Thursday, December 29, 2005

Moments in the ER

In her book, Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood, Naomi Wolf writes with naïve surprise about being “infantilized” by the medical community. She is highly critical: “The medical establishment too often produces a birth experience that is unnecessarily physically and psychologically harmful to the women involved, even according to its own standards of measurement,” (Wolf, p. 6). She found her obstetricians condescending and reluctant or unable to give specific answers to questions about such matters as episiotomy and epidural rates. Being Naomi, she attributes this condescension, disrespect, and disregard for the patient to the condition she was in at the time (pregnancy). I would be surprised to find Naomi had much experience in the medical system prior to this, her first, pregnancy. If so, she might have been more inclined to use her journalistic skills to find another cause than her pregnant condition. In this quiet interim between Christmas and the New Year, I’m going to go off the topic of abortion for a moment to tell you a story – a few of my own, Naomi-like observations.

Late one evening several years ago, I was ordered to the emergency room by the neurologist who was treating me at the time. I was told he would call ahead and make the arrangements for me to be admitted, as it was time for a course of tests to determine the exact nature of my malady. The first lesson I learned that night was not to listen to one’s physician if he or she is dispensing advice with the clinking of bar glassware in the background. The second is that sending one’s patient to the emergency room after hours is a favorite tool of doctors. I would guess there are two reasons for this: first, there’s no money in an after-hours phone call to dispense advice to the patient, and only the patient’s impressions to go by to evaluate urgency. Second, there’s too much potential liability in not doing something, and malpractice premiums are an issue.

I did not want to take up emergency room space; but apparently, this is the only way one can be admitted to a hospital. I suspect there are far more insurance rules than health objectives that mandate this, but that’s par for the course. There I was on a busy night in the emergency room, with no emergent condition to speak of, surrounded by at least seventy-five other people in various states of emergency and non-emergency, and Dr. Flintstone, my possibly-tipsy neurologist, had not called ahead. We waited in chairs; well, I sat in chairs while my husband stood. Naomi complains that pregnant women get uncomfortable in hard, plastic waiting room chairs. Naomi, those chairs don’t do much for anyone waiting in an emergency room.

In the row perpendicular to ours sat a middle-aged man holding his sloppily-bandaged left hand. He had had an accident in his workshop, and had a pretty bad gash. Nurses kept coming out from behind the treatment area, hidden by thick walls cut with round submarine windows, but nirvana for those of us waiting in chairs, to check on his wound and apologize for the long wait. He had already been there for four hours when we arrived, but there was no one to stitch him up. He was in the best of spirits, smiling with understanding, and with a kind nature shrugging away any offers of sympathy for his condition. He had been bleeding, so we could all see his pain, and how it warranted attention.

I had been told to expect to stay, so I had packed a small “hospital” knapsack. It contained my toothbrush, my own toothpaste so I wouldn’t have to pay $15 for a hospital tube, my cosmetics, of course, and pajamas, and whatever else I may have grabbed in my numb state. I did not want to think about a hospital stay of my own, but I remembered my mother’s frequent visits and the things she needed then, so I relied on that rote memory to pack. A heavy-set young woman in the row of chairs in front of me had also come prepared with a small bag of her own. A nurse came out to finish her triage session, and asked her what her problem was, in earshot of at least ten people, including curious me. The young woman told the nurse in a bored voice and memorized words that she was bleeding down there, from her “vagina and urethra.” She was asked if she needed assistance with her bleeding, and said no. So, the nurse, who was carrying the patient’s very thick file, made a note on her admittance form, told her she’d be seen “as-soon-as-we-can-but-we’re-backed-up” and returned to nirvana. The young woman, oblivious to me and anyone else who was watching, reached into her bag and pulled out some provisions: a bag of raw vegetables and a novel. She started munching her veggies and seemed to settle in for a long read.

There was a slight commotion from behind us, and then a very thin young man dashed in between our rows. The veggie-lady looked irritated as she jerked up from her novel, jaws still moving, tucking her short legs under her plastic seat, squeezing as far back as she could. He stood looking back and forth at the floors and the walls, then ran toward the corner to my right, speaking breathlessly in Spanish I didn’t understand, until finally I could make out in my high-school Spanish, “Aqui, aqui!” His wife, a tiny woman, was scurrying directly behind him carrying a machine that looked bigger than she. Then I noticed for the first time that the man was cradling a small child. It was a boy of about three; he was wheezing. His mother bent over the electrical outlet that his father had located, and plugged the breathing machine in. The ER was under renovation; they had been unable to find any electrical outlet for the boy’s asthma treatment machine from where they had been standing, near the outside doors. Between the two of them, the young parents had the machine hooked to all of its complex hoses and outlets and to the child in seconds, and his medicinal breathing treatment began. “Holy cow, asthma,” I thought with alarm, and I looked around for the rush of ER personnel, a gurney, Dr. Welby, or anyone who would immediately rush this child into nirvana immediately. But all was still behind the submarine windows, and the doors didn't stir. Those seated near the outlet were kind enough to surrender their seats to the young mother, who sat rocking the child. As quiet waiting returned, he settled into sleep, the machine hissing gently. His father paced in silence, stopping often to peer into his son’s face.

Off and on, my husband had been calling Dr. Flintstone, who wasn’t getting any further from the clinking glasses. Eventually, we were allowed into nirvana, even though we protested that it seemed so unnecessary; wasn’t there a place just to be admitted? There was a man out there bleeding, and a child who couldn’t breathe. But no, I was to be taken to that special place where, even though I would still wait, at least I could do so under the watchful eye of medical workers. At many times while we waited, I battled the temptation to leave; but the longer we waited, the more time we had invested, and Dr. Flintstone had given us reason to be concerned.

I was placed on a gurney in the hall, because there were no available rooms. I didn’t mind, because I hoped I wouldn’t be taking up space for very long and I had no intention of needing privacy in the ER. My husband stood next to the gurney, and we people-watched for the next couple of hours. To my immediate left was another gurney set-up, but this one had a mobile privacy curtain. Across from me was an empty room that awaited a patient coming in from an auto accident, according to the chatter of staff, who always speak as if the patients can’t hear. Down the hall to my right, there were various rooms, and they all seemed full. There were a few more gurney set-ups like mine at that end of the hall, too. The staff was oddly slow. From our vantage point, we could see what I would call the nurses’ station. It was always surrounded by people in scrubs who sat, stood and talked, with occasional break-aways who would disappear into various rooms, then return to sit, stand and talk again. They seemed uncomfortable; but not occupied.

From behind the curtain to my left I heard a plaintive female voice call, “Nurse?” It was tentative and soft, at first, as if the responder was expected to be near. A few moments passed, and then more loudly, “Nurse? Nurse?” A maintenance man with mop and bucket was passing. He stopped on his floor-cleaning journey, and said to the Curtain, “I’m the janitor, but I’ll tell ‘em you need ‘em, Miss.” Moments later, we saw him stop down the hall at the nurses’ station, talking and pointing back toward the Curtain. Then he continued with his mopping rounds until he disappeared from sight. In the moments that followed, scrub-adorned staff members walked back and forth, up and down the hallway in front of us. Sometimes, the Curtain’s hoarse, “Nurse?” would be timed just as one went by; other times, she called to an empty hall, and us. We waited for the janitor’s message to get a response from the nurses’ station. A few more minutes passed, then my husband made the walk down the hall. He told a group of people standing at the nurses' station that the woman near us was calling for help. He returned to my side, and within a minute a male nurse came to attend to the Curtain. They spoke unintelligibly for a few minutes, and then he left her again, with some kind of return promise of something she needed, it seemed. The Curtain became quiet for awhile.

From the big double doors at the left end of the hall came a commotion; a gurney with many people around it. This was the motor vehicle patient. From what we would soon overhear, we learned she had been to imaging, and serious injuries had been ruled out. However, she was not exhibiting full consciousness, so she needed observation. Several staff members wheeled her gurney past us, into the room opposite. As they did, it was clear her hospital gown and blankets were seriously askew, and gave her no privacy. No one noticed or corrected the indignity as she was maneuvered into the doorway, first in, then out because they didn’t have the angle, then in and out of the doorway again. Finally, her bed was properly aligned, and she was out of sight. We looked at each other in relief, and then heard from our left a plaintive, “Nurse?”

The crowd that had installed the woman opposite us disbursed, leaving three men standing in the doorway. One seemed to be a nurse; the other was obviously an emergency responder, relieving himself of the responsibility of the patient; the third was Tom Bergeron.

“She’s a head case,” was the first thing the fireman said, consulting his clip board. “The cop says she drove off the road on purpose. Seems she’d left a suicide note for her family. Social worker called ‘em, and they say she’s going through a messy divorce. They can’t find anything wrong with her upstairs; but they sent for a neurology consult. She won’t wake up, but they think she might be faking that.” The male nurse nodded all the while. Tom Bergeron smirked. We watched and listened, openly. No one seemed to care or notice. The Curtain called, “Nurse? Nurse?”

The fireman left, and the other two men went into the Head Case’s room. I saw that it wasn’t really Tom Bergeron, cheesy host of both Hollywood Squares and the latest version of American’s Funniest Home Videos. He looked like him, and wore a similar almost-a-leisure-suit suit. He carried his own air as if he was important, and I soon figured out from their conversation that he was the emergency room doctor. The only one, it seemed, so that did make him important. From our position, we could see Dr. Bergeron bent at the waist over the Head Case’s bed, but we could not see the patient. He cupped his mouth and pseudo-yelled into her ear, “Yoo hoo! Are you in there? Hell-ooooo?????” We heard a soft murmur, much like a reluctant sleepy child would make on an early school morning. Dr. B. and the nurse chuckled at each other, shaking their heads in private understanding as they left the room. They walked over toward the crowd at the nurse’s station, as the Curtain pleaded weakly from the opposite direction, “Nurse? Nurse?”

The neurology consult finally arrived, and I wasn’t at all surprised to see he looked exactly like Howie Mandel. In appropriate triage, Dr. Howie went to see the injured woman in the room across from me first. Shortly thereafter, Dr. Bergeron came scooting down the hallway, sliding around the doorway on his shiny shoes to join Howie at her bedside. Dr. Bergeron told Dr. Howie about the patient’s history, including his opinion that she was faking it to get attention. Dr. Howie called to her, more gently than Dr. B. had. He asked her various questions; but the Head Case would not, or could not, speak. Dr. Howie took more than a few minutes to review her file. Apparently, there was nothing in her tests to explain this and she had a psych history, Dr. Bergeron pointed out over his shoulder. Her family could be called and asked to pick her up. Dr. Howie headed off to the nurse’s station to contact the social worker.

In the meantime, Dr. Bergeron paced the hallway in front of the Head Case’s room, and in front of my husband and me. He whistled casually. As he walked by the Curtain, she called with more hope than I’d heard in a while, “Nurse?” “No, Doctor,” he sang in response to the Curtain, smirking and snorting, then looking at us to share the chuckle. We stared back at him. He looked into my husband’s face, and he suddenly had something to check on at the nurse’s station. He scurried off in a rush. I thought I heard a very soft, stifled sob from the Curtain.

Then Dr. Howie Mandel was standing in front of me. We went through what was by now a litany of why we were there, and how we got there at the advice of Dr. Flintstone. We explained that I had no emergent problem, but a need for a complete neurological evaluation under hospital conditions. This is what we had been told by Dr. Flintstone, anyway. But now there was some conflict between what we had heard and what Dr. Flintstone had told Dr. Mandel, who had called him at our insistence. Unfortunately, it was now getting close to last call in Dr. Flintstone’s world. This was appropriately enough the final straw in this farce, and more than I could take since now I was convinced that Dr. Howie would whip off his thick glasses and expose the Candid Camera-style trick at any moment.

We simply walked out of the emergency room shortly after my conversation with Dr. Howie, and we got more attention in that thirty seconds than any patient received in the hours we had been there. Scrubbed personnel waving paperwork suddenly knew who we were. But we had had enough, and under no circumstances would I check in there. Apparently, I survived. And it will be the last time I ever go into an emergency room unless a.) I’m bleeding beyond the control of Band-Aids or b.) I’m unconscious and can’t say wait, let me see if duct tape will work instead. But I present this story to you not so you will feel sorry for me. I am the least of the characters in it. I still wonder what became of the Head Case, and if she ever found some reason to want to speak again. I can still hear the particular timbre of the voice from behind the Curtain whose condition I never knew. I was able to see the asthmatic little boy and his parents be admitted to care in nirvana right behind me, and saw a nurse go into their room to stay. That was a relief. But when Naomi complained about the medical community’s response to its pregnant patients, I was reminded of this night at the ER.


At 4:07 PM, Anonymous Jewels said...

Wow. I've had similar experiences in ERs, as far as the time issue is concerned. I've never encountered a doctor or nursing staff so cold-heartedly indifferent though.

::shakes head::

At 2:40 PM, Blogger Douglas Cootey said...

Chilling story. Well written. I came across your page over at TTLB but I'm glad I stayed. Do you ever regret not having checked in on the woman behind the curtain?

I haven't read Naomi's work but I can say from your references that she sees life through The Victim's glasses - something I used to suffer from. I have disabilities and I would often make myopic statements about life's events purely from the position of my disabilities. It almost seemed as if all of life's events were arranged to inconvenience me unfairly. Well, that was at the worst of it, and many years ago at that. As I hit my thirties maturity found me as it does many men (Thank Heaven, most women exclaim! ;) and I've discovered that disability, or hardship, is relative. What is easy for me to bear is difficult for another and visa versa. It is better to be more understanding and accepting of other people's hardships instead of dismissing them because they aren't the same as your own. That's something I've worked out over the past year in my writings, but I think I've digressed a bit from your point.

My favorite ER story is when I took my daughter in for a burn because my wife and daughter were distressed about it. It was only a small burn from an eletrical arc from the hair dryer. But it was a small matter to bring her in and have it checked. We waited on a gurney as well because there was no room. We waited in the employee hallway as they went in and out of their inner sanctum. Most ignored us, busy about their jobs, but they weren't rude by any means. The doctor who eventually visited us was a hairy guy with a bushy mustache right out of the 70's. He spent all of 5 minutes on my daughter, if that much, and mostly poo poohed the burn. Didn't dress the wound, offer a salve, or even a band-aid. Then he rushed off. But the bill was tallied up like he had waited on her hand and foot and bandaged her like an Egyptian princess. I'm still contesting it. ;) lol


~=~ - Fighting neurological disabilities with attitude and humor

At 4:22 PM, Blogger Silent Rain Drops said...

Jewels, me either. Being busy and overwhelmed, I can understand, and we have a shortage of ER physicians where I live. I never should have been in there clogging up the system.

But the one who openly mocked the accident victim took the prize, didn't he?

Thank you for reading and commenting!

At 11:41 AM, Blogger achromic said...

I have been in such ER's and I have also found some that were not like that. Fortunatly the ER closest to me and that my health covrage works in is one of the better ones........ but now that you remind me of the other ER's I am suddenly filled with fear about moving ever again.......


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