My Night in Purgatory
The evening started pleasantly enough, as my wife and I strolled some two miles out to Navy Pier. It was hot and humid though, and I was likely dehydrated as we approached the main building. As journalists like to say, "for reasons that remain unclear," I turned too quickly into what appeared to be an open space. It was, in fact, a giant plate glass window. I bumped smack into the thick glass, driving my glasses into the bridge of my nose, and managed to shed quite a bit of blood from a skin wound.
My quick-thinking wife guided me to a nearby bench and summoned help. Within an instant, I was surrounded by caregivers. There was the off-duty EMS tech who began peppering me with questions to test my condition. And soon thereafter, on bikes, appeared two on-duty techs who took my blood pressure and gave me the once-over.
"You'd better go to the ED," one said, adding that I was not the first person who had mistaken the pier's massive glass panes for air. Even though that made me feel a little less dumb, I of course resisted his advice, stalwart male that I try to be. But when he mentioned that my blood pressure had dipped, and could suggest something problematic, I paid heed.
Next thing I know, I am being whisked to the ED at a nearby teaching hospital. In the ambulance, I was promptly hooked up to an EKG machine. The firemen who tended to me were efficient, supportive, and even playful, suggesting colorful stories I could tell about how I smashed my nose.
I arrived at the ED right around 10 p.m. I was interviewed quickly by the desk receptionist, then within minutes was taken to another room for another interview by a triage nurse. This is really cruising along, I thought, not yet paying notice to the 40 or 50 people who were crowding the waiting room. But my wife cautioned me: "This could take a couple of hours."
I figured she was being pessimistic. But by midnight, I knew she was, if anything, being optimistic. I began paying attention to all those other people. And a motley crew they were: a potpourri of ages, races, and demographic niches. The well-dressed intermingled side by side with the destitute. They were mostly well-behaved, and patient. One fellow, however, became belligerent, yelling out about he had been inappropriately touched. A swarm of security guards hovered nearby, acting like this was some routine manner.
I was surrounded by truly sick people (a man with a growing pustule on his arm, which he showed me and told me all about) with the likely malingerers (the sad person clamoring to know why the hospital was denying her methadone). Then there was the sullen, edgy young guy with the Sinatra-style hat. We talked for a while, and I mentioned how tired I was getting. "Cocaine is the best thing for that," he said, before retreating into his blasting iPod world.
Most of the time, I just quietly watched, taking mental notes of this marvelous cast of characters around me, patients like myself, and their entourages. I persuaded my wife to go home around 1 a.m., reassuring her that I was feeling better and might even come home if the wait became too protracted.
An hour later, I was ready to "self-discharge"--which the hospital said we could do and incur no expense whatsoever--when the nurse called my name. It felt like I won the lottery--even though they don't announce lottery winners at 2 a.m.
But whatever euphoria I felt quickly abated, when the nurse explained she just needed to take my blood pressure one more time. And have me rank my pain on the Likert scale. It was still at six, I said, later realizing I probably should have said 11, and perhaps moved up the line a bit quicker. This was most confounding aspect of my visit--some people entered and quickly were ushered into the ED, but most others, like me, waited, and waited, and waited, as the staff shuffled--and reshuffled--our charts in the prioritization bins.
The nurse did me a huge favor, however. Remarkably upbeat for the hour, she told me the likely consequences of not having my nose stitched when the wound was still fresh, which were either a permanent scar or plastic surgery. Easy call: I stayed. Finally, at 3 am, after sitting for five hours, I was called and escorted into an ED bay.
In about half an hour, a physician assistant popped in, asked me what happened, and nonchalantly gave me a tetanus shot. "It's good for 10 years," he said.The next few hours are a bit of a blur. But I recall thinking that getting treatment in the ED is a lot like watching baseball. There are interminable periods when nothing happens interspersed with pockets of frantic activity. How else can you explain why, after 60 minutes of nothingness, both the rad tech, there to take my x-ray, and the nurse's aide, there to clean my wound, entered the room simultaneously?
Finally, at 5 am, the resident arrived to stitch my nose. It took five minutes, and he advised me he would have done it in three had he better equipment. He put in two stitches and advised me, "sit tight."So I spent the next hour pacing the room. The lottery did come, at 6:05 am, when another resident came to tell me I could leave--after he explained my wound care.
All went well, until I tried to modify the instructions to reflect what he had advised, which was not what was printed on the page. "We'll have to redo the paperwork if you edit it," he said, or words close to that effect.
Soon I was scrambling to the cab stand, bolting through the ED waiting room, which was still fairly full even as day was breaking. Still cheery, the nurse who advised me to stay waved as I went out. I thanked her for her advice, and, hearing that, she beamed like she was the lottery winner, not me. The slightest compliment is like gold to these overworked, underappreciated nurses.
Already, my nose is starting to heal. But my night in the ED will take some time to sort out. Is the ED half-full? Or half-empty? Was I the beneficiary of dedicated caregivers? Or was I the victim of complex bureaucracy in a hospital contending with an overflow of people who don't have primary care anywhere else? Should I just be grateful that I could even be treated, no questions asked, we'll figure out the payment later? Or should I be miffed that a 1-minute tetanus shot, a 5-minute x-ray and a 5-minute suture wound up taking 8 hours?
Truth is, I am coming down on the side of the half-full glass. After all, all those doctors, nurses, aides, and emergency techs were there waiting to treat whoever came through the door, even through the glass door like I did. I'm also among the lucky ones. I have an internist to call to remove my stitches and an insurance plan to pay for it. That said, I also have a newfound appreciation of how patient tracking systems can improve operations in the ED.
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
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