11 Hours at the Emergency Department: A Patient Story
Although I’ve previously needed medical care at urgent care and emergent care facilities on multiple occasions in the past, January 13–14 was my first experience as a patient in an actual hospital emergency room.
This is an exceptionally long piece, so you may want to choose to listen to it instead of reading it if you experience eye fatigue.
If it hadn’t been a Friday night during an ongoing pandemic that has led to staff shortages in every aspect of healthcare, I could have continued my personal 40+ year no-ER streak. But the emergent care facility, a satellite location much closer to my home than the hospital it’s associated with, is no longer open for 24 hours. None of the local urgent/emergent care facilities are. So everyone has to pick a hospital and go to that ER for treatment when all of your regular doctors and specialists are off-duty for the night and/or weekend.
I’m going to try to condense this into something resembling journal format, but this story isn’t just about me. Times are approximate except where I have specific timestamps in my medical records.
What’s the reason for your visit?
10:00 pm Friday. I’d just received news of the worst possible outcome concerning a stressful ordeal that had been going on since Tuesday, a few days earlier. I’d been banned from a place that provided the best peer-to-peer disability support I’ve managed to find online… over a disagreement concerning AI tools. But let’s not focus on that, let’s focus on what that meant for my physiological state.
10:15 pm. After typing furiously in a private message to the bearer of this bad news, I was in psychiatric crisis. I wasn’t suicidal, but the stress of the situation had me unwittingly harming myself with the hypervigilance that had led to two long periods of insomnia — 25 hours awake, 3 hours sleep, then 31 hours awake — just between Tuesday and Friday. I was not well.
I asked my husband to check my blood pressure. He grabbed the cuff, which showed that my BP was 181/99 and my heart rate was 139. I was hypertensive and worried that I was about to have a heart attack or stroke.
10:30 pm. I don’t remember exactly what flipped my switch from “I’m not quite myself” to “I’m a completely different person who I don’t even recognize,” but I had started screaming — actually screaming — at my husband, who was only trying to help me. My normal speaking voice is best described as “too quiet,” and even when I try to “shout” to get someone’s attention from another room, I’m not always heard because I’m subconsciously modulating my voice so as not to bother the neighbors who share walls with us on either side.
But here I was, shouting mean things at my husband, dropping f-bombs in every sentence. I hope the neighbors didn’t hear the words I was saying, because they would have gotten the completely wrong impression from me screaming, “Don’t you fucking touch me!” and “Get the fuck away from me! I don’t want to fucking look at you right now!” Thankfully, our daughter slept through all of it.
10:45 pm. I’d made the extremely bad decision to drive myself to the ER. I wouldn’t let my husband drive me. This was excessively poor judgment, because I was not in any condition to operate a vehicle. I had a headache, I hadn’t slept properly, my cognitive skills were impaired, the weather was a “wintry mix” that had left the roads slippery, night driving is difficult for me even at the best of times because of my vision problems, and I hadn’t driven a vehicle in more than seven weeks since having surgery two days before Thanksgiving.
I got lost in my hometown driving what I thought was the straight route to the hospital in a nearby city. I should have turned around and gone back home so my husband could drive me once I’d started screaming, “Where the fuck am I?” over and over again before finding the road I thought I’d been on the whole time and finally being on the route I could auto-pilot from there.
I continued to scream at the top of my lungs the whole way there, narrowly avoiding hitting the metal pole that exists to stop cars from hitting the telephone pole when I slid making the turn into the ER parking entrance. It’s a miracle I made it there safely.
11:30 pm. According to my discharge paperwork, I got registered at the ER around 11:30. I was having clonic seizures in my limbs — always “fun” when you walk with a cane — with tears streaming down my face and barely able to speak. I was very glad I had my elastomeric P100 respirator instead of just a KN-95 mask, because everyone wearing only surgical masks while packed in past waiting room capacity would have been an immunocompromised nightmare.
The triage nurse took my vitals. My BP was down to 168/98, which was still bad, and my heart rate was still up at 136 bpm. What they took from my self-report was written in my notes as “headache, generalized body pains, and uncontrolled twitching and movements.” My body temperature was low (96.44°F / 35.8°C) but this was nothing new for me. My temperature has always run lower than 98.6°F.
12:13 am. I was taken back for an ECG, which would later show sinus tachycardia (103 bpm) and low voltage QRS (78 ms duration). When I looked up the latter, the two relevant potential causes are because I’m fat and because I have edema. I was placed in a different waiting room where the lights were dimmed and I was all by myself for a little while. There were no open ED beds.
12:16 am. I attempted to text my husband to let him know I had gotten to the hospital safely, as I’d had time to process how horribly I’d left him at home. But I was not capable of typing coherently because of my uncontrollable movements, so the messages came out like this:
There yiu
87puy call here
Canny 5tupe
Translations: That you? Did you call here? Can’t type.
I’d overheard one of the receptionists fielding a call from an upset husband trying to find out information about his wife, but all the receptionist could tell him was that his wife was in the waiting room and if he wanted to know more about his wife, he needed to call her on her cell phone. Since I hadn’t been able to hold onto my phone, I worried that the upset husband was my husband. (It wasn’t.) But he got my messages and replied at 12:38 am to say he’d just gotten my texts.
12:33 am. Nurse Jemima took my history. We had a nice long talk about my current problems, my many medical conditions, and my medications. All that fun stuff.
12:56 am. My husband texted me to say he’d just left a message with reception but didn’t know if they were going to tell me about it or not. But he was worried about me.
12:57 am. I texted him back, “Can’t get my blokjd,” which meant that Nurse Jemima had tried to take my blood but couldn’t. Husband replied, “I was afraid of that. Are you able to communicate with them still?” In three separate texts, I responded with “Yes,” “Hard,” and “Not on waiting room.”
We texted back and forth for a little while, and I was trying to convince him to go to bed and get some sleep, since he never gets enough sleep. But it came out like this:
“Rest for eotmk”
He asked for clarification where I could answer with the number “2.”
Sometime between 1:30 am and 3:00 am. Because they were unable to get blood to come out of the vein they’d finally found in my left arm on my second stick attempt, the charge nurse had to be fetched to draw my blood and place my IV. I ended up with a “roommate” in the waiting area who mostly cried quietly when she wasn’t on the phone with whoever she’d told where she was, and she was apparently a difficult draw, too. So there we were. I have a feeling you only got to stay in this “semiprivate” waiting room (that’s only actually open during the daytime) if you were flagged during triage for closer monitoring and ease of access for the overworked nursing staff who were otherwise going in and out of the reception area shouting patients’ names when it was their turn for something.
There was a doorway on one side of the waiting area that staff kept using to get to another part of the emergency department, so I overheard a lot of staff chatter. The nurse who did my ECG was in tears at one point because she’s been so upset they can’t help more patients faster. (She’d told me this when I’d commented about the woman next to me in the main waiting room who had been there for 11 hours already.)
The only nurse who stayed visible most of the time at the closest nurses station could be heard complaining over the phone to someone about how the hospital system had been affected by its takeover by Trinity Health, how the actual healthcare workers have been begging for better staffing ratios, especially overnight, but the board members we like, “Nope, all you get is two MDs overnight, and the ‘overnight’ PA leaves at 3 am.” This may have been Nurse Jemima, but it’s been a month since I started typing this up, and my memory just isn’t that good, especially at putting names and faces together. I only know names because I could look up my visit report(s) on the Hixny Patient Portal.
Sometime between 3:00 am and 5:00 am. I was taken in for x-rays. X-rays are so much faster than they used to be. I remember an x-ray tech at another facility last year telling me that patients are rarely required to wear lead shielding to protect them from too much radiation exposure these days because the equipment uses radiation for only a small fraction of what older equipment used. Although you’ll often note imaging techs wearing lead protective equipment because of their repeated exposure to radiation every day in the course of their work, instead of occasionally when ordered by a doctor. I think it took less than five minutes before I was brought back to the waiting area.
4:23 am. I texted my husband “Later you get mom to drive you over with my Mesa [sic]. Haven’t taken since 1pm.” Followed up with, “And charge r.”
Since I’d foolishly taken his car to drive myself to the hospital, I realized he’d need to ask my mom for a ride to pick me up when I got discharged. I’d tried to type meds but it came out (strangely) as Mesa. Autosuggest is weird.
4:55 am. I texted back to also request he bring me two other things: “And belt and a drink.” My support belt that’s helped me so much since my hysterectomy, and a drink because I wasn’t taking my mask off to drink anything if I could help it.
He woke up briefly to tell me to try to get to sleep, too, so I replied, “Tried. Trying.” And then, “Pain.”
5:27 am. Dr. Homaira finally made it my way and took her time to assess me. The timestamp is for when my records indicate she ordered IV ceftriaxone, Benadryl, dexamethasone, compazine, and prochlorperazine for me.
“Differential diagnosis also includes migraine headache versus viral syndrome, electrolyte disturbance, brain mass, pneumonia, appendicitis given her periumbilical abdominal pain.”
The ceftriaxone was for my initial tachycardia and in case my chest x-ray indicated bacterial pneumonia.
Benadryl makes sense because antihistamines are often used as a first-line defense when your inflammation markers are elevated but nonspecific. (My CRP was 2.58.) Dexamethasone is another anti-inflammatory medication, a glucocorticoid. Good to attack inflammation from multiple angles. My inflammation markers have been elevated since the age of 10.
I recognized the name of the drug compazine from another lifetime when I worked at an inpatient facility as part of the nursing department, but not as a nurse myself. I never knew it was given to combat nausea and vomiting, which could have become symptoms given my abdominal pain or as a side effect of being given some of the medications Dr. Homaira ordered for me. Prochlorperazine is also an anti-nausea medication, but it’s also indicated for dizziness. As someone who has POTS, I am very familiar with dizziness and lightheadedness.
My lab results indicated low hemoglobin (10.8 g/dL), low hematocrit (33%), low MCV (72.8 fL), low MCH (24 pg), low MPV (7.3 fL), high platelets (490 x10³/mcL), and high absolute neutrophil (6.4 x10³/mcL). If anyone happens to know if these are indicators of any particular difficult-to-diagnose condition, please let me know.
5:33 am. Texted my husband after the doctor left me:
Getting headaches cocktails and CT scan
Poncho maybe it’s freezing
Since it was January in Northeastern New York, the chill inside was getting to me in a way that I needed a warmer outer garment that wasn’t my puffy coat, and the poncho wouldn’t get in the way of my IV and other stuff.
6:28 am. Shortly before 6:30 am, the 3 bags of saline really caught up with me, and I had to pee so badly that my bladder hurt. I had to ask one of the nurses to wheel me to the bathroom. I was able to leave the chair outside and walk in using my cane for support, but I never would have made it walking the whole way.
(Remember this when you see people in wheelchairs or people using grocery store scooters stand up to reach for something. Mobility problems are not all or nothing. Many of us do have at least partial use of our legs.)
Using the restroom also allowed me to provide the urine sample they’d requested of me hours earlier when I was unable to go.
7:05 am. Texted my husband, “Still waiting for meds and ct.”
7:24 am. Nurse Amber checked in with me.
7:33 am. I texted my husband “CT time.” I’d seen the CT technician arrive and ask for directions at the reception desk, as she normally worked at a different facility but was coming in to help here due to staffing shortages.
I was her first patient of the day at this hospital she was unfamiliar with, so she had to apologize a lot for not knowing where everything was. It wasn’t the most comfortable CT I’ve ever had, but at least her bedside manner was above average!
Also, I knew that the main reason I hadn’t been discharged yet was that they were waiting for a CT tech to arrive in the morning to make sure there wasn’t anything serious they were ignoring before letting me go.
7:51 am. X-rays logged. I was told there was nothing to report, but Dr. Homaira’s notes indicate, “on my independent interpretation [her chest x-ray] shows possible left lower lobe opacity, likely atelectasis, in the setting of clear lung sounds and lack of focal respiratory complaints,” but deferred empiric diagnosis of pneumonia. I realize now that I’d been given this antibiotic shortly after my IV was placed before I’d even met Dr. Homaira because it was standard for someone presenting with my symptoms.
Oh, and no one at the ER ever mentioned the findings from my chest x-ray as anything but normal, so I only know about it from reading my records online.
8:18 am. CT scans logged. I had two findings listed that I couldn’t interpret:
Neck: The aortic arch is left-sided with normal three-vessel configuration.
Neck veins: There is inadequate opacification of the venous system.
I don’t know what either of these signify. They are not easy to Google because they mostly appear in research papers that don’t indicate what normal findings might look like.
8:46 am. Nurse Amber took me back into an office to perform tests for COVID, flu, and RSV… things I really think should have been tested for when I first got there, not ~10 hours later.
I did not actually feel safe taking my mask off in the office, because that’s where they were bringing everyone for testing. Based on my observations of various overnight staff members with masks dangling loose at their necks, I had no confidence that this office would be disinfected every time a new person came in. But I was really fucking tired, and I didn’t have the energy to even ask about infection precautions, let alone advocate for myself. So I removed my mask for the nasal swab and the meds being administered to me orally.
It’s hard for me to swallow pills without a carbonated beverage, but I managed to swallow the migraine cocktail pills with the nasty tap water (I assume) I was given. The taste of the water did nothing to wash away the disgusting flavor of the two doses of potassium I had to drink. (Each dose was in a container that reminded me of coffee creamer or fast food sauce packages where you have to pull back on the flexible lid to open.) I’m lucky I didn’t gag at any point. I have a hyperactive gag reflex that could have made me vomit my meds right back up. I think it was sheer force of will that prevented it.
8:53 am. Texted my husband, “I might be able to leave after my test results come back.”
9:12 am. I met Dr. Chittaranjan, a day shift ED doctor, for the first time as he took over my care from the night shift. From my perspective, there was no meaningful interaction, just him catching up on my status.
9:24 am. Dr. Chittaranjan’s notes based on his assessment of me:
Patient is currently asymptomatic. Patient has no headache. Headache is all gone patient has improved. On reviewing patient’s blood work I find INR is normal. CBC is normal with a white count of 8.6. Chemistry is within normal limit. Urinalysis is negative for UTI. CT scan of the abdomen is unremarkable. Patient’s troponin is 8.3 which is also negative and CTA of the head and CT of the head are currently normal within normal limits.
After discussing the findings of her results patient agree that she will take some medicine for headache and she will go home. Patient be discharged home patient was given a prescription for Fioricet.
The times don’t line up concerning when I took my meds and the doctor saying I was “going to” take my meds, but with the shift change following a chaotic night, not everything is going to get documented 100% properly.
9:45 am. Nurse Annamma assumed my care for the day shift. She didn’t have many care tasks to worry about, as I could tell they were almost ready to get rid of me pending my COVID et al results. She was nice enough, doing her best to wade through the crowded reception area.
10:00 am-ish. My husband arrived by Uber (because he failed to reach my mom for a ride) when I was brought back into a curtained area to process my discharge paperwork sometime after I met Nurse Annamma, though I didn’t spend much time waiting there. During the wait, though, with my husband at my side, another patient was wheeled in from an ambulance. She’d had a terrible fall down the icy steps outside her home when trying to catch the bus to go to work.
She was a nurse, and there was some other hospital department or facility that would be short-staffed because of her absence, possibly for an extended period of time, by the sounds of the head injury and other injuries she’d sustained. Even though she was a nurse, the EMTs and ER staff talked about her like she wasn’t there while she screamed in pain.
10:30 am. I was finally discharged, and my husband drove me home. (The woman who’d been in the waiting room for 11 hours when I’d first arrived was still there when I left, still with severe head pain that had not yet been treated after 22 hours.) My husband made sure I got food and drink into me before I collapsed in bed and slept the day away.
Important Takeaways
- Before you decide to tear someone to shreds for a perceived slight online, please understand that what you do to attack them with words can create mental health problems that manifest themselves into life-threatening physical problems. My hypertension and tachycardia put me at a real and imminent risk of having a cardiac event that could have killed me. How many people have been literally bullied to death this way, but have never had it acknowledged as a result of verbal and emotional abuse because it wasn’t death by suicide?
- Our healthcare system is severely overburdened, and the problem is only going to get worse as hospitals drop masking requirements and allow COVID to spread among staff and patients alike. More patients with life-long disabilities are created by the 1 in 10 chance of developing “Long COVID” that accompanies every COVID infection, even the asymptomatic ones. That’s not 1 in 10 COVID patients, that’s 1 in 10 COVID infections and re-infections. How many times has the average person who doesn’t consistently take basic COVID precautions like masking in public been infected already? Too many times. Reinfecting medical staff will result in even greater staff shortages due to the development of permanent disability and sudden death.
- Patient experience at the emergency department is abysmal even when you have nurses and other medical staff who seem to genuinely care about helping you but do not have the time or tools to do so in a timely manner.
- Chronic illness and chronic pain patients like me often ignore life-threatening symptoms like hypertension, tachycardia, and new types of severe pain because doctors are often dismissive of our concerns because “there’s always something wrong” with us and because the ER experience is absolutely exhausting, exacerbating other symptoms we live with every day and putting us at risk of hospital-acquired infections. I’ve had two instances since January in which symptoms of a new type, location, and/or severity made me consider going to the ER, but I decided it was safer to stay home as an immunocompromised person.
- Even the best healthcare professionals are unable to provide adequate, quality care to patients because of the working conditions they are subjected to by increasingly tight budgets and staff cuts while hospital mergers continue to be necessitated because medical facilities can’t afford to stay open under this capitalist hellscape of a healthcare system.
- Demands on emergency medicine continue to increase because there aren’t enough doctors and other medical providers to provide preventive care and adequate treatment that would prevent patients from requiring emergency care — and/or patients cannot access them because of financial costs and other reasons; doctors and other “regular” healthcare providers aren’t available on nights and weekends; urgent care facilities that would normally keep many patients out of the emergency room are now closing on nights and weekends due to staffing shortages, shunting the patients they didn’t get to before closing time to nearby emergency rooms; and due to previously mentioned staff shortages caused by the death or disability of emergency medical providers due to the pandemic that is still ongoing. 1,160 deaths were attributed to COVID (acute infection only, not Long COVID) during the week of April 13 to 19, 2023 in the US alone.
- Considering everything you’ve just read, make a conscious attempt to treat disabled and chronically ill people better, because this was just one 11-hour period in my life that my body still hasn’t fully recovered from as of April 29, 2023. Believe people when they tell you what they can and can’t do due to illness, including when they tell you that you need to wear a mask to protect them from COVID and other airborne pathogens. (Dying of the flu isn’t any better than dying of COVID; you’re still dead.)
- And consider your current life and how much that would change if you get sick or injured, seek emergency medical care, and end up with organ damage or other chronic illness due to hospital-acquired COVID. Packing too many people into too small of a space as emergency departments have to treat patients out of the waiting room without requiring masks to prevent the transmission of COVID, flu, and RSV is a recipe for disaster.
It’s your life. And mine. And billions of others. Please choose to be kinder, more understanding, and more protective of your own health. In protecting your own health, you’re also protecting the health of family, friends, and strangers alike.
