Falling Through the ER Cracks

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Screen shot 2014-10-05 at 12.55.42 AMThere is an axiom in modern society.  When all else fails, when you run out of excuses, you blame the computer.  That is what they’re now doing in Dallas, explaining how someone infected by the Ebola virus fell through the cracks.  It’s a good excuse, but if you’ve spent as much time in ERs as I have, these past 10 years, you realize the excuse is a crock.  It was such a crock they were forced to retract the story by Friday evening.

There has been quite a bit of consternation about how Duncan Taylor could have fallen through the cracks during his first ER visit, when he was ill.  Those who are puzzled about this, obviously don’t spent much time in an ER.  Unfortunately, I’ve become something of a pro at it.  Since the first of March of this year, with my mother, we’ve had something like 6 trips, with 2 of them in an EMS transport.  If you wish to avoid triage, you call EMS, and go for transport.  When dealing with an 84-year-old senior citizen with a bad heart, transport can be a life-saver.

An EMS transport gets priority.  From my experience, and I’ve had quite a bit, the people who are involved as EMS are highly-trained, very competent men and women who have a tremendous amount of pride in what they do.  Considering they’ve saved my mother’s life, they have my eternal thanks.  In an ER, you get what you get, on a triage basis.  At times, they are incredible.  Other times, I’ve been known to go from fairly nice person to bitch in just a matter of seconds.

I was forced to do that last Saturday.  My mother has been suffering from agonizing back pain since the first of August.  On Friday, she was feeling better, so she decided to fix breakfast.  She pulled open the drawer at the bottom of the range, and started having muscle spasms in her back.  The following morning, we headed to the ER, reaching it about 11:30.  I had to hit the bank, take the poodle home, and do a couple errands.  Knowing ‘everyone’ in the ER, I arranged for a wheelchair, with a couple EMS techs pushing her in for me.

My errands took about an hour.  When I returned, around 12:30, the check-in clerk caught me, telling me she needed my mother’s info.  Yes – they know us.  She thought it was on file, but wasn’t sure.  Of course it was.  I’ve been through this so many times, I’ve made photos of all her vital information, and keep it on the iPhone.  So does my sister.  That took about 15 minutes.  When I was finally able to get to her, I discovered she had been hooked up to a monitor, but that was about it.

She was in agony.

A nurse practitioner finally came over to her about 1:30.  “Did you check-in or were you just coming into the ER and not bother with checking-in?”  The woman was officious and nasty.  She was also new.  My mother is so well known to the crew there, that they hooked her up to a heart monitor and assumed she was having more a-fib problems, which is why we were there the previous week.

She began explaining what a fib was.  I looked at her.  “We are well aware what a fib is.  My mother has a pacemaker.  She is not in here for that, but for agonizing back pain. If you go back through the records from last week, you will find the notes about her a fib from last Friday and back pain from her visit last Sunday.”  I told her how long she had been there.

The woman ignored the fact that she was in pain, then ordered a morphine shot, which sent my mother into serious a fib.  When the monitors went off, everyone rushed into the room.  Her heart rate went up to 186, then 192.  The attending, my favorite physician because he doesn’t take any of my mother’s shit, was more concerned about her heart rate than the pain.  He stabilized the a fib, then went to do a little research.

We never saw the nurse practitioner again.  We were there until nearly 5PM.  She was no where in the small unit. I suspect she had been sent home – and it was an extremely busy weekend.  Dr. Whitti, after about 2 hours, informed my mother that he had been back through her x-rays for nearly 2 years – when the compression fracture in her lower vertebra first appeared.

Long story short, she’d been through hell for months, this was the first time the true nature of the problem had been located.  He’s a good doctor.  I swear, when people know he’s on duty, they time their ER visits to get him, instead of their usual family practice physicians.  He’s that good.

To put things into perspective, though we’re dealing with a small hospital, it has a top notch ER, highly rated for cardiac.  The accompanying ICU is one of the top 100 small-town units in the country. It is that good.  BUT – after the problems we had in March, I’ve learned to be extremely vigilant.  In March, an ER team I did not know, put my mother on DNR – Do Not Resuscitate – and classified her as having a heart attack in progress.  They were going to let her die – and say that the family had authorized it.

You learn the tricks of the trade.  You learn what to do and what to say.  When questions are asked, trying to facilitate the triage & diagnostic process you learn to explain – everything.  You don’t wait to be asked, you inform, during the process. If the right questions are not asked, then the right answers are not easily available.  If the ER attending did not ask the correct questions of Duncan Taylor, they were not going to get the correct answers.  If a person does not want to be forthcoming with information, unlike an episode of House, the process may not be very thorough.

Add that to the arrogance, incompetence, and basic generic problems real people in the real world have, and well… people sometimes die.  We shall see if their incompetence costs lives this time.  It will take nearly three weeks for us to know that one.

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