Thursday, February 7, 2013

Lesson Six: Your ER Visit

Lesson Six: Preparing For Your Emergency Room Visit

We’re talking medical preparedness, and let’s be serious: there are only two types of people—those that have been to the ER, and those that are going to go.

And since, by virtue of my hospital’s estimation of my skills, *I* (or someone very like me) is who you’re going to see first, I’d be seriously remiss if I didn’t give you a little coaching to make an unpleasant experience for you go a little easier. Pay no attention to the fact that it’ll make my night a little smoother too.

There are a number of informational tidbits I’m going to want from you, as rapidly as you can supply them. This will be true whether you’ve been to the ER once, never, or a hundred times. It will be true if it’s your infant child or senile great-granduncle. And if the patient is actually unconscious, not breathing, or has no heartbeat, at some point after we take care of those important little details, I’m STILL going to want this information.

First, what to bring. (BTW, 10,000 of my colleagues agree on this, so don’t think you can pull one over on us. We’re pretty cliqueish about this stuff, and you won’t be the exception that proves the rule. Trust me.)

1. Why are you here?
No, not in a college philosophy metaphysical sense, but rather ”Why are you darkening MY hospital doorstep right this minute? If it’s 4 AM, especially.
I don’t want to know the history of your internal organs, the strange things that went on since 1962, or the comments from the 5 people that finally chivvied you into coming. What I’m digging for, and usually none too subtlely - is an explanation in 10 words or less for why you’re in my assessment room chair this minute.

Good examples:
This crushing chest pain since 20 minutes ago.
The arm bone poking out of my lower arm after I fell.
This swelling in my throat since we ate the crab stew.

Bad examples:
I’ve had this headache for 14 years.
It’s Friday night at 2 AM, and I decided to detox from alcohol and drugs just now.
My arm hurts and I have this sore on my toe and I’m coughing and I’m tired all the time and once in 4th grade I think I might have had a stroke and…

Try to remember, it’s the Emergency Room. If there isn’t some pressing reason you’re here right frickin’ NOW that you or an immediately accompanying friend or relative can elucidate, no amount of college essay exam b.s. will conceal that fact from me. I will screen you, and send you back out to the Siberian Winter of the Waiting Room while I attend to more pressing concerns. I swear to God. You’ll get seen, but not until we’ve taken in all the more serious patients.

2. What medical conditions do you have?
We’re talking real, serious, known, pre-existing and which have been diagnosed by someone with a medical LICENSE conditions.

Good examples:
Hypertension (or high blood pressure - English is fine if you don’t speak medicalese)
High cholesterol
They took out my (appendix, gall bladder, female plumbing, etc.) in year XXXX

Bad examples:
Inability to answer direct questions
“I think I had a heart attack once” (Either you did, or you didn’t; if you don’t know, you just lost 10 points with me as a personal historian.)

3.What medicines do you take?
Good answers:
Lasix, Plavix, Lovenox, Librium, etc.
furosemide, aspirin, amoxicillin, etc.

Tolerable answers:
blood pressure pills
heart pills
cholesterol pills

Really sucky dumb@$$ answers:
A little white one
A big yellow one
Those two tiny ones

Know your medications, by name (Trade or generic name) and WHAT THEY’RE FOR, or understand why you’ll lose 10 points with me for being a bad historian and making my job more like being a vet than helping people.
If all else fails, bring me the pill bottles, if necessary, in an empty pillowcase, just like the paramedics do when they pick up grandpa with 47 bottles on the nightstand.
And BTW, if you have a condition, and you've been prescribed medication, but for whatever fill-in-the-blank excuse you have, you aren't taking the meds, own up to it and say so. 

4. What are you allergic to?
I don’t care about cats and dogs—I’m not going to hand you anything to pet.
I want to know about food, and particularly, DRUG allergies.
Good answers:

Bad answers:
all antibiotics
all pain medicines
that one that starts with “D”

And BTW, getting nauseated isn’t an ALLERGY, it’s a side-effect. Turning red, getting itchy, swollen all over or hives, or not being able to breathe is an ALLERGIC reaction. If you’re really allergic and you don’t know this, -5 points.

But how in heck can I remember all this stuff? I’m DYING here? It’s IN MY CHART! Etc. etc.
Thanks for asking.
A) I don’t expect you to memorize it, though it’ll impress me.
B) I don’t have your chart, and I can’t get it. I don’t ask these questions for my amusement, I ask them to save your life. So kindly cut the crap and whining, and answer them, please, now.
C) You’re reading this on a computer, so you have no excuse for not for not doing the following:
Put this info into a word processor file, and print out a copy before you need it. Update it when you need to, and always have a copy in your wallet or purse. Bring it with you to the ER.
If you don’t have a printer, I’ll accept an index card, or even a folded napkin. And I promise, you’ll get 10 bonus points with me for being smart and prepared.
And don’t think you get an excuse for being on vacation, out of town on business, at DisneyWorld, blah blah blah. THIS INFO IS LIKE AMERICAN EXPRESS - DON’T LEAVE HOME WITHOUT IT.
If you’d like to also list your doctor or doctors’ name(s), their telephone numbers, and perhaps your blood type, knock yourself out.

And the same goes for all your kids, your wife’s father, or your crazy Uncle Tim if you take care of them or bring them to the doctor.

If you have this info on a sheet of paper, I’ll photocopy it, and learn enough about your medical history to make a far better and quicker decision on how serious your emergency is than if I first have to play “20 Questions” to puzzle it out. Work with me, and I’ll work with you, and we can get you in, seen, and hopefully treated or home a lot faster. That’s what you want too, right?

And lastly, a few insights to my job for you to remember:

EVERYBODY on your side of the desk “doesn’t feel good.”
EVERYBODY on your side of the desk is “in pain.”
EVERYBODY on your side of the desk is “having an emergency.”

I don’t sort people by the amount of blood on their face, the amount of panic in their parents’ eyes, or the volume with which they holler. Take this as gospel.
I also don’t care who got here first, unless we’re down to the minor complaints (by which I mean, you aren’t dying any faster than the rest of the planet).

I’m an experienced professional. I’m also human. I expect that when you (or your child or relative) is in pain, you’re going to be testy and a bit distressed. That’s normal.
But if you insult me and go above and beyond the call to piss me off, AND I determine that you aren’t a priority patient, consider the likely results for your plans for the evening. It’s my house, my rules, and I can count my mistakes at sorting people in the last 10 years on my thumbs. If you want to count the times I erred on the over-cautious side, I’d need my fingers and toes. I almost always err on the cautious side, BTW. The same will generally be true for any of my colleagues you meet in YOUR town’s ER. Think well before you test this.

I don’t know “how long the wait is.” This isn’t the [i]Chez FouFou[/i].
Your doctor didn’t call ahead and make a reservation for you.
It is a Jewish proverb that “The more you complain about life, the longer God lets you live.”
It is an ER proverb that the Triage Nurse is godlike, and the more you complain, the longer you will wait. (In fact, if you’re frisky enough to get up and whine, we generally know you aren’t that serious. That quiet guy in agony in the corner is the one I’m keeping one eye on.)

On a typical night in my house, I sort through 50-200 people. I ask enough questions to determine how serious they are, and how quickly they need to be seen. And if there’s an empty bed, I put as many of them back with my fellow nurses and the doctors as quickly as I can. And if you thought that calling 9-1-1 for your week-long flu-like symptoms or back pain will spare you any waiting...think again. My boss will meet you at the back door, and tell the medics to bring you to me. Then you’ll answer the same questions, and go wait with everyone else. And get a $500 ambulance bill that your insurance probably won’t cover. Save 9-1-1 for real emergencies.

If you’re having a serious or life-threatening emergency, I will get you in very quickly. If you doubt this, get in my way when I’m trying to get that old guy with the chest pain into a wheelchair and back to the cardiac room.
If you’re not serious, but you’re still in pain, distress, or just having a lousy night, I’ll get you in as fast as tonight’s patient load will allow.
And if you or your child are there “just to be safe”, I’ll respect that concern, and get you in too.

The more prepared you are to help deal with what brought you to us, by giving us the key information I asked for, the simpler and quicker your night will be. That, I can absolutely guarantee.

No comments: