Changing Faces

She walked into the ER's waiting room, her belly protruding from her third pregnancy, only to find an overwhelming number of people standing around, hoping to either be the next called to be taken back into the ER treatment area or, at a minimum, to cop the next available waiting chair.

Tugging a four year-old with one hand while pressing an active two year-old to her chest with the other, the young mother asked a security guard where she should sign-in to be seen. He pointed at the circular desk that sat in the middle of the room, behind which sat two nurses and a technician. Noticing the snaking line of people formed at their counter, she scowled to herself and dragged her gravid belly and two kids to join its end. After standing in the stagnant line for just a few minutes, frustrated, she marched to the left of the line to its front and sat her two year-old on the counter, letting go of her four year-old's hand.

The nurse, startled at the abrupt interruption during her triaging, asked her current client to please wait before focusing on the mother.

"May I help you?" the nurse asked the mother.

"Yeah," the mother answered, "my baby here got a fever two hours ago and I want her looked at. And as long as you all are looking at her, I want my son and me both looked at, too, since we'll probably get what she got." The nurse looked at the baby, sitting on the counter, cooing and slobbering over a lollipop given to her by her mother. The nurse felt the baby's forehead, feeling its coolness, and reassured the mother that they would attend to her and her children as soon as possible. "We'll get your histories and take your vital signs as soon as we take care of these people before you."

The mother obviously didn't want to wait. "You mean I have to go back in line and wait? Can't you see I'm pregnant with two kids hanging off me?" she yelled at the nurse while looking down, noticing her four year-old son missing. "Yes, maam, it does. Everyone before you has been patiently waiting their turn as well. We will be with you as soon as possible, though. If you would like a wheelchair to sit in while you're waiting, we can provide you with one."

"Screw that," the mother said to the offer, before screaming her missing son's name at the top of her lung, adding a few expletives that the entire waiting area heard. Her son came running from the back corner of the room and grabbed his mother's pant leg as she swatted his head. "Who the hell do you think you are," she said, "scaring me like that."

She retook her original position in line, the whole time grumbling and cursing into her iPhone to receptive ears. "Yeah, they making me wait on purpose. She don't like me." She was making a scene, surely, with her crescendos of frustration and anger very evident. Slowly she worked her way to the front of the line where nurse #2 was ready to help her.

"What can I do for you, maam?" the nurse asked her, paper and pen in hand, ready to write. The technician held the thermometer, ready to take one of three temperatures of this family. "You can help me by doing your god-damn job quicker," the mother answered snidely.

The nurse smartly ignored the comment, staring at the mother until the mother continued. "My baby here had a fever start maybe two hours ago and I want her seen. I want me and my son here to be seen, too, since we are gonna get what she's got."

The nurse and technician took the history of all three before doing brief exams and obtaining vital signs. The three were quite stable and none of them had a fever register. "How did you take your daughter's temperature at home?" the nurse asked, curious. "I don't have no thermometer at home," the mother said, "she was just burning up when I felt her."

The nurse reassured the mother that she and her two children appeared okay, and requested the mother have a seat in the waiting room until an available treatment room became available. "What?" the mother yelled, "you mean I have to go back to that waiting room?" "Unfortunately, yes, it does. I'm sorry for your wait today," the nurse answered. "How long is the wait out there?" the mother asked, adding a few more expletives. The nurse explained to the mother that the current wait was about three hours, but could be longer if life-threatening patients presented that needed to be immediately treated. The nurse then had the technician get the mother some formula, some diapers, and some snacks and juice to help with the wait. The mother, pissed at the world, stomped away from the triage area shaking her head.

Soon, the mother was on the phone again, cursing and bitching at an exaggerated level for the entire waiting room's benefit, leaving her four year-old unsupervised and running around the ER, swatting other young children. "Yeah, they making me wait even though I told them I was in a hurry." A waiting patient graciously gave up his seat to her, for which she said "About time" instead of offering her thanks.

During her wait, several patients signed in and were immediately taken to the back ER treatment area, skipping the wait. The mother complained. It was explained to her that patients in urgent need of treatment, such as those with intractable pain or having a stroke or heart attack, were immediately treated for possible life-saving illnesses. "I don't care about that," she said after her multiple complaints, "me and my kids need some life-saving treatment, too."

After a nearly three-hour predicted wait, this family's turn arrived to be taken to the next available treatment room. While being escorted down the hallway, the mother was very vocal in her her complaints, loud enough for all to hear, despite passing room after filled-room and cot after filled-cot in the hallways. Although she bore witness to the crazy atmosphere, this mother was bitter and defiant about being made to wait.

My physician assistant and I both agreed to attend to this family, dividing up the work between us, trying to make it a quick process. We had been given a "heads-up" by the nursing staff, both in the triage area as well as the treatment room's assigned nurse, as to the mother's disposition and lack of understanding on our busy day. Their stories supported their words. In fact, after this family was placed in their treatment room, we were told by the nurse that the mother made her wait until she finished her phone conversation, holding her index finger up to the nurse and refusing to talk until she was finished. "Why did you wait?" both the PA and I asked.

"That's nothing," the nurse added, "she also wanted two extra pillows after I adjusted the cot for her." Anyone who works in an ER knows how rare an extra pillow is, let alone two. "And," the nurse continued, "she is now demanding turkey sandwiches and pudding and juice for all of them." To placate them further, the nurse also got several blankets for them to cover with if they needed. However, this act of kindness wasn't good enough. "Hey," the mother yelled at the nurse as she was leaving the room, "these blankets aren't warm like they were the last time I was here. Take these back and get me some warm ones."

We treated the family. As suspected, the mother and four year-old son were both healthy with no abnormal findings. The two year-old had some mild nasal congestion and was otherwise as stable as the others.

After the PA and I explained the results of our exam to the mother, she demanded antibiotics for the three of them. We refused, explaining the overuse of antibiotics and their lack of need in their cases. "Then," the mother said, "I at least want a prescription for Tylenol so I don't have to pay for it."

My kids recently had URI symptoms and I knew for a fact that Equate brand acetaminophen was $2.86 a bottle. She, however, assured us that she couldn't afford that. I looked at the mother's gold necklaces, at her and her kids' designer clothes, at her iPhone and cigarettes hanging out of her designer purse, at her perfectly manicured nails, and finally at her eternal scowl while looking back at us. "And," she said, adding good measure, "I need someone to find us a ride home."

They found their own ride home. As for the Tylenol, I told the PA I didn't want to know what decision he made on writing the prescription. That decision alone, whether yes or no, could be examined by countless arguments as to the good and bad of our current medical climate.

Medicine is changing. Emergency departments are changing. In the decade-and-a-half that I have been an active, practicing ER physician, the changes have been astounding. Some good-astounding. Others frustratingly-astounding. Besides the current political and legal climates that exist, I feel firsthand the change in the attitudes of our patients and of our staff. The departments are being overwhelmed with non-emergent cases, and this is frustrating all that seem to be involved.

Is there an answer? Yes? No? Do you have one?

I was a people-person, enjoying the company of my fellow mankind. I am, admittedly, not enjoying their company as much. Instead, I am seeing more negative aspects and disheartening perspectives of humanity that are becoming more accepted by our community. I am seeing, too, the migration of great nurses and doctors away from our chosen field. Is this part of their reasons? Am I the next? I sometimes struggle to remember the great reasons I chose to pursue this career in medicine. Hopefully, with harder, more intense looking into myself, the good will be more in evidence. My father says that, at 81, he has never had a day in the forestry industry that he hasn't driven to work with a smile on his face. Most days I feel this way, too.

I only wish it could be every day.

As always, big thanks for reading... To my readers who have emailed their concerns by my lack of appearances on here, I thank you with much gratitude for your concerns. The family and I are well. To the nurses and technicians who endure triage and similar stories as above, thank you for all you do.