Thanks, Obama

I spent last weekend in Vegas as part of a bachelor party.  Suffice it to say that adventures were had and mistakes were made.  Predictably, one of our party ended up in the hospital.  Somewhat unpredictably, it was me.

Unfortunately, the story of how isn’t that great.  I wore my admission bracelet all weekend as a battle scar of sorts; when people asked what happened I just told them, “This is what happens when you put the team on your back.”  In reality, a girl was getting kicked out of the VIP section of a club during a concert after hilariously getting in by stepping over the velvet rope in full view of the bouncer.  The bouncer turned her around and told her to get out the way she came in, which she attempted to do, somewhat unsuccessfully.  She tripped over the velvet rope and down went a stanchion, right onto my big toe.

I left the party and went back upstairs in considerable pain; getting to the room revealed a toe that was a morbid mixture of black and purple, and because I’m a huge wuss and I’ve broken toes before, I thought, “well, probably a good idea to get this looked at.” So I got into a cab and headed to the nearest hospital to get an X-ray with the bride’s brother, whom I ran into on my way from the room to the cabstand.  What happened when we got there was, frankly, eye opening.

Checking in at the triage counter (motto: “When chicken soup isn’t enough: Triage!”) around 3AM, we discovered they’d been having a worse-than-usual Friday night; a lot of the people in there had been waiting for 10 hours or more.  They advised that it would probably be a few hours at least.  Then they advised that we take our seats and we’d be called momentarily.

Sure enough, I shortly heard my name called.  Well, I heard my first and middle name called; it was a little weird.  But it was my name, so I went back.  They asked me what I was in for, I told them I thought my toe was broken.  They asked pain level then told me they’d get me a painkiller.  They sent me back out.

They called me again, same deal with the name. I took off my shoe and a nurse said they’d order me an X-ray and to listen for my name again.   They sent me back into the waiting room.

At this point, I’d been there for maybe 20 minutes – I took this as a good sign. About half an hour later, I’m still sitting in the waiting room, and they’re still calling names.  One guy is particularly loud as he calls the names, and a woman asks irritably whether he can tone it down a bit.  He indicates that he cannot and he will call names as loud as he wants; the woman launches into a diatribe about his lack of consideration for the nerves of the people waiting, and he mutters, “whatever,” and turns back into the medical area.  It was a pretty professional thing to do, all-in-all.

Another half-hour goes by and my name is called again (same thing, and incidentally by the guy calling names super loudly, who turns out to be the X-ray tech.)   He takes me back and X-rays me hurriedly; he’s a nice enough guy, just frazzled from the busy night, and he indicates his disdain for the woman who asked him to be quiet.  He sends me back on my way and says they’ll call me when the results are in, just listen for my name.

Not five minutes later, my name is called.  Woohoo!  A woman takes me back to a bank of computers and I discover they are not ready to deliver my X-ray results, they are just doing paperwork.  Here they finally discover that they have my name incorrect on the paperwork; they add my last name correctly and that seems to be it.  She sends me back out, same deal – listen for your name.

At this point it’s about 4:30 and there is hope we will be out by 5. I’m still waiting to hear back about that painkiller they mentioned, but I can survive.  At 5, we notice that there’s only one MD back there, and he emerges to call names only sporadically.  Aha, we think, here is the bottleneckCertainly an X-ray result will be quick to deliver and they’ll want to scratch us off the list.

At 6:00, a new MD appears – shift change!  He calls a whole list of names; none of them mine.  They’re making progress!

The sun comes up.  At 7:00, another list of names is read; again, my name is absent.  Ditto at 8:00.  We’ve been here 5 hours at this point, but certainly my toe injury isn’t life threatening, so it makes sense that others would go ahead of me.  This is the entire point of triage, after all.

At this point, the pain my toe has become somewhat unbearable; I can’t elevate my foot because I’m sitting in the waiting room, and blood is pooling in my feet.  I basically can’t walk, and I’m shaking from the pain.  I’ve been trying not to make a fuss; the nurses have been dealing with irate patients all night, and at one point a fight had to be broken up by the police (no punches were thrown, just yelling and gesturing among those awaiting treatment).  But I decide that at 9:00 I’m going to complain if my name isn’t read out.

9:00 comes and goes and we hear nothing; no names.  I approach the window and, bearing in mind that they have been dealing with jerks all night, request an Advil as politely as I can.  The nurse looks at me impatiently and asks for my name.  She goes to find my chart; it’s not there.  That’s a bad sign.  I tell her I may be under my middle name; she asks how that happened and I indicate that I do not know, I gave the nurse my ID and he made my chart, and she rolls her eyes.  Then she tells a nurse that my registration will need to be re-done, that this mix-up is the source of at least some of my wait (not in so many words, of course), and tells me that I should go take a seat.

I wait fifteen minutes (during which time my compatriot, the brother-in-law, has set off to find a CVS so he can just buy me Advil – seriously, what a guy), and then go back to the counter to ask about that Advil.  She says it’s out of her hands; the nurse who will take care of me is back there somewhere and I should wait for my name to be called.

I sit back down; my compatriot returns, I take his Advil.  It is of only moderate effect.  We continue to wait.

At 9:50, the nurse calls me back.  She tells me there’s been a paperwork issue, but that everything should be sorted out; she gives me a prescription painkiller (hooray, relief!), and scans my wrist.  The scan does not go through; the paperwork still hasn’t been worked out.  This escapes her.  However, she does take me back even further into the medical area and says, “Might as well have the doctor see you now.” I take this as a huge victory for Team Me.

This is where things get real.  The system of calling in several names at once has moved the backlog from the waiting room in triage to a series of chairs in the ER proper.  The doctor does not have enough room for patients, and is working as quickly as he can, so he simply pulls the patients one at a time from the chairs and interviews them in full view of everyone else, then he gives diagnoses or orders tests as necessary; admittedly, he was pretty efficient in this regard. The following cases are in the ER that day, and are being disclosed to me, a total stranger:

  • A man complaining of chronic chest pains worried about heart problems who has waited 8 hours to be told he has heartburn.
  • A man complaining of high blood pressure who, no, has not been taking his blood pressure medication; after waiting 9 hours he is directed to take his blood pressure medication.
  • A man who has been there since midnight who had surgery last week and whose sutures ruptured, he is literally bleeding from an enormous gaping wound and has not been seen, nor given pain medication, for ten hours.
  • A Dutch man with a sore shoulder who has been waiting 2 hours.  He is directed to rest his shoulder.
  • An 18-ish looking young man who is worried he may have caught a communicable disease due to a recent bout of unprotected sex; he is asked about this encounter and his worries thereabouts in full view of everyone, and tests are ordered.  It is unclear how long he has been waiting.
  • A 20-something guy who has been waiting for eight hours, and whose toe is in fact not broken, and whose pain is caused by blood pooling under his toenail.  This is me.

Meanwhile, all around us a seemingly scripted world is taking shape. There’s the nurses complaining to each other about the other nurses, and how the backup is their fault because they don’t understand the system (this was in relation to my paperwork snafu, I eventually put together).  There’s the cute nurse who’s clearly dating the hunky EMT, possibly even secretly, as their behavior changes radically when other hospital personnel are around.  There’s always exactly one nurse around, whose response is inevitably, “You’ll have to ask your nurse,” to any inquiries about what the next steps are, despite no one having been told exactly who their nurse actually is.

From the time I got back there to the time the doctor saw me was about 45 minutes.  After the doctor saw me, I waited another 40 or so minutes to find out what the next steps were, during which time I struck up a conversation with what I thought was going to be a kindly Dutch man, but turned out to be a crotchety Dutch man.  He complained about his two-hour wait in predictable fashion (just like everything else): “In Holland, this would take 5 minutes.”  The next steps for me, by the way, were to receive a printed out fact sheet about subungal hematomas (incorrectly describing treatment that hadn’t been given), and then I had to sign a paper saying I had received said sheet. Then, eight and a half hours after I had arrived, I got to leave.

When I heard the Dutch man’s comments, my response was, “There’s a lot of talk in this country about reforming the health care system, now you know why.”  And I know that my story is just one of millions of stories that take place every day, and is comparatively not as bad as in many instances, I’m sure.  Certainly not as bad as others I saw that night; maybe it’s not that bad when a guy waits an extra 4-6 hours because they got his name wrong when they admitted him.  But when a guy is literally bleeding from an open wound for ten hours before a doctor sees him, that’s bad.  When a kid is asked private questions about his sexual history in front of ten to fifteen strangers who are under zero legal obligation to not divulge his medical history, something is broken.  I don’t know a lot about the healthcare system as it exists today, or as it will exist in the future under the ACA; I don’t know if there are solutions in the works, and I don’t have any ideas on what those solutions should be, so I mercifully won’t go into those.  All I know is that it’s somehow Obama’s fault.  Thanks, Obama.

Apologies for the preachy post today.  I have just completed my second straight Friday night sans sleep, this time on my way to Barcelona!  (My life is pretty OK I guess.)  I will be out of the country for the next 2 1/2 weeks;  I am live-tweeting my trip again @Carscafmoo, but I should warn that I may be unable to post regularly.  I will do my best to keep about 10-minutes of time per night to write about what happened during the day; no guarantees I can get them out on Saturdays, but they will come out eventually.  Expect regular posts to continue on or about 5/24



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