Anyone who works with confidential records, please get your switches ready.  I have a tale to tattle on myself.

When you live in a small town, it is hard to remember that everyone knows just about everyone else.  Especially if the families involved have been here for more than two or three generations.  I work in home health, and have to keep the identity of my patients confidential.  Normally, this is not a problem.  If I have to talk about them between anyone, I use a descriptive identity – “First house” “next appointment” or some such.  At home, the names get a little more descriptive, usually relative to the house, or chosen profession – “Out East” “cook” “Nurse”, or something similar.  This all did well, until there was an unexpected death.

One of my patients had been a young lady – almost my age – who had suffered a traumatic event quite some time ago.  Because of this, she became completely disabled, barely able to do even simple daily living tasks.  I was assigned to her, because I had the time, our ages, our interests, and I asked for more hours.  I had been tending to the needs listed on her care plan for about a month, when she became very, very ill.

After a bout at the hospital, she came home, and things seemed to be settling back to normal.  Much of the progress we had made in her range of motion had been lost during her hospital stay, but we were both determined to regain that lost ground and move beyond.  But, fate would not give us enough time.  What ever had caused her illness the first time returned.  This time in an even uglier form – gram negative bacteria in her bloodstream.  Not just one variety, but two.  One was almost completely immune to the antibiotics she could tolerate, but the other was susceptible.  The doctors set about finding a way to eliminate both strains, but could not work fast enough.  The bacteria were multiplying faster than they could be killed.  And, for those who don’t know, gram negative bacteria have a natural compound in their cell walls that causes all kinds of nasty things to happen to an animal that they live in.  It actually is a toss up, in wide spread infections like she had if the bacteria, or the byproducts of bacterial death will be the cause of the patient’s demise.

A very few, a very LUCKY few, can pull through.  Sadly, this patient was not one of them.

Because I was not immediate family, even though we had developed a friendship that had been growing, I was not directly informed of her death.  I do not begrudge the family this at all.  After all, I was only her care attendant, not a close friend.  I found out about it on face book.  So did one of my other patients.  They had a mutual acquaintance who had posted their condolences to the family.  This was when I discovered that the two patients were distantly related, but had not directly managed to make contact.  This is where I broke so many rules, I am only too happy neither family complained to the office.  I likely would not have a job now if they had.

The lady’s mother called me directly to let me know, finally on the day she was supposed to be returning home.  The call had a routine feel to it.  Probably because the mother was trying to keep herself from crying.  I took the call, which is unusual for me, while I was on the clock at the second patient’s house.  We had been talking about the recent death post the second patient had seen on face book, and I was doing everything I could to dance around admitting to having known the recently deceased.  Her incident was well known by almost anyone who lived here in town during that time.  Mostly because of what had happened, and the fact she had lived through it.

When the second patient asked me point blank “Is that XYZ” I instinctively answered “Yes.”

There was no going back at that point.  Patient 2 asked if she could have the phone, and as I was embarrassed enough, and had other work I needed to get done, I compounded problem one with a bigger issue.  I handed the phone over after telling the mother that someone else wanted to talk to her.  Yeah, those of you who work with confidential records can now bring out the switches and freely use them.  I admit, I screwed up by the numbers.  Patient 2 did not see anything wrong, as the person being discussed had passed on, but looking back, I should have held the confidentiality even closer because of that information.  Not just thrown it out the window.

Yeah, I’m human all right.  With all of the memory and compassion issues that can bring at a time of bereavement and shock.

Thankfully, when I ran into the mother a few days ago, and tried to apologize to her for the incident, she blew it off.  I have’t tried to even bring the issue back up with patient 2.  Now I refuse to even use a descriptive that might even HINT at who one of the other patients might be, just so I never have to face a similar situation again.  And, I have also made super-sure to not allow myself that close to any of them either.  If they want to “connect” on facebook, I find some excuse to deny using that platform.  It is a defensive measure, but it is also a safety net.  This way, perhaps, I will not encounter a similar situation again.

Yeah, I “spilled the beans” unintentionally.  But, I learned from it, and I hope the lesson stays with me forever.

Writing prompt from http://dailypost.wordpress.com/dp_prompt/locked-and-sealed/


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