Lessons I Learned in the Emergency Room Last Weekend
When new symptoms of heart problems took me to a different hospital
I walked through the doors of the Emergency Waiting Room directly into the end of a line. A woman on my right scooted her seated walker and boldly informed me she was next — before me; there were seven or eight people before her in the L shaped line.
Lesson #1: Me First, I don’t care what is wrong with you.
This is a major metropolitan university-based research and training hospital in the Northeast. It is considered a regional expert in cardiac and many other areas of health care, and is highly regarded all over our country.
Three glass booths and two spaces alternated on our right; one person at a time went into a space from the line. The waiting area was overflowing with people in all stages of suffering.
They had been triaged to Wait.
My sister joined me, having parked the car. “What a place to be on a beautiful warm fall afternoon like this.”
Thirty-five minutes later it was my turn at the window; step into the space and pull the chair from in front. I cleaned the filthy counter in front of me with hand sanitizer and a tissue to remove partially dry gunk. So much for COVID instituted cleanliness standards.
I was addressed by the unidentifiable person in the glass booth on my right. She located me on her computer, banded me with white and orange bracelets, and told me to turn to the window behind me. Just like clockwork. Like the ticket booth in a parking garage, it had a nurse in the window. I could tell by the stethoscope.
Lesson #2: Health Care Employees in that setting do not introduce themselves any more. I could not tell by their uniform, upside down nametags, or demeanor what they do. I had to guess.
“What is your problem today?” Looking as healthy as any 74-year-old with zero health problem looks, I explained that I have been a cardiac patient since 1999, have 10 stents, and have had bypass surgery. The angina I have experienced frequently for about 8 weeks has been treated, unsuccessfully. Four days ago I had a nuclear stress test, and am to be scheduled for an angiogram. This morning while sitting with my feet elevated, I became light headed and weak, and stayed that way for four hours.
My blood pressure which had been running 135/70 to 185/80 depending on activity and pain, was 110/50, and when I laid down it was 100/45. I talked with the Cardiologist on-call and was taking his advice after not feeling better within a couple hours. I let him know I was coming.
I also explained that when I stand up my pressure rises to about 120/60. “I am afraid that the (portion of my heart) that has (reduced circulation) is not perfusing when I lie down.” A question mark crossed her face as she took my blood pressure.
Lesson #3: I was not supposed to speak knowledgably in medicalese.
I told the that I am a retired RN, I worked for 42 years. Ever since my first stress test for unrelenting chest pain revealed a 95% blockage and was reopened and stented, I have stayed on top of my own symptoms. I have become very familiar with my signs and symptoms over the past twenty-three years. I further said that my EKG is always normal, and because of my vigilance, I have never had a heart attack.
Lesson #4: I am a person in need of the nurse’s health care expertise; I am not expected to know what is wrong with me, and certainly should not be telling the experts.
“You may find a seat in the waiting room.” Go join the unhealthy, the writhing and moaning masses. My phone told me it was 3:30 p.m.
The floor was filthy. This is a hospital. Oh dear.
Lesson #5: Cleanliness is not essential in that healthcare setting.
Three long rows of chairs, one with backs to the windows, the second faced them, and the third with backs to the second row faced a wide space, which had people traversing it constantly. Expressions on visitor’s faces silently shouted their distressed feelings, until the announcement that all visitors would have to leave the Waiting Room. My sister went in search of lunch.
A pleasant gentleman manned a booth at the far end of the room, giving stickers allowing visitors to enter the Emergency Room area. His patience was unfathomable as people told him off for not straying outside his job description to do their bidding.
A female student-of-life, recently a teenager, sat in a chair by his booth behind the nylon barrier, observing his activities. Was she an orientee? I never learned her position, but she gave me directions to the restroom within the ER proper.
Walking through the bustling corridor within the ER, I noted that every inch of wall space in the hallways had a stretcher with a very sick person on it, some with IV’s running, portable screens up around others.
These were the sickest of the sick.
After a couple hours, I suggested to my sister that she might as well go home — to my house where she would stay overnight with my dog. Her daughter had visited and taken him out. Her husband had brought her things to my house that she needed for the night and next day. I was thankful my home and dog were going to be cared for by my generous, loving family.
Certain an angiogram would reveal that I needed bypass surgery again, on Friday I packed personal items, pjs and robe, socks, and some materials for reading and writing as well as chargers for iPad and iPhone. Two lightweight bags, or so they seemed. My cash and jewelry and cards were all left home. I was here for the week, I figured.
6:45 p.m. My name was called from one of the doorways across the busy passage — I was told it was time for an EKG. The tech told me the results were “Fine.” I told her, “As always. The years of prompt interventions have helped me avoid the steamroller of heart attack which show as dramatic changes on the readings.” Another time I was called for labs and a capped IV to be inserted.
I was directed back to the waiting room. I took a chair in the far corner where I could plug my cords into a power strip on a WOW — Workstation-on -Wheels, the rolling computers that lurk all over hospitals now.
At 7:30 I approached the now not-so-busy nurses area. “May I have something to eat, breakfast was a long time ago?” “Tuna, turkey, or PBJ, water or ginger ale.”
Lesson #6: Advocate for myself, no one will offer even a drink of water.
I took the tuna sandwich and beverage back to my corner. Mighty glad to have brought something to do, I texted with family and friends, checked everyone’s Facebook, and played Words With Friends. I started reading a recent Amazon delivery, On Writing by Stephen King. Fascinating! I am a student of writing these days, having started my new career.
11:00 p.m. My cousin, a hospital-system-administrator-in-another-state texted, “Stop looking calm and being patient, stand up and shout, ‘I’ve got chest pain.’ They’ll move! This would never happen here.”
My name was called from the nurses station shortly after I placed a call to the Cardiologist on-call to complain. I thought just maybe I was about to be transported to the Cardiology unit. Fat chance.
“Yes?” “I need your vitals,” as she stood behind a barrier with a thermometer, oximeter and BP cuff. “When will I get a bed?” Like rote she spoke, “there are no beds in the hospital or Emergency Room. Until someone goes home, there are none, then those who were here first will go upstairs. The hospital beds are full of nursing home patients with no nursing home beds available to be discharged to.”
The community overcrowding problem is now directly hindering my healthcare. I am being told, “too bad, so sad, nothing can be done.” In other words, “It’s your problem, lady, not mine. I just work here.”
Thus, I was summarily dismissed. The Waiting Room had thinned out. A few folks had been there as long as I.
Lesson #7: If I die, I die. Nobody who in the past would have cared, does. Again— Self-advocacy must rule.
I decided I would not go home and start all over again tomorrow. Just sit. Entertain myself. Make notes of this present situation. Find new games on the ‘Net. Stay awake. Two o’clock I asked for more food and drink and was blessed by turkey.
6 A.M. Sunday Morning. I hear my name called from the opposite front corner again. It is time for vital signs. Hmmm. I came in for an unstable blood pressure and angina and this is the third blood pressure reading that has been done in 16 hours. Incredible.
I attended a three year hospital school of nursing, 1969–1972. I graduated as a diploma RN, with a white cap and black band. I learned to become a nurse by doing nursing under the instruction and watchful eyes of nursing instructors. Sometimes I found socializing to be much more important than studying, but in the end, when I completed a two month internship under high-pressure observation, while I worked as a nurse in the ICU of a large university hospital, I was awarded a 98% for my practice. I knew how to be a nurse. What to monitor and when to do so. To treat people with care and respect, always. And I knew why.
Lesson #8: Focus on the humanness of the being appears to have been lost. Sadly.
It is basic, a patient who presented with my complaints would have a BP taken lying down, sitting, and standing, on arrival to document the reality of the problem. A bed would be found, and regular BPs would be checked. Doctors would come. The patient reporting an unstable cardiac condition would not sit in the back of a Waiting Room for SEVENTEEN HOURS.
At 7:15 a.m. I was called up again. The man at the booth with stickers and patience was still on duty. “Come with me.” “Where?” “To the tent.” “You did not tell me to bring my things, I have to go get them.” Tension. Move quickly. Pick up my two now heavy bags, walk fast. “Where?” “Outside” — into the cold. “Up the ramp.” Urgency ruled.
“I have angina. I need a BP check and Nitroglycerin,” I tell the director of activity. Cold air. Anxiety. Lift and tote. Move fast — uphill. Any one of these things will bring on my angina. All together — Big Time!
I was shown to a booth in the temporary, built for COVID, add-on building. She barely acknowledged my complaint. I sat on the Geri-chair. No one came. I took a Nitro from my pocket and in a couple minutes my breathing began to slow and the pain dissipated. In half an hour a nurse came and checked my vitals. I told her my experience and self-treatment. “OK.”
In fifteen minutes a doctor came to discuss my symptoms. She was the first doctor to lay eyes on me in the nineteen hours I had been in the medical facility with cardiac complaints indicating instability. My blood pressure had been checked four times.
“I need my medicines.” No response. “Shall I have my sister bring my Mediset from home?” “OK.” Said the doctor. That is the most ludicrous breach of nursing practice I can imagine. Taking one’s personal medications has always been verboten. During treatment, how does a doctor assess your condition if you are under the influence of medications and she does not even know what meds?
Lesson #9: Rules are made to be broken. Even basic healthcare rules. Should they be broken, though?
But, I was still in the Waiting Room. I understood I was not really a patient yet. Maybe not even a person. My beloved sister came for several hours, we talked with a girlfriend who would stay with my dog until I came home. My fears were relieved in that arena.
3 p.m. “May I have a PBJ, I have already had the other two sandwiches during the night.” “Of course,” the very pleasant nurse smiled. “Water or ginger ale?” “Ginger ale, chips and a pickle!” She returned with two sandwiches — one for later, ginger ale, and chips. A picnic. Then forty-five minutes later, “Look!” She brought a box lunch with the same food plus peaches and juice. I am not sure if Famine or Feast is a lesson.
For whatever purpose, she gave me a shot of heparin, “You’ll get one every 6 hours.” It was the only one I was given while I was there.
4:30 “It’s time to go.” “Where?” “You have a bed in a room in the Acute area of the Emergency Room. You have a roommate.” I was given a chariot ride. Blessed, I figured. My roommate, 11 years my senior, was an LPN who worked her career in NY City. She had graced that bed since Tuesday when she came in as a crisis, and was going home tomorrow. She never saw the outside of the Emergency Room in six days. No wonder there are no emergency room beds when the ER is used as hospital beds. After all, the hospital is being used as a nursing home.
What tales we swapped, it was social hour in the ER, complete with laughter. Old nurses have lots of stories.
At 7 p.m. a nurse came with her WOW and a pile of pills for me. I asked her to go through them before opening them. They were my morning pills. “What do you take in the evening?” I pulled out my list. I take about 14 prescriptions, four of them blood pressure or anti-anginal medications. They are carefully balanced for my stability.
“Who went over your medications with you before these orders were written?” the nurse asked testily. I pointed my finger straight up as I carefully stressed the words,
“Not ONE person.”
The information had come from the computer, obviously. She asked for my list and left to call the doctor. When she returned she had the right medicines. She was no longer angry with me. “Do not eat or drink after midnight, you’ll have an angiogram tomorrow.”
Lesson #10: If it is in the computer, why bother to ask the patient. Computers know everything, apparently Patient, be ever vigilant.
I slept at last. Up at 7 a.m. Saturday, it was 11 p.m. Sunday. I made it through with just one angina attack. During the night the blood pressure kept alarming — I would check it each time — 88/34 was the lowest I saw, but it never went above 100/systolic. I probably needed to stand to get it up to normal. Well, my blood pressure did what I said it did, the abnormal.
“I am scheduled for 12:30,” I told my sister Monday morning, when she arrived. We agreed she would go home when I was taken. We heard the page for “Cardiac surgical team to Angiogram” and figured I would be much later than 12:30. Then the day nurse told us that a heart attack had arrived and had to be de-clotted immediately, so it would be 5 p.m. at least. My kid sister and I took a walk through the sadly decrepit, overcrowded, and extremely busy unit, then out into the sunshine, up and down the sidewalk outside the Waiting Room windows.
As we settled back on the edge of the bed, my stretcher arrived. “But it is only 3 o’clock!” “Your time has come!” Hugs and smooch, and Sister left.
I was whisked from the “third world jungle MASH unit” as I came to describe it, to the pristine heaven of Cardiac surgery. Cleanliness, peace, kindness, silence, gentle nurses and doctors.
It was Monday afternoon. Soon I was taken to the Cardiac Catheterization Room, chatting and laughing as I went. To me, this was all so familiar, I had been this route many times, and always came out on the up side of life. Here, they treated me like a person, like a professional, like I mattered. Like I knew something. Like my heart health was the most important thing they could imagine, and my emotional health and complete understanding of procedures was top of their list.
But, like everyone in authority all along the way, when I told anyone about my ordeal of 17 hours through the evening and night sitting in the Waiting Room, I was given The Phrase that must be ingrained into the employees, from On-High — “I’m sorry that happened.” It was said without emotion, with no offer to do anything about it, not even a report. It started to grate, like the universal, “sorry about that.” Are you?
What can they do?
Lesson #11: No employee is helpless, even in a big system. Speak up.
Lesson #12: Everyone has a face and a voice.
Lesson #13: Each individual matters, patient and employee.
They can report patient’s complaints, they can give suggestions, they can offer to be a part of helping to bring about change, even a revolution. A committee (or many committees) can be formed, and ideas can be thrown out, “Green Light” we called it in my day. With enough attention to details of what is wrong, a plan will form that will make a difference. Persistence, open eyes, honesty — drumroll, please. Focus like a laser, one author says.
What they can do?
They Can Care!
Everyone can care enough to speak up, to say “This is wrong”, to Admit: WE HAVE A PROBLEM HERE, to offer personal suggestions, and personal time, to help Fix the Problem. No accusations, no guilt, no retribution. Just Fix It.
Caring — Isn’t that what the heart of nursing is all about?
P.S. Six angioplasties and two new stents have reopened my right coronary artery again. I shout out a huge THANKS to the Cardiac Angiography Specialty Team! I was discharged the next morning from the recovery unit. There still were not any beds in the hospital.
