The Real ER

(Cheesy title, I know. Forgive me. P.S. I'm going to put in some links here in case anyone wants more information, and also to give a better idea of what I'm talking about.)

Last week I spent the morning in the cardiac catheterization lab, and watched a cardioversion and cardiac catheterization. We had to wear lead outfits (which weighed about 20 pounds I would guess?) and got to look inside a man's body, starting in his femoral artery and vein and snaking up to his heart. The craziest part was that he was awake the whole time! And let me tell you, when you see blood squirting a foot upward out of someone's artery on TV, it might not be that unrealistic - it really happens! I wouldn't want to work in that place though; they said that some people are so fragile when they go in for the procedure that they just die on the little table because their hearts can't handle the stress. Everyone we saw came out well though, thankfully.

After lunch, I spent 4 hours in the trauma section of the ER. The ER has one area for colds, sniffles, asthma, and other non-emergency basic care - most of the people who use it are those without insurance. The other part of the ER is divided into a trauma side and then other emergencies - those having heart attacks, reaction to chemo, or just plain... dying. I was following a nurse who had several different kinds of patients. I will just talk about one woman who made an impact on my day. Sadly, this was not necessarily a positive, happy impact.

I was led into one of the rooms, and briefly introduced to my nurse. Immediately I was hit with probably the most awful smell I've ever experienced, and I'm not exaggerating. On the small stretcher in the center of the room was an elderly African-American woman. The nurse assessed her, and her Glasgow Coma Scale rating was 4, which means that she didn't open her eyes to even painful stimuli, she made no physical motor movements, and she made only incomprehensible sounds when she was moved. This indicated she was in a deep coma. Her body was in decorticate posturing, which indicates some type of brain damage, tumor, brain hemorrhage, or stroke (above link is a picture; decorticate is the bottom image.) The picture doesn't show this, but when in decorticate posture, the arms and legs are also extremely rigid and tight to the body, so she was nearly impossible to move to start an IV, catheter, or clean her. The nurse believed that she was septic, because her blood pressure was about 60/40 (normal is 120/80) she had a fever, and obviously was in a coma of some sort.

I asked the nurse where she had come from, expecting her to say "the streets." Instead, I was surprised to find she had come from a nursing home. She said this was a common occurrence - many nursing homes take awful care of their residents, such as only changing their diapers once or twice a day, not cleaning them at all, and basically providing little to no care while charging the family several thousand dollars a month. Two patient care techs (PCTs) came in to help the nurse wash the patient, change her diaper, and start a urinary catheter. When they lifted her gown and removed the diaper, we discovered was the horrible smell was. A diaper full of feces and urine, most likely not having been changed for 8 or so hours, as it had soaked through the diaper itself, 2 very absorbent hospital bed pads, and the sheet. The real base of the odor was worse, however. What we were smelling was essentially rotting, raw human skin and muscle. She had bed sores all down her bottom, on her thighs, and on her knees from never being repositioned or cleaned properly. It was sad, depressing, and revolting that she had been treated this way, and that there are probably hundreds (thousands?) of others being taken care of this way as well.

The family came in about a half hour later - the patient's daughter and two grandchildren. It's awful and embarrassing to say, but I immediately judged them, particularly the grandson. He was in his 20s and dressed in stereotypical "gangster" clothes, with long baggy shorts, big tshirt, and baseball hat. I thought "Why are they here? Don't they know how she's been treated? Why do they even care?" One by one, each family member walked up to the patient and petted her face and hair and spoke soothingly to her, trying to get her to respond. After a few moments, they were all quietly crying, even the grandson - even me. It was heartbreaking to watch them see their family member in this state, and I silently berated myself for ever thinking that the way they appeared outwardly had anything to do with the emotions they were feeling inside. Worst of all though was the way the nurse treated them - she completely ignored them, not saying a single word to them while they spoke to the patient and cried. Thinking back, I feel terrible for not saying something to them sooner. I can only imagine how I would feel if I went to see an extremely ill family member and the nurses and doctors ignored me - I would be outraged. Once the nurse left though, I went over to the granddaughter and spoke with her and told her some basic information about her grandmother's condition. There are rules about divulging patient information, so I couldn't tell her much, but I'd like to think I comforted her at least a little. I also spoke with the patient's daughter, who told me that her elderly father was also in the ER just down the hall, so she had even more to be worried about.

My nurse had two other patients who she also basically ignored. One was Spanish-speaking only, and the other was an African-American man. I could see the judgment in her eyes when she spoke with them, and it was sad, upsetting, and disturbing. I could go on and on about those few hours I spent in the ER, but what I really hope to remember is to NOT BE LIKE THAT NURSE. She could have easily said to the septic patient's family "I'm sorry that I can't talk with you for very long, but let me tell you a few things about your grandmother/mother." There was just no excuse for the way she acted towards her patients and their relatives. Part of me is scared that I'll become desensitized to others' pain, but I hope that experiences like this will keep me from ever forgetting that inside those sick and silent bodies, a person lives and needs emotional support, too.