Wednesday, September 10, 2003

E.R.


My brother and I took our grandma to ER yesterday. She could not breathe. She would not go to the hospital though. Why? Because they torture her there. I do not mean it in a sense that tests are intrusive, or treatment painful. I mean it very literally - ER is set up as a torture room through lack of organization, and absence caring for the suffering patients. There is really nothing more to it. Was the ER overcrowded, definitely. Was it understaffed or underfunded - I do not think so. There were plenty of nurses, doctors, residents, and assorted personnel for her to call. It is just that none of them were willing do any of the basic tasks she asked of them:

    1. Help her sit up

    2. Tell her what is going on or find someone who will

However, she did get her name entered in about 10 different computer systems, and her age asked dozens of times on paper forms and entered into the computer. Yet, every person who would stop by would fill out some new paper with her name, address, and age on it. They would get annoyed if an 80-year old admitted to ER would not answer quickly or clearly enough. They would ask their questions and fly away, ignoring her requests, having no answers for her, nor caring to provide any. They would forget to order her medicine, yet they would not let her take any of her own that she brought from home.

At one point she refused to go through some test, correctly predicting that it involves lying immobile on a tiny board in a machine for 40 minutes. Something she is clearly incapable of physically. They did not mind. They just left her sitting in the corner of ER, not admitting her to the hospital or running a test. This was 7 hours after we brought her in. What if I did not stop by back at ER at 10PM? Would she just sit there without food or medicine. I am sure she would. As she came in with an ambulance at 3PM I was told by her attending physician and her ER physician that she would have to stay overnight. Despite nodding politely to my insistent pleas that they request a bed for her overnight stay they did not do it. At 10PM they finally did. Why did it take so long? Because they are waiting to see if she would need to be admitted. Did not they know? Sure, but they did not have to execute that step until her tests came back. I left ER at 1AM and she still was not transferred to her bed, even though they got one assigned pretty quickly. Still, this is better than her previous trip to the ER when she was stuck there, amid vailing, beeping, and groaning, without food (and she is a diabetic!), or any human concern for her well-being from 9AM till 5AM. Again, both times everyone knew she needed to be admitted, and noone did anything because she is considered "stable".

From a systems standpoint, it is these stable patients who should be the fast movers through the ER. They take up the space, and nothing is really done to them or for them. Moving them either into beds or back home should be the highest priority beyond stabilizing critical patients. However, hospitals turn the ER into a staging area for all arrivals, screw up the process, and fill up the room with people who really need not be there. Once the ER has too many people everyone has an excuse of being overworked and getting nothing done. During the hour and a half I was not allowed into ER she asked for water from at least 5 different ER personnel. They stopped, they listened, they said, "one second" and never brought the water. The water fountain was literally next to her bed.

Is that not torture? Is there some better way to show someone sick and helpless how little you care? Is it impossible to actually educate personnel about the process so they can help calm people down and make them feel like humans? Why does it take a transport crew a few hours to come to ER and move a patient? If I can get FedEx to stop by a random house 'most anywhere in this country and pick up a package within a couple of hour's notice, why cannot a crew from the same building find a patient and take a stretcher to an assigned room? Why is it impossible to actually reach admitting by phone?

Sometime soon I will have to take her in again. She is old and frail so that is an inevitability. This time I got her to go by promising that they will treat her like a human and that otherwise police will fine her and arrest me. I do not think it is going to be enough the next time. She is not going to get to the hospital on time, and it will be due entirely to the fact that they tortured and humiliated her the previous 4 times. It is not going to be because of her condition, or their inability to help her, but because they do not want to treat people humanely if it is going to take any effort on the part of the hospital to improve the process, or personnel to care just a bit more. I honestly, cannot even blame the personnel. It is a tough job, and hospitals just do not want to invest anything into training, or streamlining the process. Clearly, it is just easier to hire a couple of "patient reps" who dress a bit nicer and ignore your requests and complains with the skill of a White House press-secretary.

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