that for a week, um, without much, um, too much of a sacrifice on my part for sleep. It was fine. It was what it was anyway. Researchers call people like. Like me and many of you out there, the sandwich generation. And I think I've talked about this in a previous episode. It's where you're caring for aging parents while still supporting children, grandchildren, and while working full time. The majority, though, is, by a wide margin, done by women. Almost none of us have institutional support that accounts for the full weight of what we're dealing with. I carried it, and I am still carrying it. Again, not to sound like a martyr, I'm not doing it all by myself. But the lions share. The majority of it falls for sure on, uh, me. And so this goes back to pillar six, you know, protecting yourself. What I want to talk about is it, uh, may sound small, but it's really not small. I, for a while, was getting massages twice a month. Not as an indulgence, as maintenance. It Was a scheduled protected investment, My own physical and mental health, something that was mine. And I haven't had one in six weeks because my mom requires, as her doctor noted, around the clock, 24 hours, seven day a week care. And David and I are managing this pretty much alone right now. Um, I do have my brother who comes, but unfortunately, like most of the times, the time that he's able to come is about 10 hours out of any week. And that's difficult because 10 hours out of, you know. Yeah, it's tough. And so, yeah, my mom requires a 24 hour K. So the slot in my schedule where it used to live, used to exist for me, is now occupied by something that just can't be moved. When she needs her bag changed, I have to change it. I have to help her get dressed, I have to make sure she's brushing her teeth, I have to do all those things. And I named this specifically because caregivers are expected to understand that self care disappears during a crisis. And many of us don't say anything about it. It's treated kind of as obvious, acceptable. The cost of love. But multiple studies have documented that family caregivers during acute care episodes significantly reduce their own preventive health behaviors. Exercise, sleep, medical appointments, self care routines. And this can go on sometimes for months. After the acute episode resolves. The caregiver who stops maintaining herself does not come back automatically when the crisis ceases. And so that depletion compounds. And that's why Pillar 6 became the hardest one for me to practice. Protecting myself. I preach it, but I was failing at it. The massages stopped, the walks stopped. The version of me that had gone on calendar, oh, my red lights. Oh, I have these red lights, you guys, because I have, um, inflammation. I don't know, the menopause thing. Oh, it's frustrating. But I have these red lights at home, so it's not like I have to go somewhere to get them. I just didn't have time because again, if you recall, I was sharing, I was going in for the night shift. So I'm at the hospital at nine, ten o' clock at night, until eight o' clock in the morning, I come home, I take a shower, I jump on my laptop. Why? Because I gotta work. And so it became this vicious cycle, uh, for, you know, the whole time that my mom was in the hospital. So Pillar six is where I failed myself. And so that's why I'm emphasizing this for you, is not to say do what I do. I'm just telling you what I learned and what, you know, God forbid, but if I'm in another crisis situation or an acute crisis situation, I will be taking that time for myself somehow, some way, even if it's just one hour out of the day. But um, just wanted to share that because that was a really hard part for me. This is not self pity, please do not even go there in your mind. This is about being accurate in my statements, being accurate in my feelings and my experiences. And it's because of this accuracy, that's where my recovery began. Okay, now I'm going to break this into the suits argument versus the pajamas truth. The suits argument. I think we all know that hospitals operate on evidence based pro protocols and clinical guidelines that have been developed over decades, centuries even, and that system has saved lives. No doubt night staffing reflects the global resource realities, however, and family members who are present and advocating are a resource to the clinical team. The fact that your mother survived major abdominal surgery, right? Or your father survived major abdominal surgery, it's evidence of what the system can do. When it's working, they survive. And so I want to give this argument its full weight because it's not wrong. The medical professionals who cared for my mother were not malicious. At least if they were, I never knew they were working within real constraints. Staffing ratios, documentation requirements, shift schedules and clinical guidelines. And the fact that she is alive at her age with all the work that had to be done. She survived major abdominal surgery with severe advanced dementia and she had a few significant complicating factors. This is all evidence of what the system can do. And so the suits argument also says patients and families can and should be active participants in care decisions, ask questions, advocate. The informed family member is a resource to the clinical team. That is 100% true. I've lived it. And it places the entire burden though of the advocacy on people who are already holding everything else. Again, my plate was full, my cup runneth over. So I was holding so many other things. So the suit side of this does not count that cost, however, the pajama truth does. And so I want to shift to that. The night shift is a documented higher risk environment for patients who cannot advocate for themselves. The person filling that advocacy gap is doing it while holding a full time job, marriage, children, grandchildren and a parallel caregiving relationship. Sometimes because maybe that other parent is aging, which in my case during this time found out my dad has cancer. It's been a rough six weeks, everybody. So I apologize again for being delayed, but I'm not sorry because everything that was going On I needed to be present for my family. So anyway, all that to say, the system does not see any of that. It sees a family member in the room. And I would even question, do they see a family member? They see a person in the room. It doesn't see what the caregiver is carrying and even what she's losing to be there. And so here's what the system doesn't account for. It doesn't account for that 42% error rate on the night shift, the 100% fatigue acknowledgment, the dementia patient who cannot tell you what happened while you were gone, the lab tech who ignored the sign on the door, the nurse who doesn't want to, um, doesn't want to split that pill. And alongside all of that, the caregiver providing the protection the system cannot provide while simultaneously doing everything that life requires with no pause, no substitute, no handling or, um, no giving her a plan. Right? There's nothing. There's no manuscript here. The shift change is also a vulnerability. Every time the nursing staff changes, your parents or your loved one's story gets summarized. And so each handoff is an opportunity for the detail that matters the most to get compressed out of the record. Not again, not maliciously. So, for example, with just splitting the pills, if the nurse, the first shift nurse, did not tell the second nurse, the night shift nurse, that you have to make sure you break up her pills, they're just going to pick up those pills, put them in the little cup and bring it to her to give to her. Right? And so that handoff is not always going to provide the best continuity of care. When it, when it fails, that's where harm can come to your loved one. And so the family member that is sitting there, the caregiver, is the only person positioned to catch that failure. And the dementia training gap is real and documented. A lot of hospital staff, here's what I really learned. A lot of them, I don't think, have training or they can't recall receiving training specific to dementia patients. And that is a really freaking big deal, because they kept trying to talk to my mom, like she was able to understand what they were saying. And every time they would ask her a question, it was a lot of medical crap. And I say crap because they knew better, because I had made it very clear what her status was, and they were still using terms. And so she was just confused and looking like, uh, like she. She was lost. And every single time she looked at me, and then I would have to try to explain it to her as if I was talking to a five year old. They knew better. So if I'm not in the room again, they're just telling her all this stuff. And what they love to say is, well, we told your mom. And I'm like, what would. Why would you tell her and not tell me? I just went to go get some coffee. You could have waited till I came back. Oh, so frustrating. So frustrating. Um, so anyway, uh, the staff who really struggled with my mom's care, like I said, they weren't malicious. They were just under trained for the specific patient that was in front of them. And so she, unfortunately, for the cost of that gap, or she could have, I should say, if my family wasn't there, because y', all, we were there. My family showed up and showed out, and I was so, so, so proud of them for being there to help make sure that mom was seen if by no one else. She was seen by us. Okay, I'm almost done, I promise. But this is a really big deal, and that's why this is broken up into three different, um, pieces, because I learned a lot. So here's what I actually believe after living through two weeks in a hospital while also living the rest of my life. Your presence matters. Your advocacy matters. The question you ask in the room matters. The system should not require your presence for your parent or your loved one to be safe. The fact that it does is a failure, but naming it doesn't change it in time to help your parent right now. And so here's a little framework, uh, that I would like to share with you, because it basically became my little personal rule. Not because I'm just a naturally outspoken person, and if you know me, you know me, but because I really realized that if I didn't speak up and if I was silent, it was going to have serious consequences. So again, remember, part one of this series is about the in hospital experience. So hospital advocate questions that I recommend you ask before any procedure. Simple they may sound, but trust me, common sense is not so common. So here we go. And I'm just going to rattle these off. There's like 10 of them, I think. So why are we doing this? You need to ask why is this even necessary? Is there another option? What happens if we wait? What happens if we do nothing? If something is explained in a way that you don't understand, ask. Can you explain that differently? Is there. Excuse me, is there a less invasive option in my case also, is there a smaller tube? Believe it or not, you can ask those questions Is this documented in the chart? Who made this recommendation? Who makes the final decision? And here's a good one. And I think it caught one of the doctors off guard when I asked this question. I asked, what would you recommend if this was your mother? That last question changed conversations that I had. Doctors stopped speaking to me, especially this one doctor. He stopped speaking to me like a family member and started speaking to me like another human being trying to make the best possible decision for someone we are both supposed to care about. And so sometimes all it takes is reminding people that medicine is personal. And now I'm going to share some night shift tools or suggestions. Build a family schedule if you can. Rotating 24 hour presence is better than one person running on fumes. Make it a schedule. Assign shifts. Treat it like the job it is. Know every line, every port and every access point. Write it down, post it visibly. I don't care. The Lab team at 5am May not read the chart. The sign on the door may be the only thing that prevents a preventable needle stick. Plan to enforce that sign yourself because again, lab tech shows up to the door, the nurse is in another room. They're just going to walk in that room and do what they do. Get medication modifications into written orders. Pills need to be split. Have them put that in the chart. Throat needs to be moistened first. Write the orders, um, for the survive handoffs. Verbal instructions do not always work. You're going to have to write it down because whoever the next person is in your family that's taking that shift, make sure that they know to do the same. Don't always assume your loved ones know or that they remember. It's a very emotional time. Everyone reacts differently. My brother can't stand Ben in hospital. He cannot. It is not his thing, never has been. And so he tried to be there as much as he can be, but it's just not his thing. So he just didn't take any notes really. He sucks at note taking in these circumstances. But make sure you push your family members to do it because that becomes really important. Introduce yourself to every new shift. When the nursing staff changes, introduce yourself. State your parents key, uh, care notes and ask them to confirm they've seen the chart. Do not assume they've seen the chart. You are the continuity when there's fail. So when you do that, also what I noticed when you challenge them, asking and not challenging, a, uh, confrontational challenge, I mean when you challenge them thinking that they need to go and review that chart, that's your opportunity to say hey, did you look at that chart? At the chart? Because we want to make sure you guys know that xyz. And then when they do come in for their first real review of your loved one, you can ask them. So can you confirm for me that you saw in the chart? This, this, this. Don't say it once and forget about it. Say it over and over if you need to. I would also say for night shifts, uh, bring your bag. I have my little go bag. Unfortunately, I've been through this many times with my mom in the hospital. So I have my little go bag, my little backpack, and I have my backup charger, extra cords, of course, my iPad. Sometimes. Sometimes I didn't take it. Snacks, water, juice, whatever it is that you want to drink, and any other reading materials. In my case, I had my laptop because I was working. And any other things that you think you're going to need for an overnight stay. I brought also my slippers. I didn't want to walk around in the hospital floor. You can bring your own pillow. Confirm if they have a bed that they can bring in for you. I was fortunate that they had a couch that was actually more comfortable than I would have thought. Uh, so I didn't have to sleep in a chair, which was kind of nice. But make sure you ask those things. Um, I kind of said this a little bit already. Make sure you write everything down. Every diagnosis, medication, every name of the care people. They usually have it on a board somewhere. So actually, I just took a picture of it so then I could share it with my family when we were changing shifts, um, date and timestamp, all of it. Your notes are your continuity again, when the system handoffs fail. So that became really critical. I love my family. They did a really good job. My brother aside, but my husband, my aunt, my daughter. My daughter took some freaking badass notes. But then again, she knows me. Lynn knows me. She knows how her mama is. But she took exceptional notes. So definitely make sure you do that. Flag unresolved issues at discharge in writing. If there was a concern documented in writing, a verbal concern is not going to be a good way to keep them accountable. There were some challenges that I had that I made sure I documented. And conversely, when they did great things, like I leave reviews, I have no problem with that. We had some very exceptional people who provided care for my mom, and I made sure to highlight those folks as well. And the one thing I'll say, I had support. Like I said, round the clock care for mom. But I also recognize not everyone has that. So I would say find a way to protect one thing for yourself. Whatever the equivalent of my massage is, protect it the way you protect your parents. Medication schedule. At the end of the day, your depletion is not a personal failing. It is a caregiving crisis waiting to happen. Trust me. I stayed in the room. I asked the question. I stopped the lab team. I split the pills. I covered the night shifts. I went to work the next morning. I showed up for my husband and coordinated my auntie Mom's care. I missed my massages, but I kept going. The nurses said they'd never seen a family so committed. But what I wish someone had said is, I see what this is costing you. I see all of it. And you should not have to be this exceptional just to keep your mom safe. That's a bar. You should not have to be exceptional just to keep your loved ones safe. And so here's what I want to end this with. I don't have all this figured out. I just don't. And neither do you. And honestly, that's the point. We are navigating real situations with real stakes in real time, together. So until next time, whether you showed up today in your suits or your pajamas or somewhere in between, which is where most of us actually live, know this. You are not alone in the tension. And you don't have to resolve it to keep moving. I'll see you in the next episode.