"Would you eat off a toilet?

"Are you alright?
Originally uploaded by Regina Holliday

Have I mentioned that the mural painted on the back of a gas station? The mural  73 cents resides on the back wall of the BP gas station at 5001 Connecticut Ave. Yep, it is a BP gas station. The owner is a wonderful man named John Conner. He gave me permission to paint 73 Cents without ever seeing a design sketch. I began to paint on June 23, five days after Fred died. At first I worked in very short shifts. As the summer progressed and my painting shifts grew longer, I drank a lot of water. It wasn’t long before I needed to use the restroom. Of course, I was not going to use a gas station bathroom. I have been in many service station bathrooms in my life, and it has usually been a very unpleasant experience. John called me out on my prejudiced attitude. He asked, “Have you seen my bathroom?”

I could not believe it. The bathroom in the BP gas station at 5001 Connecticut Ave. is beautiful. The fixtures and paneling are all made of stainless steel. The countertop is the deepest blue with specks and sparkles of gold. The floor is ceramic tile. In my experience it is always spotless. It looks like it should be in a fine hotel. John believes in treating his customers with greatest respect, and it shows.

With this lesson in mind, I visited the bathroom at the Sheetz Station in Hancock, MD during my family vacation. It was a functional bathroom, also unisex like the bathroom at the BP Station in DC. It was a little dirty, but I was pleased to see a note placed above the mirror with the following statement.

“WE WANT YOU TO BE SATISFIED EVERY TIME YOU VISIT SHEETZ, SO I PERSONALLY PROMISE THE CLEANLINESS OF ALL SHEETZ RESTROOMS. IF THEY’RE NOT TO YOUR SATISTFACTION, OR IF YOU FEEL THERE IS ROOM FOR IMPROVEMENT, PLEASE CALL ME TOLL FREE AT 1-877-4SHEETZ OR EMAIL ME AT SHEETZ.COM

-Steve Sheetz, Chairman"

Not long before reading this I had painted a picture called The Onion and The Orchid. Not long after seeing this I wrote the blog post of the same name. I explained in that post that an onion letter is a letter you write when you have a bad experience with a business. An orchid letter is written to a business that exceeds expectations. I emailed Mr. Sheetz. Guess what? He emailed me back the very next day.

At this point you might wonder why a medical advocacy blog is writing so much about gas station bathrooms. It is simple really; we expect gas station bathrooms to be a little dirty, and in juxtaposition we expect hospital bedside tray tables to be really clean.

I am sure many readers of this blog are familiar with the rolling adjustable table used in hospitals for the food service. Perhaps they have even seen it used to hold prep supplies for a dressing change of a surgical wound. I was astonished when I saw the other way it is used. If a patient is incontinent the bedside table becomes a changing table. Each hospital may use different supplies. Some use adult sized wipes and foaming soap. Some facilities personnel use piles of white washrags and throw the rags in the soiled linen container. I was astounded as I was instructed that this was the proper way to do a change. I have worked as a preschool art teacher for many years and we would never use a changing table to feed a child.


I focused much of my advocacy on records access. Yet, when Institute For The Future created a visual competition called Bodyshock the Future, I thought I must address this issue. My entry is called Would you eat off a toilet? I created a painting called Are you alright?. This was the euphemism a nurse used to ask my husband if he needed a bedding change. I wrote more in depth about that in the post Code Brown.

This painting looks very different than my regular work. The colors are the bright tones of the 1950’s. I was trying to show the danger that lurks below the pleasing surface. Everything seems slightly disjointed and disturbing in the piece. But I really love Fred in it. I got his eyes perfectly. Those are his quiet pleading eyes. Those eyes are saying, “Help me, please.”

Well, I will try to help other patients and caregivers by spreading awareness of the multiple uses of that bedside table. After I tweeted my entry to BodyShock The Future, my friend Peter Amsel, better known as the crazycomposer on Twitter, pointed out that Mythbusters had already proved that a toilet seat is cleaner than most surfaces in a home. I loved his comment, partially because when Fred was hale and hearty we had watched that episode as a family. The main reason I thought his comment was so apt was because it proved the need for greater awareness. The toilet seat is as clean as it is because we clean it with the knowledge that it is a toilet seat. But when I floated this art awareness proposal around to my friends, some of whom are doctors, none were aware of the dual use of the table. We need to know. We need to know so we can protect ourselves.

All of this brings me back to the email for Mr. Sheetz. He said:

“I thank you for your ‘onion’ letter and I apologize for the conditions you encountered. We will work to make it better and hopefully one day we will earn an ‘orchid’ letter from you! I’m very familiar with this store because it’s one of the only ones in the company with one restroom for both males and females, a situation I don’t like. We can’t expand, as we would like to because of zoning issues so we have to live with the current state. But believe me this is no excuse for the conditions you encountered. As I said we will work hard to make it better!

I read your blog and found it very interesting. You are a very talented writer as well as painter! You touched a chord with me because my brother was diagnosed with kidney cancer in February 2006 and died August 21st, 6 months later. I spent a lot of time with him at the Cleveland Clinic and really feel we had great care, unfortunately it was stage 4 when it was caught and the only hope at that point was ‘trial’ drugs.

Once again I thank you for taking time to write.”

I wrote an onion letter to Fred’s first hospital, the one we stayed in for almost four weeks. They wrote back two months later. They said they would use my many comments as educational opportunities for staff. They had excuses for their behavior in virtually every instance including the poor communication about my husband’s bedding changes. They did admit, upon reflection, that they regretted they never had a family meeting with us.

I went back in person on May 14, 2010 and told them of my advocacy. I encouraged them to place “Speak Up” patient advocacy signs throughout the facility. The customer service representative took my name and number and email.

I am still awaiting a return call.

What does a Sheetz and BodyShock the Future have in common? They are both trying to harness the power of communication. The BodyShock competition gives us a reason to read about brilliant visual ideas that could change the future of medicine. Sheetz believes so firmly in their customer relationships within new media that the president responds to emails from consumers. They both get the idea that future is about transparency, relationships and communication. They get the power of social media.

I hope you can vote in the upcoming days on my entry. We can change things if we are all willing to speak out.