Suzanne was taken to the hospital because she had extremely severe stomach pains and vomiting. Her husband Al had never seen her so sick in the 30 years they had been married. It took hours and hours for the Manhattan emergency room to run diagnostic tests. In the meantime, Suzanne was still throwing up.
She was also upset and worried. It was hard for her to ignore the fact that Al, normally a source of entertaining remarks about any situation, was very quiet and almost withdrawn. Another unfamiliar experience that threw her off balance was the nasogastric tube they had inserted in the ER. This is a tube that goes in through the nose and down the throat to the stomach.
After Suzanne had been in the emergency room for three hours, she started to get nervous. She had epilepsy, and needed to take medicine every eight hours in order to avoid seizures. Her neurologist in Brooklyn had often warned her, “If you skip a dose or stop taking this medicine, you could cause a seizure. Don’t do it!”
She was due for her next dose of the epilepsy medicine in another hour, but she didn’t think the doctors or nurses were paying attention to this issue. She and Al had told them all about it when they had arrived, but the medical professionals were much more focused on figuring out her vomiting and stomach pain. She supposed it was understandable. Still, she was worried about a possible seizure.
She was especially worried about what would happen if she had a seizure when she had the tube going through her nose and down her throat. What would happen? All of the unknowns crowded into her head and she grew increasingly frantic. The ER staff kept telling her to calm down -- but still did nothing about her epilepsy medicine.
She had the medicine with her in her purse, but she didn’t dare take it without permission from the doctors, since she still didn’t know what her stomach problem was. Would she make that worse if she took the drug? Also, the hospital had a policy against allowing people to take medicines they had brought with them, for safety reasons.
Eventually, Suzanne was diagnosed with a partial intestinal obstruction. After 16 hours in the ER, they brought her the epilepsy medicine prescribed for her. This meant that she was about 12 hours late taking it. What happened? Why was there such a delay? Of course, one reason is that if they suspected an intestinal blockage and thought that Suzanne might need emergency surgery, allowing her to drink water and swallow any medicine could have been a very bad idea. But some other factors probably came into play.
Dr. John Maa, Assistant Professor of Surgery at the University of California at San Francisco, is a specialist in emergency medicine. He was not involved in Suzanne’s case, but made some general observations about delays in emergency rooms. He offered suggestions to help speed things up.
First, he said, “When we ask people what drugs they take, you’d be surprised how many people say, ‘I take a red pill in the morning and a blue pill at night.’ What are they called? What are they for? They have no idea. Then we end up waiting and waiting to give them any medicine, because we don’t want to overdose them.”
While this was clearly not the case with Suzanne, it leads Dr. Maa and other emergency medicine experts to emphasize a key point: bring a list of your medicines with you to the emergency room, along with the doses and instructions (for example, 500 mg three times a day). In fact, Dr. Maa said, “Bring the medications themselves with you. It helps the doctors to see the pill bottles.”
Second, “Bring your medical records with you. Preferably, these will be on a flash drive, and they can just plug it in to a computer and get your whole medical history.”
Third, “Understand that the doctors in the emergency room are often junior. They are in training. Ask for the attending [physician].” The attending physician is the senior doctor in charge. If you see a gap in your care, talking with someone more senior can help get your needs addressed.
Fourth, “Understand a funny thing about how emergency rooms work. If a decision has been made to admit you, then you are officially under the care of the floor or department to which you are being admitted, even if they don’t have a bed available for you yet. That means that you may be physically located in the emergency room, but the people responsible for your care are not the ones you see walking around in front of you. They no longer have responsibility for you.”
As a result, the emergency room staff are not the ones who can order medicines for you. That task falls to the professionals in the department or on the floor to which you have technically been admitted. It is reasonable to ask, “Who is responsible for my care right now?” if you seem to be having trouble getting attention.
Fifth, Dr. Maa emphasized the importance of bringing a family member or other advocate and asking them to handle tasks that you can’t. One can imagine, for example, that armed with the appropriate information, Al might have been able to step outside to call Suzanne’s neurologist to ask for advice about the epilepsy medicine.
By understanding some of the issues in the emergency room, you can help ensure that you get better care.