Save The Scowl

During yet another busy shift in our emergency department, our staff was on the receiving end of multiple scowls by patients and their families. None warranted, mind you, and none were taken personally. But, nonetheless, it seemed to be the theme of the day.

What started the scowling? Simultaneously, we had three ambulances arrive to our ambulance bay, within minutes of one another. A chest pain patient, a stroke patient, and a trauma patient. Our staff, always ready to rise to the occasion, planned our divide and conquer.

I treated the stroke patient. A 60 y.o. male, normally healthy except for his smoking history, had a sudden onset of slurred speech accompanied by some extremity weakness. His symptoms had started within the past hour and were witnessed by his wife.

"We were sitting in our Lazy-Boys, watching our favorite show, The Wheel of Fortune, when he started having these problems," she said, frightened. "Is he going to be okay, doctor?

We called a "stroke alert." Similar to treating a multiple-trauma patient or an actively-infarcting heart attack patient, we have an emergency response team composed of ourselves, an in-house neurologist, multiple nurses, and the IV team. Our goal? To stabilize a patient, get imaging studies (especially a CT scan), and intervene as quickly as possible. With the right circumstances, we have several treatment options that can reverse such devastating symptoms.

Well, my patient did have a stroke. His CT scans were negative for any hemorrhaging and he qualified for tPA, a clot-buster used very cautiously but effectively to treat ischemic strokes. Simply, this type of stroke is usually caused by an embolus (or clot) that travels to the brain, occluding an artery and preventing blood supply to the brain tissue beyond. tPA can dissolve this clot.

It worked. Within the hour that followed, all of my patient's symptoms resolved.

The cardiac patient went to the cath lab. Unfortunately, the trauma patient died. And, all the while, patients began to back up, waiting for their emergency care. This, I'm afraid, was probably the moment when scowling became an epidemic.

Outside our triage station (the nursing station where a walk-in patient is first greeted and evaluated), patients lying on cots started backing up, lining the hallway. A bad sign that we were getting crowded. Between the patients and their accompanying family members, you couldn't walk down that hallway without having several people give you dirty looks. This, despite them being able to see how we were all rushing around, working hard.

Several patients later, I walked into a very unforgiving room. Lying in the cot was an elderly man with enough piss-and-vinegar to last me a lifetime. Pacing the room, his son. Sitting in the corner, his wife. They were upset with their wait. They had been sent to our ER by their family doctor (so they said) for a problem that was chronic in nature. Specifically, continued urinary problems from an enlarged prostate. Nothing new, they simply called for an appointment and couldn't get one for a week.

"I don't understand how you can make people wait like this," the patient started, before I even had a chance to acknowledge their delay. After assuring them that we were all working quite hard, I simply focused on this patient's history and physical. All stable. With the delays in care, the triage nurse had ordered a UA and blood work, also normal. I explained in detail my exam and the results of these tests, reassuring the patient and his family that everything looked okay.

Three scowls greeted that news.

Finally, just when I thought the scowls were slowing down, a mother walked out of her child's treatment room, quite gruff, while I was handing a chart to our secretary.

"Can someone give me the access code for the internet? For some reason, I can't sign on," she said, clearly annoyed with her wait, her eyes rolling.

Wait a second. We give out turkey sandwiches and lemon pudding. We pass out warm blankets by the dozen. We reimburse parking. And we even have a TV in each private room. When did we start having available internet access for patients and their families? Did I miss something? Do we have a coffee bar I don't know about, either?

"We don't have internet access in the ER, maam," our secretary answered the mother. "Sorry about that."

The mother bore her angry eyes into us. And scowled. "That's ridiculous," she mumbled, before turning and stomping back into the room.

Eventually, during that shift, we caught up with our patient-load and the scowls lessened. In fact, I might have even seen a few smiles. Always a plus

Truthfully, the scowls don't bother me. Well, okay, maybe just a little. But only because they seem to be accompanied with a sense of entitlement. Yes, I understand that when someone is sick, it might be hard for them to comprehend that their symptoms may be less urgent than the next patient. We aren't minimizing the symptoms, simply prioritizing them. We are an emergency department. We don't ask people to come in. We would never deliberately make a patient wait. The scowls being given to us are for things that we, the ER staff, can't control.

Well, short of getting internet access in the ER, that is.

As always, big thanks for reading...next post will be Wednesday, March 24. Interestingly, as I finished this post, the health reform bill passed...more scowls to come...