Experiences of a med student with an incurable travel bug.

Posts tagged ‘medicine’

ED: Emergency Dysfunction

Considering that I’m a relatively healthy individual, I’ve spent more than my share of time in Emergency Rooms, or as they now prefer, Emergency Departments; who thought it was a good idea to switch the initials from “ER” to “ED” is beyond me, but that’s a point for another day. I’m going to stick to “ER” since I’m not mature enough not to giggle every time I type “ED.”

Last week started with me, bleary eyed and sleep deprived, shuffling over to work (yes, work as in job. I have two. In medical school. Post forthcoming.) when I was notified that my father was heading to the ER.  This is, unfortunately, not an unusual occurrence; I learned at a very young age to be wary of any unexpected phone call, and to this day my stomach drops a little when those calls come in.

Thus began yet another ludicrous ER experience.

Upon arriving at the eerily quiet ER (no cars in the lot and only one room occupied…which never happens…), he was immediately checked in, roomed, and saw the nurse. One would expect the next logical step to be seeing the doctor.

One would be silly to expect such things.

Instead, one should expect to be virtually ignored for the next few hours. The most contact that can be expected will be the ER resident running through the room, pausing just long enough to say that they’re not really sure what’s going on but the attending will be by soon. Oh, and they’ll call transplant since no medical personnel in the contiguous United States are willing to touch a transplant patient unless, of course, they only work with transplant patients. The nurse will stop by again, berate the attending for not stopping in yet but assure you that you’re next on the list. Several more hours will pass, over which time the ER will actually become busy and suddenly every medical staff member in a three mile radius will appear in your room in an effort to treat you as fast as possible so they can put someone else in your bed.

Now that several hours have passed and they have yet to actually do anything aside from verbally acknowledging that something must be wrong since you’re here, the docs finally concede to do some testing. Really, we were fortunate this time; during his last hospitalization for the exact same thing, they didn’t bother to culture the infection until 24 hours later after they’d pumped him full of antibiotics. Now, call me crazy, but my problem solving skills have led me to one universal conclusion in life: if you don’t know what’s wrong, you can’t fix it. Culturing an infection is the only way to find out precisely what’s wrong; if you don’t know exactly what’s causing the infection, you can’t effectively treat it. Like I was saying, we were fortunate this time because they actually remembered to do a culture, so they were able to put him on the most effective antibiotics more quickly. They also managed to both schedule him for and take him to get a CT to positively identify the cyst.

By the time they wheeled him up to CT, the ER was swamped, so they booted my mom from the room so they could put someone else in it. No problem, that’s what the waiting room is for…as long you come back for the people who are waiting. Again with the silly expectations. I mean, when you ask explicitly that 1. Someone come get you as soon as the procedure is over and 2. The patient, your family member, not be taken elsewhere before getting you, and the nurse vehemently states that she will be sure these things happen, why would you believe her? Clearly it’s far more reasonable to just leave the family members in the waiting room indefinitely and hope they just forget why they’re even there and just go home.

As long as patient and family wishes are being ignored here, it’s no surprise that they went ahead and violated stipulation #2 and took the patient straight to the room he’s getting admitted to at the other end of the hospital. In order to do this, a specialist gets called in: you see, the hospital employs highly skilled personnel specifically to wheel patients around the hospital and deposit them in various locales. So, this individual picked my dad up from the CT room and began the trek across the hospital, managing to get within one floor of their destination before things went awry. My dad questioned why they were getting off one floor below the transplant ward, but he was assured that “Oh, they take everybody here!” and was promptly wheeled into “his” room – only to find some guy (I’ll call him Ned) already in “his” bed. After many phone calls and a mild panic involving the concern that Ned didn’t belong in that room and that the guy who did must be missing, they finally realized that all the orders had been crossed – Ned did indeed belong in that room and had, in fact, been in CT earlier that day….someone just forgot to mark that he’d been taken care of , so when this young lady went to pick him up, she instead got the guy who was currently in the room, my dad. Eventually she figured out where he actually belonged (surprise, on the transplant floor!) and, I assume, found the poor orderly who was likely searching for my dad for the past hour.

Eventually, we all end up making it to his room, but the fun doesn’t stop there. The next visit, which of course takes hours to occur, is from the pharmacist. As it turns out, transplant is just about the only part of the hospital not yet utilizing electronic records (ironic, considering the chronic nature of the illnesses and the frequent hospital visits); instead, they keep their own paper charts. This would be fine if they managed to keep accurate records. Emphasis on “if”. Considering that he was admitted three months ago on that very ward, they should have had an extremely up to date medication list, but somehow they had one that was utterly and completely wrong. Shocking, I know.

Ultimately everything worked out; he was treated and discharged in just a few days, and everything is back to normal. But does that excuse the absolutely abysmal experience in the ER? Absolutely not. Was this perhaps a fluke, was this just maybe a bad day and the ER is usually not that dysfunctional? Absolutely not. We have had similar experiences time and again, and not just in our home ER, but at others across both our and at least one neighboring state. This is an appalling, and worse, a DANGEROUS standard of patient care. He was lucky; there were so many opportunities where these mistakes could have easily been detrimental to his health and outcome rather than simply irritating.

Absolutely appalling.