My Time in the ER: The Healthcare System is Broken

 

My Time in the ER: The Healthcare System is Broken

Heading to bed, I feel the familiar pains.   The gallbladder pains.  Usually, they subside, but not tonight.  By 1am, I am in tears, asking my wife to take me to the hospital.  Worse than it has ever been, I know I need intervention.

2-15-2023

0218: Admission to the ED

There is a strict no-visitors rule here. Unless I am a child or a dependent adult, I am on my own.   I am promised that once I am put in a room in the ED, my wife can join me.  Triage is simple.  All my vitals taken, I am sent to a chair to wait. To try to take my mind off my pain, I observe the room.  A large handful of people are waiting.  Two mothers with children who have already been seen are waiting in the waiting room for diagnostic test results.  Others still are waiting to be seen. 

0251: Portal

I, along with another patient, move to a room called a portal.  I walk. He was already in a wheelchair.  I am told to sit in any of the chairs in the room.  There’s one other person in the room someone is attending to, but otherwise, it’s empty. 

0256:  Hallway

They did nothing with me in the portal. I am escorted to Pod A and given a Hallway Bed.  Hall 7 for short.  Note, this is not a room, so no, I cannot have my wife come back.  She sits in the parking lot in the car in freezing temperatures, waiting.  This part of the ED is packed. I am one of six or eight patients in a Hallway Bed. All the rooms are full. The constant beeping in various tones fills the air and contributes to a steady level of anxiety. I am where I can see patient monitors at the nursing station.  I am on no such monitor, and none of my Hall-mates are either. 

0304: ED doctor

The ED doctor is a nice gentleman.  He is very tired.  He listens carefully, both to my words and then to my lungs.  Honestly, he listened better to me than any of my primary doctors have in the last 3 years. He expressed sympathy and understanding.  Given my history of known gallstones, he suspects cholecystitis.  He orders an IV to be started, pain meds to be given, and blood tests as well as an ultrasound.

0318: IV

The nurse carefully selects a vein for my IV.  It’s been years since I’ve had an IV, so I can’t advise him on the best place to look.  He gets the catheter on the first try and obtains blood samples.  I also get to pee in a cup while he goes to get my pain medication.  

0323: Pain relief

The nurse informs me that he doesn’t know if there is anyone to do an ultrasound.  He believes they have all gone home, but he will be making calls to check. He then gives me Dilaudid for my pain.

0325: Impending death

While the pain begins to subside, I am aware of a crisis happening just out of sight.  I am hearing all the phrases I hear in my veterinary ER world that tell me someone is about to crash.  “He’s maxed out on pressors,” meaning they’ve given all the drugs they can to keep a patient’s blood pressure up – and it’s not working.  I know what’s coming.  My pain has lessened, but it is not gone.   

0402: Some labs

In this day of technology, I know about my lab work as soon as it’s released.   That’s a good thing for me because I know how to interpret lab results.  For a lot of people, having those answers at your fingertips often brings more questions and with that, anxiety.  Some of my lab work has been released, and so far it is normal.   They’ve paged the ED doctor to the patient whose blood pressure won’t respond to meds.  His BP is 55/32.  Yes, I get to hear that, and it’s bad.  I’m sitting in the hall.  My wife waits in the car, periodically starting it to warm up. 

0409: More labs

Good news.  I’m not pregnant.  I wasn’t expecting to be expecting as my uterus was evicted long ago.  The one question my doctor didn’t ask about my health.   There is blood in my urine, so I wonder about that, although I know it’s not related to my current issue.

0413: CPR in progress

I don’t know anything about the patient, except that he’s male.  I don’t know the circumstances behind his current cardiac arrest.  I do know that he has several nurses and at least one doctor trying to rectify his problem, and I sit in Hall Bed 7, silently hoping it is successful.   

0416: A pulse

After CPR and medications are given, the patient’s pulse returns.  The department scurries about, working to get him moved to ICU for more care than this ED can provide.  As they rush him out of the ED, I feel guilty for wondering if I can get moved into his room, now that he’s gone.  Then my wife can come in and I’ll not be alone waiting.

0421: Pain and noise

It’s back.  It never was gone, but it was tolerable.  Now, barely an hour later, it is there.  It’s not horrible, but it’s getting worse.  The ED is still bustling with activity, and I don’t know where my nurse is.  I have no call button.  The different-toned beeps continue to sound off with a lack of rhythm or care about the distress they continue to cause.  Some of the beeps are the monitors, ensuring that there is life in each of their patients.  And some of the beeps are call buttons from rooms, continually sounding as no one can go to silence them.

0435: Alone

My wife has decided to go home.  No one has told me about the timing of my ultrasound and the dogs need to be fed. And it’s cold.  And she needs sleep. And she can’t be with me anyway.  So now I really am alone. If something happened, would they know who to contact? No one verified that with me.  I ponder this as time ticks on and my pain continues to increase.

0501: More labs

My chemistries are completely normal.  While this is comforting, it also sparks another fear. My experience with healthcare over the last few years has been disappointing, to say the least.   The worst was visiting my primary doctor for a cardiac concern about a condition both my mother had and my sister has that I thought I might be experiencing.   I had been experiencing episodes of a rapid heart rate that were becoming more frequent. In visiting my doctor, she didn’t listen to ANYTHING I said and didn’t even listen to my heart.  She did offer a short-term cardiac monitoring device, where I would journal every time I felt the rapid heart rate to determine what I was doing when it happened.  I couldn’t recall what, or even if, my mom was prescribed anything for her condition.  So I asked what the treatment was if I had what my mother had.  Her response?  “Yes, you can shower with it. Everybody asks that.”  No lie.  That was how well she was listening to me.  She then went on to say most of the time they find out that there is nothing wrong with the heart and that the problem is all in your head.  No other mention was made of sending me with the monitor and I was sent home with a prescription for blood pressure medication.   As I look at the lab results in front of me saying that I was normal while the pain that brought me in here increased, I begin to worry that I will be told it is nothing and be sent home.  My nurse stops by to tell me I won’t get an ultrasound until after 0700.  I tell him the pain is back and getting worse.  He says he’ll check with the doctor.

0545: More pain meds

The doctor ordered more Dilaudid and I am grateful that it is finally given.  I was back at the original pain level that brought me into the ED.  I google how often you can have Dilaudid and suddenly feel like a drug addict. 

0631: Ultrasound

I am put in a wheelchair that looks like a converted shopping cart and pushed to ultrasound, along with another hallmate of mine who walked – they didn’t have another person to transport him and he said he could walk, so they had him tag along for the journey.  The ultrasound takes 30 minutes and is very painful.  The sonographer had to push a lot on my abdomen.  I am also a teaching case and there is a new staff member in the room watching the scan, commenting on the process while it happens.  I am grateful that the gel is warm.  I am grateful when the scan is over.

0711: Skylight

I have been returned to the ED and have been upgraded to Hall 2.  It’s an upgrade because I now have a skylight to look out of.  My pain didn’t get a whole lot better with the second dose of medication and is beginning to roar again.  I have a new nurse.  He is kind and behind the mask, I can see the smile he gives me when he introduces himself.  I tell him about my pain.  I have a new view of the rooms and patients.  I have the same incessant beeping sounds that momentarily stop and in that short moment of silence, I realize how much that noise is keeping my anxiety heightened because of the intense relief I feel.  Within two minutes another call button is pressed – and unanswered – and the pressure in my brain builds again.

0733: More pain meds

Another round of Dilaudid is given to me.  I feel it drop my 9 out of 10 pain to a cool 5 and I know that’s where it will sit.  For now, I am grateful for the modicum of relief, though I know it will return if history repeats itself.  I have no reason to believe it will be different this time.  My wife and I chat over text about my fears of “it’s all in your head.”  She empathizes as she too has experienced it, and very recently. It is nice that technology keeps her at least at my fingertips.  I am sad for those in the hall without that ability.

0745: Ultrasound results

I see the result notice pop up and immediately navigate my phone to the results page.  In scanning the ultrasound read out by the radiologist, I am left confused, and even more afraid.  “Gallbladder: Multiple gallstones. No gallstones.  No gallbladder wall thickening or pericholecystic fluid… Cholelithiasis.  No secondary sonographic findings of acute cholecystitis.”   So, I have gallstones.  Or I don’t have gallstones.  Or I do have gallstones, but I don’t have any inflammation in the gallbladder.   It’s all in my head.  Or it’s not.

0754: ED Doctor

If I thought he looked tired at 0304, he looks exhausted now.  He talks to me about the ultrasound and said despite the radiologists saying there’s no cholecystitis, it’s obvious that I have a problem that will continue to get worse.  He has requested a surgery consult.  I ask if my wife – a manager at this hospital and a former surgery tech who has scrubbed hundreds of these surgeries - can be here when the surgeon comes to talk with me.  He says it would be good for her to be there for the consult, but he has no idea when the surgeon would come.

0818: More tests

One final visit from the ED doctor.  The surgeon that I have yet to meet wants to run more tests.  The ED doctor implies by his body language and speech that he doesn’t believe it necessary, but tells me he’s ordered an additional scan.  This one is a nuclear scan to tell how my gallbladder is functioning.  The nurse starts a COVID-19 test in anticipation of surgery.  Once again, my pain is increasing.  And my ED doctor is off shift.

0922: Waiting

I have been up all night and with the ever-present beeping, sleep is hard to find.  I just doze off and the cadence of the noise changes and I’m awake.  It’s an effective torture method. One hallmate is discharged from the ED and two more patients are added.  The once empty room is filled with an ambulance patient.  Within my area, there are now multiple patients that I can see or am close enough to hear all about.   There’s an elderly man in a hall bed in front of me.  I watch as multiple vials of blood are drawn and the nurses are all familiar with him.  He is a frequent flyer.  There’s a pregnant woman in a room who is febrile and they are trying to get her transferred.  There is an older woman in the hall bed behind me who had a syncopal episode and is having a CT.  And there is an elderly man in a room who is in end-stage kidney failure continuously yelling hello and asking for water.  My pain is worse.  The nurse is asking for more meds for me.

1019: More pain meds

Finally, I am given more pain medication.  This one is different – Toradol – and my nurse tells me to be patient and wait for it to take effect.  What else do I have to do?

1103: Alone again

I am finally pain free!  Yay for correct pain management. My wife, who returned around 0800 when we thought a surgeon was going to come, has decided to leave again.  We discuss, via text, that I would call her as soon as a surgeon showed up.  We know there is still the nuclear scan to be run before the final call about surgery.   Once again, we talk about her not being able to be here with me.  If she can’t be with me, she might as well be home.  We plan for her to bring back our battery pack to charge my phone as I am under 50% and this day is only getting longer.  I can’t sleep.  I observe.  I watch the nurses scrambling to keep up with the orders. I see an ED doctor talking to a woman in my old hall bed about her abdominal pain and trying to dismiss it as a UTI.  She refuses to be dismissed saying that the pain isn’t there but in her upper abdomen.  She pushes for an ultrasound, and he acquiesces.  As he walks away, I watch him shake his head and roll his eyes.  While I know he’s trying to get a bed free, it makes me sad that she must fight for her own healthcare because he isn’t listening.  

1129: Scan Scheduled

I am finally told that my nuclear scan will be at 1pm.  I watch the clouds flit by through my skylight.  I listen as the ED doctor tells the elderly man in the hall bed in front of me that he has an infection, and they are investigating it further.   He needs to pee but is not ambulatory.  He knows how to use the handheld urinal.  So, he does. In the hall. With no privacy whatsoever.  Basic human dignity is denied because he’s in a hall bed.

1256: Scan time

A nurse covering for my nurse who is at lunch wheels me in my gurney bed to nuclear medicine. There is no transport staff available to take me. I am grateful I am not Porsche.  She has been in the ED since 1600 on 2-14-23.  I meet her in the hallway at the nuclear scan.  She also has a history of gallstones and had an attack and an ultrasound and was required to do this nuclear scan to decide about surgery.  I am told they will inject a nuclear tracer into my IV and they will scan it moving through my liver and gallbladder.  This test will take 90 minutes.  It is the first time I’ve been in a quiet room for nearly 12 hours.  I am laying on a hard CT bed and must remain still for 90 minutes.  The technician positions the viewer so I can watch it if I want to.  It’s sort of uninteresting, grainy TV. It is not until the end of the time frame that they expect to see the tracer in my gall bladder. So, I sleep.  As well as anyone can sleep flat on their back on a narrow curved hard bed and arms laying in troughs next to them.  At least I get a pillow for my head and a prop for my knees.  

1434:  No trace.

No tracer is seen in my gallbladder.  This is evidence that indeed, I do have cholecystitis.  Just to be sure though, the radiologist wants a delayed imaging scan.  It will only take five minutes.   In three hours.    At least my pain is still under control. 

1515: A visit

My wife comes to bring me my battery to recharge my phone, which is down to 27%.  Security won’t let her in.  No visitors for people in hall beds.  I am a stable patient; therefore, I do not need a visitor. The security officer begrudgingly brings me the battery pack, looking very put upon for having to be a delivery man.  I am given a giant piece of good fortune when my wife contacts the ED manager and asks for a favor of a moment with me, and that moment is granted.   I get to see my wife for 3 minutes before she is hustled out of the ED. 

1605: Test results

Just not for me.  A nurse tells the older woman behind who came in for passing out that she has a meningioma.  It is benign and likely there for many years and the doctor would come to talk to her about it soon.   I can hear the woman’s confusion in her questions and the nurse reassures her that she will talk all about it with her doctor.  She too is alone.  She is in a hall bed. 

1703: Nuclear scan, part two

My pain is back.  I am afraid to say anything.  Will they think I just want more drugs?  It is time for my delayed scan. I am taken back to nuclear medicine where a new technician tells me what is going to happen.  I will lay on that narrow, uncomfortable bed and they will scan me again to see if they can see the tracer.  He is kind but doesn’t provide arm support like the other technician did.  Instead, he wants me to put my arms above my head.  This shouldn’t be a problem, as it will only be five minutes.  Except it is not five minutes. They see nothing on this first delayed scan.  So, the doctor orders that they reinject me with more tracer and watch it flow again.   Once again, it never flows into my gallbladder.  Just shy of an hour later, I am finally finished.  Back to the ED Hall I go.

1803: Still waiting

The ED doctor, who has yet to ever talk to me, informs the elderly man in the hall bed in front of me he has a urinary tract infection.  The man acknowledges this and proceeds to talk to the doctor about his late wife and how much he misses her.  The doctor says some comforting words and walks to the nurses' station, again rolling his eyes and shaking his head.  He asks which nurse is taking care of this man and, finding out that that nurse is caring for another patient, barks at the three nurses there that his patient is septic and needs to be started on treatment now. 

1815: Diagnosis

My results this time. “Abnormal study” and “Evidence of acute cholecystitis” jump out at me from my phone screen. Eleven hours after an iffy ultrasound read, I feel vindicated.  My pain reminds me that I already knew what was going on.  I get told by my nurse that I might be having surgery.  I feel myself deflating at the word “might”.

1915: Impending surgery

It’s finally coming together.  I still haven’t seen a doctor since 0818, but orders are piling up fast for treatment for me.  I have a new nurse.  My third since I got here – not counting the one who covered one of my nurse’s meal breaks.  My pain is continuing to get worse.

1925: Antibiotics starting

My nurse starts my presurgical antibiotics.  I ask if my wife can come to see me before going to surgery and she says yes.  She also adamantly says when security balks at my wife at the ED entrance, to tell them to call her.

2013: New hall bed

I need additional antibiotics that must be given over a specified time frame and requires a pump for that.  My fancy skylight hall bed does not have an electrical outlet.  So, I am shuffled with another hall bed patient to a space that does have an outlet.  I am now in Hall Bed 1. I ask about pain medication and my nurse informs me that I am allowed to have more Dilaudid if I wish.  I can’t have Toradol, even though it worked the best for me, because of the risks associated with it and bleeding and the fact that I am about to have surgery.   My pain says yes, please.  Anything to help.

2032: I love you

Things are moving fast now.  It seems like I will get into surgery before my wife gets here.  I fear that.  All the what-ifs float through my mind.  So, I text her: “I love you.  I wanted to make sure I said that in case I missed seeing you.”  I know she is driving and I don’t expect an answer.  I needed to say it.

2042: Pre-Op

My wife is still not here.  There is no transport staff available, so a surgical nurse has come to get me to take me to pre-op.   We travel through seemingly endless halls, making countless turns.  An elevator ride.  A few more turns.  And now I am in pre-op bed 1.  I am told to undress completely, put on this gown and these special no-slip socks, and come back to this bed.  A few minutes later, in my elegant gown and fancy socks, I am back in bed.  They cover me in warm blankets and a special forced air warmer. 

2057: Doctor

I finally meet the surgeon.  After answering all my questions and reviewing the surgical procedure, she offers this nugget.   The surgery was warranted based on my symptoms and history, as well as the ultrasound and I didn’t need the nuclear scan.  Small comfort 14 hours after the ultrasound.

2109: A real visit

My wife is here. Finally.  I feel myself relax and my fear abates. She is allowed to wait with me until they take me away for surgery. 

2247: Surgery

I am anesthetized and intubated for surgery.  Twenty hours and twenty-nine minutes after admission to the ED.  Eighteen hours and twenty-four minutes spent in the ED.  Seventeen hours and forty-six minutes in the ED hall, in three different beds.   I leave the hospital at 0630 on February 16^th,  twenty-seven hours and 34 minutes after admission.

In that time, I had three nurses.  I watched my nurses and all the nurses around them doing so many things.  They pulled a life back from the brink of death.  They answered ambulance radio traffic for incoming patients.  They turned over rooms to get ready for those patients.  They transported patients to a myriad of locations.  They acted as a liaison for the doctor, providing answers to questions about test results and sometimes providing test results themselves. They answered so many call buttons and still can’t get to all of them. I had excellent care from all my nurses, and I watched them provide the same compassionate care to all of their patients.  They were overworked and understaffed. I know this is the picture of every single ED across the nation.   

 

The hallway was never intended to be a patient destination.  It has no amenities for patient care.  No outlets, no call buttons, and no monitors. No room for visitors.  I was reached over countless times by countless people for gloves, barf bags, and pee pads because that’s what the wall in the hall was designed to provide – a place to hang supplies for nurses and staff to do their jobs.  While I was seen by a doctor initially quickly, I spent so much time waiting in the Hall. Without the hall beds, those patients would have to be in the ED waiting room, getting no care.    It is a conundrum without a clear solution.  It is just more evidence that the healthcare system is broken.