A Night in the Emergency Room

“The very first requirement in a hospital is that it should do the sick no harm.” ~ Florence Nightingale

“A hospital bed is a parked taxi with the meter running.” ~ Groucho Marks

“I joke, but only half joke, that if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI and orthopedic consult.”  ~ Abraham Verghese

As firsts go it wasn’t exactly my idea of a memorable milestone.  But there I was strapped to a gurney, taking a ride in an ambulance.  And this one came complete with a paramedic in training.  “Do you mind if our trainee treats you today?” one of the paramedics asked?  “No it’s alright; go for it.”

It all started when I came home from the gym and sat down to watch sports.  I felt a crappiness that I'd never felt before.  The wife and I debated what to do and I decided that maybe we just ought to drive down to emergency.  We’d just about got out of town when feeling crappy turned to feeling like ten pounds of shit in a five pound sack.  “You know I’m not feeling at all good.  Let’s just swing around and go back to the fire station.”  

Three firefighters greeted us and led us into the garage where they hooked me up to a cardiogram.  My racing pulse had slowed down and the irregular heartbeat was back to normal.  I was actually feeling a bit better than when we pulled in.  That’s the way it always works isn’t it?  That toothache that felt like a cattle prod in your mouth all day long turns benign the minute the dentist walks in and you end up feeling like a dumb ass.  I tried to beg off of the ambulance ride but I was talked out of it by all three firefighters and the wife. 

And so there I was being lifted into the back of the box on wheels feeling weak and wimpy.  I hate being helped to move; don’t like wheelchairs, gurneys or any other conveyance of the sort.  Rather do for myself thank you.  As we took the drive the instructing medic prompted the trainee on questions to ask and tests to make.  He did a finger stick to test for diabetes and a few little tests to make sure I hadn’t had a stroke.  We were about 10 minutes from the hospital when the trainer suggested that the new guy get an IV going.  Yeahhhhhh – NO.  The roads in the San Francisco Bay Area are only slightly better than a rutted country dirt road and I didn’t fancy the new guy sticking me with a needle while riding in the back of a rocking, bumping truck so I vetoed the idea.

I suppose that one of the things that sticks out about that ride was the music.  There was a very faint, kind of angelic, relaxing elevator music.  Okay it was a bit creepy.  Really the last thing you want to hear in an ambulance is soft heavenly music.  I wanted to suggest that they play something a little more upbeat; a Toby Keith song maybe.  “Ain’t As Good as I Once Was” might have been quite appropriate at that moment.

Riding in I was regretting the ambulance trip and then we got to Kaiser Hospital in Richmond.  We went in the back way where the ambulance dumps you off.  They rolled me in and I quickly changed my mind because  whoa…hail, hail the gang’s all here.  It was standing room only.  As far as rooms went there was no vacancy at the inn and the hallways were jammed with people in various states of illness and injury.  Doctors, nurses, orderlies and various hangers on and stragglers were rushing around trying to keep up.   I was told that the waiting room was overflowing.  And then it struck me; oh yeah they closed Doctor’s Hospital.  Doctor’s Hospital is in San Pablo, about 5 minutes from Kaiser.  A few months ago it was a working hospital.  Now it’s an empty building.  Closed; because of money they say.  Well of course it was closed.  San Pablo is a relatively poor community.  English is a second language in San Pablo.  It’s a community where guys wrench on the junker that’s sitting on the front lawn and people keep Christmas lights up all year long.  These are the places where they close hospitals.  Forty five minutes over the hill are Walnut Creek and Danville and Blackhawk and Alamo; places where you park your Beemer in the garage and the HOA makes sure that the guy you hired to put up your fancy Christmas light display gets it down in a timely manner.  They don’t close down hospitals there.  It isn’t that the folks in San Pablo don’t have a voice.  The problem is that the voices often speak in Tagalog or Spanish or Chinese or Samoan but they don’t speak the language of money.  And so their voices are ignored.

The ambulance boys found a place in the harried hallway to park my gurney.  This isn’t the ER that you see on TV unless it’s a disaster movie where people just hang out in various states of injury or pain or uncertainty.  Some aging hippie looking guy wandered back and forth down the hall, “We’re patients, and we have rights.”  I wasn’t feeling so bad and I was glad that I’d had the foresight to bring a book so I just figured on hunkering down for the long haul.  They got me off the gurney and onto a bed in the hall and the ambulance boys wished me luck and I thanked them and they headed off into the night. 

It wasn’t long before a long, lean ER doc sat on the side of my bed and told me that since I’d had some heart rate issues this night they were going to do a blood test to make sure that I hadn’t suffered a heart attack.  Then they would have to repeat it so I could figure on being there until, he looked down at his watch, about 3 in the morning.  Ugh.  The wife came in a short while later and I told her that I would be here until oh-dark-thirty and I sent her back home. 

A nurse came to my bed and introduced herself; “I’m Stephanie.  I’m going to start you with an IV.”  As she was preparing to drill into a vein she kept getting bumped and jostled from the traffic in the hall.  “Let me find a room.”  She found a spot in a holding room, wheeled me in and got the IV going.  It was the last that I would see of Stephanie.  I wouldn’t hold that against her because the place was an absolute madhouse.  As it turned out though her handy work would stick with me.

Time passed and I dozed on and off but even in light sleep the noise of the ER never really gets shut out; talk, loud and soft; moans and the occasional plaintive call, "Nurse, help;" clatter; machines and monitors beeping and pinging.  There’s no real privacy.  There was a young Hispanic woman sharing the room with me.  We were separated by a thin drape.  She was there for a stomach ache that she was suffering because she took most of a bottle of aspirin to calm a persistent headache.  “Were you trying to harm yourself?” asked the ER doc. 

The doctor came in and told me that the first blood tests came in negative.  My next step would be a CT scan.  A short while later a burly tatted Russian sounding nurse name Sasha came in to take me to the scan.  He looked at the IV in my arm that he would have to disconnect. 

“Look at dees.  Who would do dees ting?” he asked in disgusted Russian tones.

I looked at my right arm in horror.  Holy hell!  Stephanie; baby, ya done me wrong.  I thought we could be friends.

The IV tube that she’d put in my arm was held down on my hairy arm with what looked like enough tape to lash down a fire hose.  Geeze girl, do you own stock in Johnson and Johnson?

“I’ll tell you who would do dees,” continued Sasha.  “Female nourse.”  He slowly shook his big bald head.

CT scans are a real sensory adventure.  They give you an IV – yes a NEW one because it seems that every nurse and tech in the building has their own particular favorite vein of choice.  They poke you and then shoot you up with iodine to light you up and then they put you into what looks like a giant donut to get an image.  And so the tech put an IV into my left arm – ouch; and explained the procedure.  She retreated into the control room and the donut lit up with flashing lights and emitted beeping sounds.  Then she started the IV and here’s where the fun began.  You get a metallic taste in your mouth from the iodine and a few moments later you get this warm feeling in your groin that feels like you just pissed yourself.  I told you it’s a sensory experience.  Not even Disney can do this. 

Back to ER and night has turned to very early morning.  I dozed and woke to find out that the ER was in lock down.  Lock down at Kaiser Richmond usually means one thing.  An “upstanding citizen” from a “social club” was knifed or shot or garroted or done some other form of harm by another “upstanding citizen” from another “social club.”  These two “social clubs” usually don’t see eye to eye on certain community issues or they don’t like the color clothes that the other “social club” sports and so the “upstanding citizen” members debate their differences with guns and knives sometimes to the detriment of the health of folks who have no dog in the fight.  Lock down happens so that the offending “upstanding citizens” don’t finish the job on the injured “upstanding citizen.”  When the ER goes into lock down and you’re on the outside, you don’t get in.  So if you have a loved one on the inside breathing a final breath you don’t get to say good bye.  You see these “upstanding citizens” don’t give a shit about any collateral damage that’s inflicted during their debates on colors and community issues.  They don’t care about you or me or the ER doctor that they need now but would kill in a heartbeat if it seemed convenient or fun at the time.  Ironically when one of these “upstanding citizens” expires we hear from a legion of weeping family and friends about what a “good boy” he was; a real upstanding citizen he was.

About 2 in the AM, the ER was quieting down.  Lock down was lifted.  Aspirin girl’s test results came in negative; she didn’t blow up her stomach.  Sasha came back to plumb for more blood.  He came to my left side and inspected my arm.

“Look at dees.  Who would use dis vein?”

“I don’t know,” I said half asleep. “You’ll have to ask the young lady that did the CT scan.”

“Better vein right here.”

Sasha looks like a guy you might see in a prison yard.  He’s got a five o’clock shadow; he’s tatted and huge, with hands as big as pie pans.  And he’s going to draw blood?  I looked away and a few moments later I felt a little pressure on my arm.  He’d drawn the blood and I didn’t feel a thing.  He was holding some cotton on my arm to stop the blood.  This big bear gave me the kindest smile and said, “I won’t put tape.  I’ll hold till stops bleeding.”  I thanked him and a few minutes later he was gone to drill into the next patient.  The man is a true master of his craft. 

The doc came over to my side of the curtain and told me that I have a pulmonary embolism and I’ll have to go on blood thinner.  Swell; my second time around.  The previous was when my leg was in a cast and I developed a clot in my leg that eventually found my lung.  Turns out that the 10 – 14 hour drives that we took on vacation delivered the same results – a clot in my inactive leg found my lung.  He told me that I would take Warfarin but for the first week I would be on something called Lovenox; blood thinner that I would inject into the fatty part of my abdomen twice a day. 

Three AM rolled around and the doctor, who must have been running on adrenaline by then, came in and told me that I could get ready to go home.  The nurse would bring me my meds, give me the instructions and show me how to give myself the Lovenox injection (which I already knew).  He also added that as long as I’m on blood thinners I need to be careful about cuts.  I imagine that a shaving cut will look like a scene from a Quentin Tarrantino film.  Oh and be careful on ladders or in situations where I might bump my head.  My brain might bleed.  And to think I was about to join the local rugby league. 

My new nurse came in and opened up the bag of meds.  She waved the pills at me and instructed that I would get a call from a pharmacist later in the day to go over the dosages.  As for the injection, she didn’t spend much instructional time.  She popped off the cover, grabbed a hunk of skin and jabbed it straight in like she was trying to puncture a football – yeowwww!!!  She then read the instruction to me.  The Lovenox would be given subcutaneously “which means under the tongue,” she said.  That didn’t register until a few moments later when she’d left.  What the fuck do you mean “under the tongue?”  If I’m supposed to give myself shots under the tongue then I’m just going to go home and drink a fifth of Jack Daniels and put a .45 under my tongue.  After clearing the cobwebs of fatigue from my head I realized that subcutaneous means under the SKIN not under the tongue.  What the hell.  The nurse doesn’t know the meaning of subcutaneous?  That’s kind of like your mechanic telling you that your check engine light is on because the framistam in the doohickey is loose and has to be tightened with a whatchamcallit.  The nurse came back and I looked closely at the badge hanging from her neck; registered nurse.  I could only imagine that somewhere in the building was a registered nurse laying in a closet, knocked unconscious by the orderly who always wanted to be a nurse.  

As of this writing it’s two weeks later.  The shots are done thankfully.  The problem isn’t so much putting a needle in my boiler but the medicine burns like fire.  The wife asked why they have to make it so painful.  “Hell I don’t know.  Why hasn’t somebody invented soft ice cubes?”  The blood clot has me out of breath after a ten minute run but the doc said that’s to be expected.  The side effects of the Warfarin are kicking my ass.  Nausea, a stomach ache; the other day I was feeling disoriented and decided that maybe a drive in the new 500 HP car might not be a capital idea.  The good news is that I haven’t sprouted the German Shepherd ears yet. 

And while I sounded critical of nurses I mostly have the greatest admiration for them; unless they don't know the meaning of "subcutaneous."