Revisiting the ER

My column last month about our four-hour ER experience after Cheryl's over-the-handlebars tumble didn't go down well with the emergency room staff.

My less-than-laudatory account had "devastated" his employees, said Shanon Watkins, director of emergency services at Queen of the Valley Medical Center. From staff's point of view, Cheryl's care had been right on, he said.

I sat down last week with Watkins and two ER docs to go over the Courtney experience. They had a bone to pick with me. I came armed with Cheryl's issues.

At a time when many ERs are closing for financial reasons, Napa has an excellent trauma center staffed around the clock with emergency specialists who have the best equipment, said Dr. Paul Kivela, head of the Queen's emergency medical group.

"You're there because something terrible has happened," Kivela said. "That's one of the eternal problems that emergency departments face. We won't make everything wonderful like when you woke up that morning, but hopefully we'll make it better than when you walked through the door."

It is true, Cheryl left considerably better off than when she arrived. I had not come to argue that the ER was not well-equipped or the staff not well-trained. Further, given the ER's high patient volume and Cheryl's non-life-threatening injuries, our wait was unavoidably what it was.

Cheryl's care had been fundamentally good, yet our ER experience was a messy, frustrating one. Without warning, residual anger still bubbles up.

I'd debriefed Cheryl in preparation for my meeting with the ER staff. Her issues boiled down to these:

1. Why was she allowed to bleed in the waiting room for an hour in full view of other patients? She was a horrific sight, blooding dripping from face and arm. For her comfort and that of the other patients, all of whom were externally intact, couldn't they have hidden her from view?

2. While the ER staff displayed cool competence, no one uttered a comforting word or verbally acknowledged her 90 minutes of suffering before she was evaluated by a doctor.

Granted, the ER staff is primed to save lives. Granted, her injuries were not a threat to life or limb. But this was the bloodiest, most painful trauma of her life. Her anguish was off the charts. A few words of compassion would have made a world of difference.

3. An on-call plastic surgeon thoroughly cleaned and sutured her deepest facial injury. Perhaps to avoid causing pain, ER staff made only a token effort to clean her lesser wounds, leaving grit that continues to hinder healing. If cleansing was being left to her, shouldn't she have been told?

4. Finally, pain control. Had not she had the presence of mind to inquire, the doctor would have sent her home with a prescription for Motrin. She was convinced she needed something stronger.

In the end, Cheryl got Vicodin, a powerful painkiller, but felt shame at having to advocate for herself. Shouldn't the doctor have asked about her pain level before deciding on Motrin?

Her criticisms were quickly parried by the ER staff.

The idea that bleeders would upset other waiting patients was an issue they hadn't considered. Their focus is on getting people from the waiting room into the ER as fast as possible.

Those who work in emergency medicine naturally become used to blood, one doctor said.

Regarding our assertion that staff withheld words of comfort, Dr. Carl Speizer, a veteran ER doc, suggested that Cheryl and I were so shook up that we may have missed them.

A busy staff can have other priorities, he said. If it comes down to one or the other, "do you want a surgeon who is caring and compassionate or a surgeon that is very skilled?"

As for dirty wounds, some patients prefer to clean their own, staff said. It's a way to control the pain. We should have been told this.

Staff regarded the Motrin-Vicodin issue as insignificant. Hadn't the doctor ordered the stronger painkiller once Cheryl asked?

What was significant, Speizer said, was that Cheryl's injuries were, by ER standards, of a "minor nature," yet her doctor had been extra thorough, ordering X-rays and a CT scan to make sure there was no hidden damage.

During our visit, all 15 beds were full and staff was dealing with two potentially life-threatening cases, he said. Staff must allocate resources accordingly. That's the nature of the ER.

It was suggested that someday Cheryl and I might return to the ER with a true life-threatening condition. When a life is on the line, watch the ER do its stuff, they said.

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