I recently had the pleasure, good fortune, need to go
the ER, or more properly the Emergency Department of my local county
hospital. Pro-tip: It turns out that
Mondays are the worst days to be in need of an ER, as the staff knows it’s the
day following the weekend. It’s the day
that all the sick people find their doctors are not able to help them all. So
without fail the ER is swapped on Mondays.
The scene unfolded as I walked in at 6:30 PM and I quickly realized
there were nearly no seats available, including outside of the main lobby. Nearly as quickly, I noticed lots of kids,
and several puke buckets. I knew this
was going to be a long night.
The typical check-in followed and it’s where I found a moderate
piece of armament to protect myself- a face mask. Even with that I became mentally
uncomfortable with all the signs of ‘stomach flu’ around me. Deb stayed in the lobby while I escaped into
the heat of the evening waiting to be called to Triage. Triage came fairly
quickly and I explained that my doctor instructed me to come since my blood
counts were quite low and I needed to get a transfusion. It was there that I learned there were 3
people ahead of me. One was ‘coding’ and
two others were at the same severity level as I. Back to the outdoors to wait for a room,
which actually didn’t take terribly long, maybe just half an hour or so.
The Physician’s Assistant (PA), really my doc for the night,
came in promptly. She also as quickly
indicated that I would be admitted to receive my blood and be observed
overnight. Our bit of lively discussion
hinged on my past experience where if that has to happen then I’ll be arguing
with the Pharmacy. The local hospital
doesn’t carry all of my meds, so I bring them with me, yet the Pharmacy tries
to mandate that I relinquish control over my property. Nope, not going to happen. Then they will come up to the room take one
of each type of pill with them, and verify the identity by looking at a catalog
of know brands/generics to rule whether I’m being honest and not trying to
sneak in my own opioid or something.
Once all that is settled, the Hospitalist (the doc that manages your
care while in the hospital) will find my case perplexing (cause I’m just that
way 😉) and find a reason to keep me for another
day or two. I conceded that I knew there
were other people in the waiting room needing to be seen, but I sure would
rather get the blood and be released.
Ultimately, I ended up staying in the ER.
There’s a lot that happens on a shift in the ER and while I
hope you never have to experience it, what the staff goes through each day or
night is astonishing. If you just follow
my experience you will get a small taste of what it might be like. You might have even more respect for those in
the profession.
The first nurse Sydney tried for a likely vein, and as I
feared, it proved tricky because it “rolls” and then finally it “blew.” In other words, it ruptured and was not
useful. Many of the veins in my arms are
that way. My guess is that they have
been abused to much over the years of IV meds, but who really knows. There are those of us with funky veins. She brought in another nurse. This one was trained in ultrasound guided
venipuncture. As you guessed, the ultrasound
shows the nurse the veins which are a little deeper and allows the catheter to
be seen while entering the vein. Kind of
cool, not that I was watching during the procedure. She got it, and it worked, though the end of
it landed right at the bend in my elbow.
A little uncomfortable if you bend your arm, and also stops the flow of
the IV if you bend as well. Honestly, at
this point I’m relieved that it was just two sticks to get this going. It might be a good night after all!
What I did not mention until now, is that while we had
waited to be called in to Triage and waiting outside, there was an older-middle
aged woman that exited the hospital and was incredibly distraught. It did not
take long to assume the person who had coded was lost. A gentlemen approached her from the parking
lot and she yelled out “he’s gone!” to which the reply was “bull crap”. Another
woman rejoined quickly with “He can’t be, he can’t!.” Cries of he’s gone melted into an embrace of
the three grieving souls. Left stunned into
silence, Deb and I waited, and continued to bear mute witness to the shock and
turmoil of their pain.
Now in our room, I noticed over time a repeating scene. People came past and entered the room next
door. It was the one an officer remained
near. The teary eyes and slumped posture with red and watery eyes said it
all. And eventually I put it together
that the gentleman that passed was in the room next to mine. It was a lot to take in, and it felt very
numbing to me.
Enter the sound of screeching brakes, metaphorically at
least.
We had to move out of the room because my room had heart
monitoring capability. Another patient
needed that care, while I did not. We
went just around the corner and stopped.
My new room was H14, which means "hallway near room 14.” It was here that we remained for the next six
hours or so. Now, not only was I in a
hallway, it was probably the busiest section of the ER. It was the hallway that led to the imaging
suite. Other gurneys inched (literally)
past me quite often. It’s sad to see the faces as they go by. Some look hopeful, others very distant, and
yet others that are simply closed.
You can’t help but overhear someone when they are 3 feet
away, even if you don’t want to. Room 14
had a young lady accompanied by whom I assume were her parents and
brother. The mom and doctor stepped out
of the room and it became clear that the doctor was either going to have her
admitted to the hospital for her own safety, or the mom could convince the
daughter to admit herself. There were several times when the family came in the
hall to discuss options. This all normal
in ERs. It’s not just our local hospital that struggles with space and privacy.
It happens everywhere.
It was also here that
the nurse approached with a request. The
doctor wanted to rule out internal bleeding as a cause of my low blood counts
so a “stool” sample was needed. She had
her little cup ready. I mentioned a lack
of privacy above, so in this particular point in time, the family of room 14
was in the hallway having a chat a mere 3 feet away or so. I’ve lost my modesty in hospitals a long time
ago, so I was agreeable to give what was required. Deb asked for a blanket to make a handheld
screen and the nurse urged room 14 to “move along, please.” Thinking about it now, I’m sure the only
reason we did this in the hall was due to me not having a colon, and instead I have
a convenient (for this purpose anyway) pouch to dispense the needed
effluent. I warned her that while I
could probably do this without much, if any mess, I can not control the release
of some odor! To which she replied, “This is the ER, there are all kinds of
sights and smells, it’s fine.” Okay
then. Mission accomplished without much
fuss at all. Hope to never have to do
that again.
 |
| O+ yum! |
The first unit of blood finally arrived and was started
there in the H14. It was all fine. Room
14 had opted to be admitted to a facility in DC, so we were hopeful that we’d
be placed in there. Only, no that didn’t
happen. Another young lady with a mask
on was walked in. Again, being close by,
I could understand that she needed some procedure on her lower spine. I don’t know if it was to grab some bone
marrow, or get an epidural. Everyone
that walked in there was getting a mask and gloves. I’m an immunosuppressed patient since
receiving my liver transplant so many years ago, so seeing a case that needs
special care like that worries me. I
asked my doctor if I should be so close to room 14! It was scary- at least to
me. Another doc came by on his way into
the room. He was fully gowned and wore
gloves and a hair covering. He said he
needed a clean space for a procedure and was not worried about germs harming
me. Phew! A few minutes later though we were moved into
room 28.
Now most rooms are single, private rooms. Not room 28.
Room 28 is a double that has a screen separating the halves. It turns out that a middle-aged woman was on
the other side. Again, you just can’t
help hearing everything, and this one was really a strange case. She complained about belly pain, that the
morphine wasn’t completely controlling.
She mentioned that her stomach is “usually flat” but not now. She claimed she couldn’t pee, but was
thirsty, and asked for a Coca-Cola! Her
request, much to my surprise was granted!
She would moan and groan in pain and often asked for more pain
management. You could hear the doctor
ask about her other chronic pain and her home prescription of Percoset. After
the doc leaves, the woman has someone on the phone and bitching wildly about
how rude the doctor was and how she insinuated that she was only seeking drugs.
This pattern was on constant repeat for at least the next 5 hours that we
shared the room. She was also told that
they didn’t have her requested pain med as “it wasn’t in stock.” I’m sure it was a request for an opioid. She had been examined via CT Scan earlier in
the night and the docs still didn’t understand what was going on. Another doctor came in, and she whined to him
about how rude the other doc was. While
he listened politely, he only confirmed to her that the other doctor asked
appropriate questions. Then he offered
to get her an MRI which would require them to wake up a crew at somewhere
around 330 am. She wanted to try the
bathroom again, and this time I happened to see her come back to the room. She was skinny except for a very distended abdomen. I would have said she was a skinny and
pregnant woman, which was clearly not the case.
That’s how large her abdomen was though!
It was about 230 when my 1st unit finished
infusing. I expected to have the second
one started in 30 minutes. However,
there was another monkey wrench to be thrown. Deb could see there was something
wrong when the nurse went to order the second unit. There was some confusion with the blood
bank. After half an hour or so, she came
back with a small vial in her hands. “And what are we doing with that, might I
ask”, said with a smile. The blood bank
wants another H&H (hemoglobin and hematocrit) level. I’ve never heard of this being done before,
and I’ve had more than my share of transfusions. The nurse hadn’t heard of it before and
neither had my PA, but the “lab” wouldn’t let the doctor override the policy
without having the pathologist (Lab manager?) concur and at 300 am it was just
easier to comply. Another hour goes by
before I’m frustrated enough to call the nurse and ask what the heck is going
on. A nurse covering for mine, comes in
and tries to explain that everything takes long in the lab “even a glucose
reading takes and hour.” My reply, “it
takes my clinic all of about 3 minutes to run an H&H.” “Well let me go ask you nurse.” A minute later she comes back and says,
“we’ll be getting you 2nd unit in just a few minutes.” It’s not the nurses fault really. It’s so readily apparent that they are almost
always over worked.
So I eventually got the blood which takes about 2.5 hours to
infuse. Approaching 630 am, and the
nurse that got my IV started says “we should have put you in scrubs, you’ve
worked a whole 12 hour shift with us.”
Yep.
I had started this essay, and held off, pondering if it was
worth sharing for several days now. My
conclusion is that, yes, it is. For a
few reasons.
First, this is just a sample of one shift of one day. Can you imagine being on staff at the ER
where this is an everyday occurrence.
You have people that are hurt and scared which leads them (and me) to be
unkind at times, and ready to snap in frustration. How would you prepare for day knowing that
was at least a part of the deal?
How would you handle the possibility that today there we be
a ‘code’ that isn’t able to be pulled back to health? How would you deal with the sorrow and pain
left in the wake time after time, while still being calm and pleasant, without
becoming callous and numb to it all as well?
I hope and pray that you haven’t needed to be the ER for any
length of time. I hope you haven’t had
to experience putting your dignity and modesty on the shelf so you could be
properly diagnosed or treated. Know, however, that it happens everyday to an
unfortunate few.
Lastly, remember that each day is precious. Life can be taken in a heartbeat. There may be no warning at all, so today
might be the day to say “I love you” to you friends and families. The day to
day grind can wear us out and our time can be spent without much strategy. Take
an hour, a minute or just a moment to look around and take in the beauty that
is unnoticed around us. It’s there if
you look. The trees, plants, flowers,
birds. You love those dog and cat videos
for good reason. Seek the joy of a lunch
with friends, a vase of flowers for your other half, the hug of you child (no
matter the age.)
Love you all,
Brian
