We hope our loved one is in the hands of ER staff who are both skilled and compassionate and we hope we are knowledgeable enough to make the right decisions on their behalf if called on to do so. We steel ourselves for the hours we know we’ll have to wait. We hope we won’t have to jump up and down like a monkey to get them the attention they need.
My most recent call came about three weeks ago. After leaving two messages for her vascular specialist on Saturday morning, a family member I'll call Daphne received a call back on Sunday evening at 9:00 PM. “Go to the ER,” the surgeon told her. Another family member was calling to tell me that Daphne did not want to go. “The doctor is just covering himself,” Daphne said, adding, “If he was so concerned, why didn’t he call sooner?”
In the end, Daphne agreed to go to the ER at the small community hospital near her home. By the time I arrived, she was on a gurney waiting to be seen by a doctor.
Several veins in her leg were inflamed and I learned later she was in pain. That’s not all I learned.
Differential diagnosis of cellulitis (a potentially serious bacterial skin infection) and deep vein thrombosis (blood clots) is hard to make without a Doppler (a test that uses ultrasound to examine the flow of blood in the arteries and veins in the arms and legs).
The ER physician told us that they didn’t do Dopplers in the ER. The general attitude was that Daphne didn't need to be there.
Because Daphne had had a Doppler with normal results about a week before and because a similar inflammation in her other leg had resolved after a course of the antibiotic Cipro®, we were relieved when at 2:00 AM the ER physician called Daphne’s primary care physician and they decided to give her a prescription for Cipro® and release her. We arrived home at about 3:00 AM with no way to fill the prescription until the pharmacy opened later that morning.
The next afternoon the vascular specialist called to find out what had happened.
Two days later, Daphne had a second Doppler, which was inconclusive, and then a third, which did show blockage of the vein. She was admitted the same day and the day after had venous ligation (a surgical procedure in which the damaged part of the vein is removed and the vein is tied off to prevent clots from traveling to the lungs).
Several weeks later, Daphne is recovering well and we are all a little wiser for the experience. Here's what I learned:
- Know about the services and ratings of hospitals in your area BEFORE the emergency—you can do this at http://www.hospitalcompare.hhs.gov
- If you are told that tests are not available in the ER, ask if they are available in another department of the hospital. This hospital’s website boasts "a dedicated x-ray unit supported by a 16-slice CAT scan, MRI and ultrasound capabilities to provide immediate results around the clock."
- Call the referring physician as soon as the patient arrives in the ER so that he or she can confer with the ER staff. We should have known to do this and our not doing it is a good example of how anger (in this case about the doctor's tardiness in returning calls) and emotions in general can cloud judgment
- Encourage family members and friends to carry a list of drugs and DOSAGES, blood type, and insurance information
- Bring a pen and paper and take notes, e.g., names of physicians, nurses, social workers and details about diagnosis, treatment, expected outcomes and recommended follow-up
Advice from an ER Physician
Serena Fox, MD, an intensive care physician for twenty years, consultant in bedside medical ethics, and human rights advocate, offers the following advice:
- Familiarize yourself with the signs and treatment options for heart attack and stroke—the #1 and #3 causes of death in the U.S. (see links below to brief videos)
- If possible, go to an ER where your primary care physician and specialists have admitting privileges because they can get information to the treating physicians and most probably have a working relationship with them (So hospital affiliation is an important criterion for choosing physicians)
- Come in with a recent medical history, list of allergies, list of medications with dosages and schedule. Many pharmacies now have computerized this information and you can access it anywhere in the country, so having a primary pharmacy/pharmacist can also be of great help
- Remain calm and polite but aware and focused on getting information about your loved one. If you haven't heard from someone in an hour, you could say "I need to hear from someone" and a physician or nurse should give you an update
- Most hospitals have patient advocates who will help navigate the system. If a patient is admitted, social workers, head nurses, chaplains, and medical students can also be very helpful in getting questions answered and necessary attention
- Keep an eye on your loved one and let the medical staff know if he or she is behaving in a way that is not consistent with their personality, e.g., is anxious or withdrawn. A great number of hospitalized patients experience some sort of psychological disturbance due to the stress of illness and being in unfamiliar surroundings
- Remember to bring eyeglasses and hearing aids to help loved ones orient to their surroundings once they are stabilized
- Ask for a copy of your chart before you leave (or ask for a copy to be sent to your physician) and ask to sign a release giving the hospital permission to do so. Privacy regulations are quite strict and specific and the patient or his or her proxy must sign the release. If your physician is on staff, he or she will have access to the records right away. It can take weeks to get your own copy.
- You can also ask for a discharge summary and summary of laboratory and test results
For a fascinating view of caring for patients from the perspective of an ER physician, I highly recommend Dr. Fox’s recently published collection of poetry entitled, Night Shift.
Her work is described by reviewers as “an extraordinary treasure” of “explosive poetry” that frames “large questions about all human life: life as fragile and persistent…as plants that live on the slope of a volcano.”
You can purchase Night Shift at http://search.barnesandnoble.com/booksearch/results.asp?ATH=Serena+J.+Fox&SZE=10
Resources
Hospital Compare is a service of the U.S. Department of Health & Human Services
Act in Time, a 13-minute video featuring the stories of three patients, addresses the importance of recognizing the symptoms of a heart attack and how acting quickly can save lives. See http://www.nhlbi.nih.gov/actintime/video.htm
Stroke Overview is a 6-minute video about how to recognize symptoms, types of strokes, the importance of prompt treatment (time is brain), new treatment options, and prevention. See http://www.youtube.com/watch?v=yH6WqBNBOZQ
Emergency Care for You. American College of Emergency Physicians Foundation. Information about the specialty of emergency medicine, common conditions from abdominal pain to vomiting, what to expect in the ER, medical history and legal forms in English and Spanish, how to prevent emergencies. See http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx
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