Everyone either knows someone or was a victim of Emergency Room Hell. While researching for this diary I ran into rants against local emergency rooms from all over the world. One of my favorite comes from Pace Miller, an Aussie who details his Emergency Room Hell. It's a good read. Here is another:
A Brit rails against the National Health Service.
After the jump I'll share with you my own Emergency Room Hell, but, first we need to consider why this problem seems so universally prevalent. Almost all of the stories I've read share one important feature: The patient was a walk-in.
My first experience with the Portland Veterans Medical Center Emergency Room began with an ambulance delivery. I was in a lot of pain. I remember almost nothing about the Emergency Room, nor how long I was there before I was admitted to the hospital. I think I was given a shot to relieve the immediate pain, but I'm not certain about it. The second experience I remember in every awful detail.
If you are not a Veteran, I found the following article very interesting: stuff the er staff won't tell you
Emergency Room Vitals
• Average cost of an ER visit: $707
• Number of visits to U.S. emergency rooms in 2007: 117 million
• Increase in the number of ER visits from 1996 to 2006: 32%
• Average time spent in the ER: 2 hours, 40 minutes
• Number of ambulances per year that are diverted to a different hospital due to lack of staff and space: 500,000
Wednesday, prior to Labor Day weekend, I ran out of Ciprofloxacin, the antibiotic I was given. I called my Primary Care Physician for direction. The cellulitius in my leg appeared to me to be as infected as the day I went in by ambulance. He called back on his lunch hour, and directed me to go to the Emergency Room. He made a note in my records requesting that someone from Infectious Diseases take a look at it while I was in the ER. Cipro is a pretty powerful drug. He thought it might be time to try something else.
Purgatory
At around 1:15 /1:30 PM I walked into the ER, waited for one guy ahead of me to check in, then did the same. Three more guys in wheelchairs came in right after me. The checkin area is a very crowed place. I helped them get to the window for checkin, moved them on to the second station, and then pulled each one out to whatever vacant space I could find. It's no big thing. Then I had a seat.
About 1:45 a guy came in with his hand wrapped in a towel. He was dripping blood. He got checked in in a flash and immediately was sent up to X-Ray.
Sometime after 2:00 PM I saw the triage nurse, explained to her about talking with my Primary Care Physician, and told her that he had left a note about his concerns in my file. She took vital signs, and sent me back to the waiting room.
From time to time I helped the wheelchair guys move to better locations or go to the bathroom. By this time I learned from each of them that they were in pain. That meant they would all see an Emergency Room Doctor before I did - and that's the way it should be. Around 3:30 PM a collective seige mentality seemed to set it. None of us had yet seen a Doctor - and no one had gone ahead of us. Things were tensing up. Then they were called in one at a time but in fairly short order.
DESCENDING INTO EMERGENCY ROOM HELL
At 4:05 PM I was called in to see a doctor. About 2 minutes after he walked into the examining room there was a knock on the door. "Get him up to vascular." The doctor sent me to X-Ray. I thought that was strange, but I went up to X-Ray. It turned out that I was getting another EKG. The technician was NOT happy about that. He did the test, wrapped up things as I got dressed, then went down to the Emergency Room angry as hell. When I saw him enter the Emergency Room exam area, he was not a happy camper.
4:30 I returned to the Emergency Room waiting area. Minutes later I was taken back to an examination room. The doctor came in, read charts, and asked the classic question: What brings you in today? I reiterated the Primary Doc's orders sending me in for a new prescription for cipro and his request that someone from Infectious Diseases look at my leg to determine if cipro was the appropriate antibiotic for the cellulitus. He examined the leg. It was very sore with a hot spot and swollen to about 2 1/2 times the size of the other leg. He drew some blood and said "We'll have results in about 1 1/2 hours."
WELCOME TO HELL
I'm diabetic. I have to eat at fairly specific times or make adjustments in advance. So, I spoke the words that sent me straight into Emergency Room Hell. "Great. I'll just run home, get a bite to eat and be back before the test results are ready." A nurse said something like, "If you do you go to the back of the line." Either I didn't hear her correctly, or didn't believe her - but I had to eat.
I left the hospital, drove home in 11 minutes [normal], let the dogs out, ate a chicken breast, drove back and arrived by 6:00 PM. I walked in, informed the clerk I was back, and she began to inprocess me. Yep. I'm now in EMERGENCY ROOM HELL and the gatekeeper seemed to be enjoying her job.
Almost immediately the triage nurse called me in. He had an attitude. As a gay man, . . . need I say more? I'm 6'5"x6'5". Usually, I'm approachable, friendly, and helpful. When I'm angry, people feel threatened. I got angry. Angry meant pissed about procedure and loud. He told me that if I didn't shut up and answer all of his questions - the same ones I answered for the 1st triage nurse - he would refuse treatment. He got the VA police - 4 of them.
I got frog-marched out to the entrance - not in cuffs or chains. They formed a nice semicircle around me and proceded to inform me that I was on federal ground and if I did anything untoward I would be guilty of a felony. I explained to them that I had been helping Veterans for over 20 years. I was not threatening anyone. I was pissed. Satisfied that I wasn't about to commit mayhem, the senior cop lead me back in.
The DEEPEST CIRCLE OF EMERGENCY ROOM HELL
You would think enough was enough. I immediately saw a doctor. She asked classic question: What brings you in today? I reiterated the Primary Doc's orders . . . ya-da, ya-da. She checked my leg. Having been on my feet for an hour, it was really sore, dark red, hot to the touch, and still 2 1/2 times the size of my other leg. She said that in her opinion the leg was no longer infected. I asked for another opinion.
Minutes later another doctor came in. He checked my leg, I repeated the Primary Doc speech, he backed up the first doctor's opinion, and I stated that tomorrow morning I would be the first person to see the Patient Representative. All I was trying to do is follow my Primary Care doctor's orders. Then he said the most amazing thing. He said that if I insisted, he would have the other doctor write the order for cipro. I insisted. I went over to pharmacy and was given the medication. I made it home by 9:00 PM - only 9 hours, plus or minus.
• Average time spent in the ER: 2 hours, 40 minutes Ah, yeah.
The Take Away
- What VA healthcare is usually like I wrote about in the tale of a nail that did me in.
- My experience with the Portland Veterans Medical Center Emergency Room only two weeks prior to this one was so good I can't remember it.
- This experience was bizaare. However, I was a walk-in. I was asking for help that was not really of an emergent nature - I just needed the medication immediately and that's the only way you can get it.
- I went to the emergency room at Portland's VMC for exactly the same reasons back in April and it took 3 hours.
- Emergency Room stories like the ones cited in the intro and this one share one common factor: the patients walked in.