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The Unpredictable ER

Posted Sep 12 2008 11:49am

Whether you have acute symptoms in need of immediate attention, want to have something checked out during non-clinic hours or have an exacerbation of a chronic illness, chances are you will at some point land in the same place: The Emergency Room. This is a place with so much activity, so many life stories converging, that they have made many hit TV shows about it. While I have met very few George Clooneys during my visits, I can see why this is a perfect setting for a great drama (or comedy, for that matter). This is the place in the hospital where anything goes. Car accident victims, gun shot wounds and people having heart attacks are all brought here. So is Fannie Falls A Lot with her ninth sprained wrist, as well as Penelope Puker who has the flu. The list of characters goes on and on but, suffice to say, it is usually a bit chaotic.

Example 1:

It was 3pm on Sunday and I had felt sick since Friday night. If it weren’t for the fever I would have waited for Monday but I don’t have the luxury of taking any chances with my health. Before leaving my house for the ER, I was sure to call my doctors, tell them when I planned to arrive and had them call ahead with orders and/or medications. The attending was not available, so I requested to speak with the Resident in charge. The hope was that this type of pre-planning would get the wheels spinning (and maybe some tests ordered) before I even got there. This was only a hope.

The first thing I encountered at the ER (besides the full parking lot) was the reception desk. I had to remind myself that an ER is not first come, first served. The most severe problems are seen first. I used to be shy when I came in and would only list my symptoms as my reason for being seen. What I have learned is that it’s important to give the people up front a more well-rounded view of my situation. That will help them understand the level of urgency in the situation and may help me get seen sooner. I don’t mean to suggest that I lie or exaggerate. I simply list pertinent information that will alert them to my needs. For example, I am sure to let them know that in addition to my fever, I am a transplant patient and am immune-suppressed. Because of this, they work to get me in a room so that I won’t have to be exposed to other people’s illnesses in the waiting room.

Once I am in the back, it is important for me to get the ER doctors to consult with my team. Most physicians are happy to do so, but on this trip, the ER docs resented outside influences and wanted to steer the ship. For someone with my kind of history, my medical care is too complicated for it to not be handled by a specialist. They were dragging their feet around contacting my doctors, so I was sure to do it myself and got them in the process as soon as possible.

Eventually, we were all on the same page and I was able to get the benefit of a functioning ER, one that worked in cooperation and understanding of my primary care doctors’ treatment plan.

Example 2:

Some of the nicest, most talented nurses I have ever known were ones I met in the Emergency Room. Unfortunately, there are always exceptions.

I came into the ER one summer with a high fever I hadn’t been able to control. I knew I would be admitted but the team wanted me to be seen at the ER until a bed was available. During the routine questions, I told my nurse that I had taken 4 Tylenol to try and bring down my fever. She was appalled. She scolded me and told me I would have to wait a long time to get any more. I certainly understood why taking 4 Tylenol was bad for me and I allowed her to make me feel like I had done something very wrong. I sat quietly while my fever returned with a vengeance.

The hospital was packed full and a bed would not be ready any time soon. I got to feeling very poorly and asked for someone to take my temperature. It was 101. I requested some Tylenol and my nurse came in with her hair on fire. She told me I would have to wait for another six hours before I could have another one. She wrapped me in blankets and told me again how wrong I was to have taken so many Tylenol.

I felt very vulnerable and very scared. I knew that a fever could cause my lungs to go into rejection. I knew I shouldn’t let my fever continue but I was too weak to fight this woman.

By the time they found me a bed, my fever was 103.9. My doctors didn’t care if I had swallowed a bottle of pills that day; the priority was to reduce my fever. The team was almost as upset with the nurse as I was. For my particular health issues, that kind of fever had the potential for devastating results.

I learned that I should never again doubt what I know and let myself be guilted into something. The solution to that problem was easy but I was too timid to carry it through. I should have paged my doctors and told them what was happening. She was uninformed on the delicate nature of my disease, she would not listen to my reason and I should have found a way to take care of myself despite that.

The Verdict:

Emergency Medicine has to be one of the most difficult specialties to work in. It is a place where the nurses and doctors need to know a little about a lot of things. It is a place of great distress and trauma. It is a place where people go when they have nowhere else to be seen. There have been times when I am in and out of the ER quickly and with very few bumps in the road. There are times that I have spent days in the ER waiting for a bed in the hospital. I have had very positive experiences and very negative experiences. One fact remains, however: the ER is an essential piece of the medical system pie.

That said, for those of us with specific problems, it is the luck of the draw as to whether those caring for you in the ER will know enough about your needs to treat you correctly. This is the place to stand up and flex your patient advocacy muscles. You may be delighted to find a doctor or nurse that knows a great deal about your specific ailment or you may find that you will be doing a lot of on-the-spot-educating. Bottom line: be prepared for anything.

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