A Night in E.D.

Last year, 201, I spent a night in the Emergency Department of my local hospital. It was a busy night there and there were no beds available at all, anywhere int he hospital. Now, once again, we find ourselves in the midst of a crisis, with hospitals everywhere under severe pressure from demand. I spent the night observing these people at work and those they were seeking to help, including myself. I wrote this story and it was published in out local paper, (Derry Journal, July 17th, 2015).

I have decided to add it to this blog because I think it is once again relevant and may be of interest.

A Night in E.D.

The other evening I had occasion to be taken to our local Emergency Department with what I can only call very severe chest pain. I figured it was some sort of nasty indigestion or something like that. The paramedics that attended me were not so sure but reassured me that my ECG looked okay though I was clearly unwell. They advised me to go to the hospital.

Well, whatever else I am; I’m not completely stupid, so I reluctantly agreed. It had been snowing and the roads were in a poor state but our journey to the hospital was uneventful and short.

It was evident that the Emergency Department was busy, all the cubicles seemed to be occupied. I remained a few minutes on the trolley as the paramedic spoke with one of the on-duty doctors. My chest pain was already beginning to subside and I was regretting calling the ambulance. By now, I knew that this was another in a number of episodes that would end and I would carry on as normal. Now, I was contemplating a stay in the hospital, unless I was lucky, and those dreaded tests I knew they would do. I couldn’t hear much of what was said, but I observed closely, as one does when one is trying to determine the nature of decisions being made about one by other people. So, I picked up a stray word here and there and deduced that the ED Doctor was not unduly worried about my condition. Nice one! I’m already beginning to formulate a plan. These are all great people, but, really, I didn’t want to be there.

I heard the word “triage” and inwardly groaned. Triage is where they try to establish how long you can safely be left waiting while they deal with really sick people. It’s fair enough, because by now, I knew that I was not “serious’ in an emergency sense of the word. But, that can mean lengthy waits in uncomfortable seats with lots of very unhappy looking people. Not your ideal night!

Ah, but I forgot, chest pain always gets a fast response. Straight away I was bundled into a seat with wheels to be transported by a porter. “I can walk, I protest, feeling slightly idiotic, because, really I can. I am now feeling much better and, well yes, these people are clearly very busy. One of them looks down at me, and simply shakes her head as if to say, “no chance mister!”

I comply and await my chauffeur who arrives in short order and pushes me to another part of the department. He deftly parks me up and heads into another room where I hear muffled voices. I hear my name. I find reassurance in that. I know I won’t just be left there like a forgotten orphan. I know it is routine for them, but seriously, why can’t they just tell you what they are doing and what to expect. It would make the whole thing much more manageable.

A nurse appears from around the corner and greets me smiling, “Patrick?”

“That’s me” I respond hopefully and I wait while she consults a file. Even as her head is moving from the file toward me she begins, “Now Patrick, I’m just going to take your blood pressure and some blood okay?” She’s asking permission, but she’s not either, this is how it  has to be. Well of course it is, I know this!

Normally, my veins are easy to get at, and I am not particularly squeamish about needles and the like. But, tonight, she’s having trouble. She looks at me apologetically. I say not to worry, just try again. On the third attempt, she uses an old-fashioned syringe and it works just fine. I like this nurse, she holds her nerve and gets the job done. I have seen some get flustered when this happens, but not this one. She fills two vials and then applies pressure to the opening as she removes the needle. I take over, keeping the cotton wool in place. Well, I like to feel useful you know!

Having labeled the vials and completed the relevant forms; there’s a lot of bureaucracy in medicine and I know it is essential, she smiles benignly and informs me that she is going to do a heart trace. She wheels me to just outside her domain, the triage room. Again, I wait. It’s not a long wait and a man comes along and wheels me into another small room. He is a support worker and he begins applying those sticky things to me. As he does this however, he assertively removes those that were earlier placed by the paramedics. He grumbles that the ambulance uses very sticky ones. I agree enthusiastically because he is absolutely right. Each one leaves behind a trace of itself in a prolonged and sharp sting as both the sticker and one’s body hair part company.

Heart trace over I am whisked back to the ED, which be now appears to be even more chaotic than before. My chair, yes I’m still in it, is placed in the waiting area, a capacious 6’ X 6’ room that is already full to capacity. There is a sputum tray on the one empty seat with traces of fluid in it. No surprise the seat is empty. It is perhaps a visual reminder of how busy everyone is and although I keep my distance, I am not cross about it. Of course, I know others would be. I can well imagine the infection control staff having a total meltdown at this and it is just the kind of thing that forms the basis of a good headline. It’s a visual reminder that lets the side down, as one might say. But I think this is of considerably less importance than what is going on elsewhere in this microcosm of our society.

At the emergency department reception desk there are number of doctors wearing scrubs each attending to a computer monitor or writing notes in files. I can see that they hard at work because there is an air of intensity.

Now I have a few choices here. There’s not a lot to look at and I want to avoid staring at my companions in the waiting room, there are no magazines or other diversions, and as my current incarceration is unplanned, I have brought nothing with me either.  So I find myself zoning in on the action behind the desk. There’s a lot of background noise in the ED, so I catch only glimpses of conversations, a phrase here a word there. I’m not being nosey per se. I have a personal interest in the goings on here.

It is now rapidly approaching 11.00.p.m., and I still want to be home tonight. Right now, I am wondering if I should be here at all. I have almost completely recovered from the episode that took me there in the first place, and I reckon a visit to my GP could be the way forward. The only clue I can get about when I might be seen is by observing what is happening elsewhere. Just in case it is not obvious, I reject the logical step of simply going over and asking. Like I said earlier, I am not the sickest person in this place by a long stretch, and it doesn’t take a genius to realise how busy these people are.  So I wait.

There are about six doctors on duty that night, and even more nurses as well as auxiliaries and domestic staff, each one playing their part. A casual observer might be forgiven for thinking that these people work independently, catching whatever is thrown at them and then moving to the next case. Nothing could be further from the truth.  I identify one doctor to whom, at the moment, the others seem to defer. I deduce that he is the ranking physician, I might be wrong of course, but it is clear that the others seek his opinion. In a short space of time two doctors and then a nurse approach him with enquiries about next steps. I observe him listen, you can almost watch his analysis as his face alters or he runs his hands through his hair as he contemplates. I can’t catch much of the detail; these people know how to talk in a crowd without giving much away to the casual observer. But I get some. Here is a man who knows his onions. But, he is clever because he seems to help the others work through their options and arrive at a conclusion themselves. Even under pressure, he is helping the others find their path. And now, I begin to see. There is an undercurrent in the space. I keep trying to put my finger on it. But, it is somewhat elusive, partly, I realise later, because they are all doing their best to maintain cool heads. Panicking in any situation seldom leads to a good outcome for anyone. You know, we all have ways to show that we are under pressure. It must be so frustrating to be on public show, like these health professionals are and not be able to show that.

My sense of being an observer to something important continues to grow, though, as before, I can’t quite figure it out. Now, I notice that another person has quietly joined the group behind the desk. She is older than the others, but that’s not what sets her apart. There is an air of very quiet and very serious authority about this woman. She is clearly a nurse by trade, a senior nurse to be sure. She sits apart from the others, though I catch her watch them. She is assessing something. I wonder if she is doing some sort of quality audit. Well, she couldn’t haver picked a worse night. I feel sorry for the people working there. As is they don’t have enough to worry about.

I turn my attention away as I hear my name being mentioned. There is a conversation between two of the doctors and without clearly hearing; I know they are discussing my results and observations. Soon enough, one makes his way toward me and motions me to follow. As we go, he introduces himself though I don’t catch his name. He asks me what happened and, as succinctly as I can, I tell him.

He is friendly and seems approachable. He asks if he might listen to my hears and chest and, of course, I consent. The business is complete in short order and we sit down. The news is reassuring; in fact, it is quite reassuring indeed.

“Your blood test is normal, you got a score of three in…..”, he is speaking, but I miss some of the technical words that he speaks so fluently. “So”, he continues, “it looks like there is no damage to your heart”. He pauses, and I express my relief. Oh, I can almost see myself in the taxi, going home. I wonder if I will make something to eat. I am, I realise, quite hungry. My plan unfolds in my mind’s eye; home, sandwich, something on the T.V., and then bed. Might sleep a bit late tomorrow?

“Sorry, I missed that” I say, but really I didn’t. My vision of domestic bliss collapsed at my feet.

“I was saying” he says patiently “that we need to repeat this test again”.

“No worries, I can get my GP to do that or” I add hopefully “ or I can come back here tomorrow”

He is already shaking his head before I have my suggestion made. “Ordinarily, I might be happy to see you go home. However, given the episode tonight, your age and your family history we really need to repeat the test here. I’m so sorry that there are no beds in the hospital at all tonight”, he says apologetically.

” I don’t want a bed”, I protest,  “really, there is no need. I’m quite happy to wait.”

” Well, the second test must be repeated at least six hours after the first test”. He tells me this with the look of a man awaiting the protest from me. But none comes. I do a quick calculation in my head and work out that they will be able to complete the second test at about 3:30 AM.

” Grand,” I say. “You can do that second test at about 3:30, is that right? I’ll just potter about the place until then”.

I’m happy enough, just so long as I can avoid a bed! I thank him we shake hands and off he goes. And I ponder the next four hours, a phone with low battery, little or no money on me, and the whole night stretches itself out like something impassive and totally unconcerned with me. So, I go for a walk. Outside it is snowing heavily and there is a wind; sharp enough to deter even the most desperate among us from venturing out. But I do take the air for a few minutes. While I am there, a police car pulls up and one of its occupants heads into the ED. I bid him good night as he passes, and he returns the favour. His companion parks the car and follows in.

I walk through those corridors that are available to me, just to pass the time and I admire the pictures of a Derry past, Ford Cortina’s, old shops, long since demolished and a dry dock, presumably along the Foyle somewhere. There are faces of women sitting on the footpath, happy and enjoying what seems to have been a hot and sunny day. There are men at work on the docks, and who knew that Austin’s was once a chemist shop? One gets a sense of time passing here, all those people, the complexities of their lives, gone now, though preserved in images and in memory. This thought bring me up sharp. In little more than a heartbeat, our lives can be changed utterly through accident or ill health. I begin to worry a bit, and start creating the possible scenarios for my own wellbeing.

Some time later I return to the ED and discover that it is now even busier than before. I make my way to the waiting room. There are no seats available and for a while I stand, as are one or two others. An ambulance crew arrives with an elderly man and his nurse. His trolley is parked in the middle of the floor and those accompanying him stay close by. Again, my focus is drawn by the older nurse behind the desk. She is still where I saw her last, but now she is on the phone. Soon, I can see that everyone is under pressure and there is an almost constant stream of consultations between her and the doctors and nurses on the floor. It has the air of competence, not panic, but, there can be little doubt, these people are working under pressure.

I can’t hear her words, apart from the odd stray escapee, but the sense of what she is trying to do is clear. She is trying to clear the ED of waiting patients and move those of them for admission onto wards. I hear her tell her colleagues in a matter of fact way that there are no beds anywhere in the hospital. And I look around the ED; there are people everywhere, waiting, some sleeping, some walking up and down as I have been and one or two heading outside for a “breath of air”. One young man approaches the desk and asks when he might be seen. He has the look of someone who wants to be dealt with and let get away. But, I can see it in his face, he has no spirit for the fight, even he can see how ridiculous his entreaties are. He retreats to his seat, no better informed as to his possible departure from this place, but maybe a little wiser.

I feel “in the way” here, so many people standing about, others sitting, and those in cubicles. Periodically, there is the sound of someone vomiting, one or two  seem to be drunk, others just lie quietly, some with family, others alone. I move to the X-ray waiting area where there are seats and no people, save for the one radiologist. She seems to understand my desire to find somewhere quiet and does not object to my encroachment. For the next hour, I sit alone, trying to read someone’s leftover tabloid paper; I quickly see why it was left there and discard it.

I doze a little, but soon I am wakened by the sound of loud voices. I look down toward the sounds. A small group of people is standing close to the exit door. A young man is trying to communicate; he is agitated and clearly intoxicated as he is having some difficulty maintaining his balance. Quickly, it is clear that he wishes to leave, but others are trying to persuade him to remain in the ED. The older nurse is working with him. As he is loud, so she is quiet; she listens and seems to speak only when there is a silence. Two others are also there, I suppose they are the young man’s parents, and a police officer stands close by. I take my attention away, this is a private matter and I have no wish to hear any more. Others must be doing the same, because, life in the ED seems to move around this scene, creating a bubble around it, so that it may unfold and others might be attended to also. Some half an hour later, I simply must get up and stretch my legs. I walk in the only direction available to me and see that the young man is still there, still being cajoled or encouraged to remain where he is. But it is quieter now. A nurse asks if I wish to leave the ED as she halts my progress. She steers me away from the scene, maintaining the bubble around it so that I might not interrupt. I am happy to comply, feeling somewhat stupid for not thinking that way myself.s

I return to my seat and close my eyes. I would be happy to sleep a while to pass the time. I look at my watch and see to my relief that it is 3.15.a.m. Soon I can get my second blood test and be on my way. I wait half an hour or so, and again make my way toward the ED. I see the doctor who has been looking after me; I wish I had caught his name earlier! He is walking away from me, clearly on an errand and I hang back.  It is another half hour before I see him again, during which time I imagine him dealing with a serious emergency or taking a leisurely lunch break, and my mind flits from one to the other incessantly. Basically, I am trying to work out if I should have just called him, even though I could see he was busy. He greets me and I ask about the second blood test.

“We were looking for you earlier” he announces, “did you leave the ED?”

“No, I was sitting just there”, I point a little frustrated to the row of seats in the X-ray area which after all is only about ten yards away. “I’m sorry, it’s just so busy here, and, if we don’t see you, it’s easy to forget, there’s so many other things going on”.  Actually, I get it. “So, I might be better staying here where you can see me?”, I suggest.

He smiles a bit apologetically I think, “don’t worry, we’ll get these bloods taken right now. Can you follow me?”

I can see he is looking for a room in which to take my blood, and I can also see that there isn’t one. But, we are in a corridor, and there’s no one else there. “Here is fine with me”, I say.

The procedure is completed in a couple of minutes and I thank him. I tell him that I will return in one hour. This is the length of time it takes for the test results to come back.  He has already told me this.

And, so I begin my pilgrimage in the corridors again. I have a little loose change in my pocket, so I get some hot chocolate from a vending machine at the front of the hospital. It’s warm, though not very good. But, it is well after four in the morning, so I’m not complaining.

Others have the same idea, but none linger, it is cold in this part of the hospital.

On my return to the ED, I decide to head outside. The young man from earlier is seated in the corridor, two adults either side of him; I presume they are his parents. They look tired. I think they are trying to keep their son where he is safe and where they can get help for him. For a moment, the father’s eye catches mine. There is a momentary recognition, one father to another; his is a difficult road tonight I think. I walk  past without speaking, but I am left with mixed feelings of sadness and admiration for those parents. We parents do what we must, not matter what. I wonder if the young man will ever know how his parents fought for him tonight?

I decide to present myself again in ED. I can sit in the waiting area of the emergency department now. There is still time before my test results are due, so I content myself to wait. The department itself is still busy and there are a lot of people working behind the reception desk. Many conversations are taking place at the same time, and I observe the senior nurse watching over it all with a keen eye. I can’t hear the details of the conversations, and indeed I don’t want to, but I can discern that this group of people are trying their best to find places and solutions for those of us who are in need. I hear someone say  “there are no beds anywhere in the hospital”. I have already worked out that this was so from the lack of movement from the ED. I want to ask about my test results, but I decide to delay this. To do so now would be like interrupting a delicate ballet of interconnected events in full flow. Decisions are being made. I work out that now was the time for the nightshift to clear up after them before the new day begins. I see the doctor run his hands through his hair again, he is the focus of a lot of consultations and it seems to be him and the senior nurse that are the go-to people on this night. Don’t get me wrong, this is a team at work and in full flight and and they are magnificent. These are weighty decisions and they are being made with an air of competence and deftness. And, as decisions are made, so they are communicated to those in cubicles and on the walkways.

I must have slept for a while, because when I woke, it was quieter.   It is 6.30.a.m. I stir myself and walk over to the desk. Doctors and nurses are at work there, most are writing or typing into keyboards. I know the shift will change soon and I want to have my own resolution before then so I don’t spend the day there. I am promised that someone will chase up my tests. My results came back about an hour later.

My doctor came and sat beside me. He told me that my test results were good but he advised me to remain at the hospital because there was a concern that what happened to me might be a warning. I agree to wait for the cardiologist and resolve myself to a long day. The thought is distressing and I feel the need to be somewhere else.

As I am walking past the desk, one of the nurses asks if I have had anything to eat. I assure her that I am okay but she asks if I would like some tea and toast. Suddenly, I am hungry and I readily accept.

I return to the small waiting area, alone now, it’s like a lull in the flow of traffic. There are some new faces behind the desk and I presume this is the day staff beginning to arrive. They are all talking about the snow and wondering who will get to work and who will not. I marvel at this space of quiet and can almost feel the tempo of the place subside. I contemplate the long day ahead. There is an internal battle going on within me. I know the writing is on the wall, as they say. I want to be away from here, not because I don’t like it, but because I don’t want there to be anything wrong. But, really, I know better. As I am preparing to yield to the inevitable, a nurse comes with a tray of tea and coffee to those working behind the desk. She has a cake that someone baked. Everyone is pleased at this little kindness. I can feel their pleasure at the treat and they seem to appreciate the thought. I’d like some cake too I think. But I know that it is for them, and really I don’t begrudge them. Tea and toast seems good right now. Truth be told, I’m feeling a bit sorry for myself at this point. It’s just that one’s life can so easily be altered forever because of an accident, an illness or some other unforeseen mishap. And then one feels very small indeed. Not for the first time, I tell myself that our priorities are wrong, that my priorities are wrong. The constant need to get ahead, to get things done, always present, but seldom fulfilling.  But I avoid the telling of false promises to myself. Life is what life is.

I can see the nurse who promised me tea and she is heading my way. She has a tray and again, I feel pangs of hunger. I know the butter, it’s not butter really, will be melted and the toast cold, but, boy, am I looking forward to it. She smiles and places the tray down beside me. My tea and toast is there. And here’s the thing; on a plate is placed a slice of the cake they are all enjoying. This is a small act, but one whose significance is almost boundless. It reminds me that I am not something separate from them; I am one of them in this place at this time. I will move on and so will they. But I will always remember that little kindness with gratitude. And I am filled with gratitude, and I am now as I write this little reflection on my night in E.D.

 

PK