Patients should not be left alone in the hospital even when they are not in immediate danger. A steady stream of research on errors in hospitals suggests that friends and families must play a more active role in the patient’s monitoring, care and do their own charting of who has done what, why and when.

Below is the full text of an e-mail (with the patient’s name changed) from a doctor to a friend’s wife. His friend is the patient. The e-mail is specifically about the friend-patient but also shows the kind of vigilance family members may choose to exercise in less serious situations. Italics indicate information which apply to all of us.

The patient has had a transplant. He is on a ventilator, which breathes for him until he is able.

“Samuel’s* intensivist (intensive care specialist) should fill things in, but to get that information you need to be at the bedside between about 0700 (7AM) and 1300 (1PM) daily and have good relations with his nurses and respiratory therapists. Bring in some muffins and talk to the night nurse when she goes off shift. Learn their names.

The key questions are:

1. What is going on in Samuel’s lungs to require ventilation or is it a heart process?

2. Is the kidney at risk?

3. Is this promptly reversible? If not should a tracheotomy be put in place so Samuel can wake up and participate in the decision process?

4. What is the state of his nutrition?

5. He is sedated, but is he in pain?

Answering these fundamental questions establishes the dialogue and gives you and your children a place in the process. You and your children are part of the team.

Love is a potent therapy.

Keep a journal. It is hard to remember things to ask the next day and often when you re read your notes things come in focus. If one of you is at the bedside at all times pass the journal along.