How to Write a Realistic Hospital Au/Setting
Because I’m frustrated with real life work stuff :( I’ve decided to distract myself by doing this. Disclaimer: I obviously only have my own country (the Handsome Ryan Factory) as reference, so if this isn’t how it is where you’re from, sorry. :/
The Environment
Hospitals do not smell like disinfectants. Hospitals smells like….nothing. If it’s a nice hospital and the facilities are relatively new/renovated, hospitals are generally scentless places (the ventilation system is better). The only time it’ll smell like disinfectants is when the housekeeping staff just cleaned a room after a patient has been discharged. Older hospitals and units like internal medicine which takes care of a lot of longer term patients and older folks smell…well not great. It seems like people and bodily fluids.
Hospitals are cold. The OR is even colder (unless for whatever reason you need it to be warm for a specific procedure).
Background noise. There are machines making noises the background, little beeps of the IV pumps or the heart monitor. Normal beeps are slow, alerts are fast.
Intercom - every time something happens that requires a code to be called, it’ll come on the intercom and the entire hospital hears it. Common ones are: code blue = adult cardiac arrest (ex: Code Blue - K6, Code Blue K6) They tell you what the code is and where to go. The code team (usually an ICU team) will show up. Code pink = neonatal cardiac arrest. Code red = fire. Code yellow = missing patient. Code white = violent encounter (security will be called up). Code orange = external disaster (a train derailed). Code Silver = deadly weapons (gun, knife). Code Brown = hazardous spill. Code Black - bomb threat/suspcious object. Code Green= evacuation Etc.
There will be rooms on “precaution”. Signs will show up on certain doors/rooms, because that patient might have some kind of communicable disease through contact/droplet/air.
The Staff
Nurses are not rude (unless you’re writing a rude character). I see a lot of “the good tough nurse” caricatures where it’s like jab and shove - No. A good nurse can be assertive, can be knowledgeable, can be no non-sense, but they shouldn’t be rude and patient consent is always present. If a patient says they don’t want a shot, they don’t get the shot. No matter how seasoned, how tough, how burned out a nurse is, everyone is habituated to start a conversation with introducing themselves. “Hi, Mr/Ms/Mrs/Miss ____, my name is _______ and I will be your nurse today.” Once the nurse and the patient is acquainted with each other, they can be a little bit more casual.
Hand washing is a constant thing. The most often thing you see is staff rubbing their hands together in and out of rooms because they just pumped a handful of hand sanitizer.
There are other people other than the medical and nursing staff. Personal Support Workers (PSWs) are very present and they help with the washing and the bathing, and changing incontinence briefs. Nurses also do this as well in some hospitals. You might see Nurse Managers come around for administrative stuff (ie discharge), Physiology Therapy and Occupational Therapist will make their rounds on those that need it (especially after an accident), Speech Language Pathologists for those with swallowing problems after a stroke. Social Worker for those who are going through a difficult life situation.
The medical team gets confusing. Because there are medical students (clerks), junior residents, senior residents, and there are attendings. Your patient character can be confused.
Internal Medicine - the “ologys” : general internal medicine is where typically a lot of folks get admitted. The doctors who take care of these people are internists. Other popular sub specialties of internal medicine that sometimes get their own wing/unit are: cardiology, neurology, respirology and oncology. If a specific specialty is needed, the doctors of that specialty is paged for a consult.
Surgery - do not have every surgical specialty in one team. That’s not how the surgical teams are divided. If one of your character is in Gen surg, and the other is in Neuro, they’re not gonna be spending their day constantly bumping into each other unless their surgeries are adjacent OR rooms for some reason. Their patients probably won’t even be on the same unit.
If you’re writing surgery, don’t forget Anesthesiology. Patients coming out of surgeries can either go to PACU Post Anesthesia Care Unit or the ICU (intensive care unit).
Specialists can read scans by themselves, but most of them time, they need a Radiologist to do it. Biopsies are processed and read by pathologists.
The Action
If a patient flat lines, don’t “shock” or defibrillate them. TV shows constantly gets it wrong. The only two shock-able rhythms are ventricular fibrillation (V-fib) and ventricular tachycardia (v-tach). (There are other pathological rhythms that require cardioversion, but we won’t get into it). Your fictional patient could still have a rhythm and be unconscious.
If a patient is unconscious or has either V-fib or V-tach or flatlined, call Code Blue. Literally have one of your character say it, “Call Code Blue.” Or press the code blue button that’s above the bed on the wall.
If a patient flat-lines, your characters should start CPR and inject epinephrine (1mg and every 3-5 minutes).
Don’t “lost 3L of blood”. If they did…they’re gone. Exsanguinated…unless they’re being transfused at the same time. A 70 kilo man typically has 5L of blood. A lot of preg fics have the woman lose a ton of blood during childbirth. Remember 500cc or 500 mL of blood in a nonsurgical setting is considered hemorrhage, and 1L in surgical setting. As a 5′3′’ female I can tell you I probably only have 2-3L of blood in my body.
Things to talk about in conversation between two staff: heart rate (normal in adult 60-100), blood pressure (ex” 120/80 systolic/diastolic) normal systolic 100-140 normal diastolic 60-90); respiratory rate (normal 12-20 per minute), O2Sat (you want most people above 95%), temperature.
Red blood cell count and hemoglobin being low indicate anemia. High white blood cell count typically mean infection. Electrolytes can be out of wack: sodium, potassium, calcium, magnesium, are some of the typical ones. Blood pH can be either high or low. High pH is alkalosis. Low pH is acidosis.
Hypothermia (because this is a popular one). Don’t do what Rose did in Titanic. You’re not dead until you’re warm and dead. Rewarming for severe hypothermia should be slow and in a hospital setting. For mild to moderate hypothermia, if it helps with your plot, yeah they can cuddle skin to skin.
Note to self...
