The Emergency Department

Although the underlying story is true,  I made several changes to preserve the anonymity of the patient and their family. 

Your Mother

Imagine your mother is 85. Imagine she is almost deaf, but she learned to read lips if you speak slow. Now imagine she also has some health problems. For example, over the many years her blood vessels became clogged up to the point of her heart becoming so weak it started failing. So her ankles swell up, making it hard for her to put her shoes on. She also gets short of breath after getting up from bed, walking to the bathroom, brushing her teeth or grooming herself. Nevertheless, the picture is not all gloomy. She does live by herself in her own apartment, even if by a big stretch. She still remembers who you and your other nine siblings are.

During a routine visit. her GP tells her to go to ED because of persistent fatigue, lack of appetite and vague abdominal pain. The young doctor at the hospital, who impressed both your mother and yourself by his courteousness, swift diagnosis and reassuring words, tells you she has digitalis toxicity, meaning the level of the drug she takes for her heart is dangerously high in her blood. This is something her cardiologist and other doctors missed.

You have just settled in, at least mentally. You waited to be seen by the emergency department doc; then waited some more to see the nice young doctor.  You established a good connection with him, but you he cannot follow your mother because she "belongs" to another hospital. This concept improves care of patients that were recently (in the last 12 months or so) treated at another hospital, expediting their transfer. Consequently  you have to leave. Your mother is sent to another hospital where the process is repeated all over again with another emergency doctor, gowns, tests and finally a geriatrician (specialist of the elderly) sees her and explains to you the course of action. But she stays in the Emergency room.

The emergency room

24-hour lighting in a hallway full of strangers, but lacking a single window. A constant stimulation of light, noise and movement that does not let anyone fall asleep, know what time of day it is or what happened since they last closed their eyes.

You are so exhausted from this runaround that you have to sleep and you go away for the night.You tell the medical staff to call you if anything happens, because you live only 15 minutes away.

The next morning your mother is all but OK. She is attached to her gurney, her speech is slurred and she is confused. She looks at you with eyes full of terror, like a hunted animal, and repeats the same words; words that will only start fading in your mind as you drive home the following evening...

 "They tied me. They tied me. They tied me..."

You ask the nurses, trying to control the rage, what happened and they reply that your mother got a little haldol (a potent traquilizer with significant side-effects, especially for older people like your mother).
Why??? Why weren't you called? You specifically said you will take care of anything.

Moreover, a little haldol would not have the effect that you are currently seeing. Oh, but we also gave her a little bit of ativan. They tell you she became agitated and started scratching the personnel. This 50 lbs lady was apparently able to overcome two well built orderlies that just passed by you.

The story goes on. When you settle down a little from the anger you demand she be detached because you want her to be able to walk. And then you notice she has a diaper, one that is full of liquid stool, which is not typical for her. In fact, she was never incontinent at home. After a verbal argument with the personnel you learn she was automatically put in a diaper because she was restrained - its simple math. It is a very overcrowded, overworked and understaffed environment, they explain apologetically. A nurse approaches you and quietly whispers that your mother, or any patient for that matter, should not have stayed in the emergency department for as long as she did, but there is no place for her to go to.

As the day unfolds, you get to meet your mother's co-patient, one who's gurney was put just in front of your mother's against the wall so the rails were actually touching. This man looks very thin, cachectic even, his wrinkled pale face distorted with pain. Even through his own agony, he tells you how your mother begged him for a knife or scissors during the night to free herself. You catch yourself having a very scary and unwelcome thought. Looking at the suffering man next to your mother you ask yourself if he might be the one who could put those tools to good use.

Early in the afternoon you also have the pleasure of a visit by a middle-aged woman in business attire who pokes her head into your impromptu corner and, without an introduction, start asking questions:

Are you the daughter of Miss Wilderton?

Yes.

Doesn't she live in the Bay area?

Yes.

At this point you get irritated enough to ask: Who are you exactly?

I'm the liaison nurse. And your mother is not supposed to be treated here because her area is served by another hospital, - that last one is said with some aversion.

We actually did go to the hospital closest to our home, and they transferred her here. She was always treated here for all her health problems. All the tests, her chart and her specialists are all here. Those are your thoughts, but you are not going to voice any of them out because you are too tired to argue over meaningless details. Besides, you have to use all your might to convince your mother, who is now untied and starting to come back to her usual self not to sign herself out of this place where she is supposed to get better.

The Ward

Towards the end of day 3, your mother is finally brought up to what you think is her destination. What you learn after speaking to the young energetic resident who visits your mother soon after she settles in is that in fact she is not on the geriatric floor, because half of the beds are taken up by patients who would be sent to a long-term care facility, except... you guessed it - there are no beds. What this means to you and your mother is that she is admitted to the internal medicine ward, where patients with complicated medical illnesses are investigated and treated.

By comparison your mother's condition is a 'no-brainer' and in a perverted way that only a proud teaching hospital ward can tolerate your mother becomes a boring patient. Comparatively speaking, she is a low-intervetion, low educational-value patient, which, therefore, requires minimum maintenance. Sounds crass? Don't take my word for it.