Monday, January 14, 2008

It Ain't Grey's Anatomy

Apparently Glenn Beck has never been to the ER.

I'm not dismissing the man's health issues, his misery or his concerns. And as much as I don't really think his show is... good... I will be curious to see what happens based upon his recent escapades at the hospital.

You can read Beck's account here.

You can read the story here.

But, from the description I see here, his visit is either par for the course for the average trip to the ER, or maybe marginally worse.

I'm not sure if Beck's surprise comes from his expectations of a clean and happy ER based upon years of TV shows filled with caring doctors who weep whenever someone has a boo-boo. Or, not to be a jerk, but it could also be that Beck has been living in a celebrity cloud long enough that he is shocked to find out about the sort of service the average person expects, even when in dire pain. In either case, the only thing in the story that surprised me was that they found dirty bandages in the shower. Which might just mean that they didn't get to clean the room between patients because they were running patients through so quickly.

The League doles out advice: By the way... if you start to think you need to go to the ER because you're in pain, go... Waiting at home just adds to wait time you're going to get when you get to the ER. We've done 8+ hours of just sitting in a waiting room before seeing so much as a nurse. There were reports of hospitals in Mesa with 16-24 hour waits in the ER.

Sitting for hours in the cheapest chairs the hospital could buy while you wait to get a room and talk to someone about your pain is not where you want to be when your eyes are bleeding out or whatever.

There's really nothing like the ER to remind you that you are not a special snowflake in need of special attention. No matter what you came in with, if you didn't come passed out in an ambulance or with a piece of metal in your head, 50% of the people sitting around you are as bad off as you are (or worse), and they've been waiting longer than you.

Here's what I want to stress, and where I think Glenn Beck is off-base: The people who work in hospitals have the hardest job in the world. I'm including them with combat soldiers.

No matter what these people are making, its not enough.

When you or I go off to work, we sit at a desk in front of a computer, or put on a tie and depose people all day. These people put on clothes specifically designed to be cheap and washable because they will be covered in blood, vomit, and other bodily fluids before they finish their 12-hour shift.

When I screw up at work, a project slips a day. When these people get a new client, which is every few minutes, their client could potentially die on them. And I've spent enough time in hospitals and ERs to tell you, most people walk out of the ER after they've been seen. But sometimes people, despite herculean effort, do not walk back out again. If things are taking a little while for you to get your shot of morphine, Mr. Beck, it could be because the guy on the other side of the curtain was in cardiac arrest and heading into the light.

I've seen kids with lite-brights shoved up their noses, people who had bugs stuck in their ears, people so constipated a doctor was going to have to go in manually, people who were in kidney failure and didn't know it carrying gallons of extra fluid around, knees completely shattered from a bad touch-football play, people with broken limbs, folks with mysterious stomach ailments that have lasted weeks and only now become unmanageable... And I do not work in the ER. I am an observer.

And these people do this every single working day. Every day.

On the regular hospital floor, its a bit different, but there it's often even more life or death. People check into the cardiac floor because their lives are at stake, not because they need some vacation time. These are people with dignity being asked to wear a flimsy robe and sit still for days while they're poked and prodded. Some of them have other ailments. Some are in pain.

Here's the other thing.... if you're not feeling well, and they keep asking you if you need more pain meds, and you keep saying "sure", they will give them to you right up to the point where you might slip into a coma. After all, they have no idea how much pain you're really in except by what you tell them.

If the employees seem a bit callous, you have to understand the wall they set up between themselves and their patients. I think that's more than understandable for people who live around misery every day of their professional lives. Ask a cop, soldier or even a person involved in criminal law if it doesn't all get sort of detached after a while... Glenn Beck can walk into a hospital and walk out again, in relative certainty he need not visit again for years. Doctors, nurses, techs, administrators, janitors... the people who keep the hospital working are the same folks who see thousands of Glenn Becks in a year, and will see just as many next year.

I can't say how much asking questions, and not expecting nurses to treat you like a customer, helps. They aren't working on tips or commission. You are not always right. Be nice. Say "please" and "thank you". If you think something is wrong, ask. But ask politely. These people are dealing with people in eight other rooms, each as sick or sicker than you. And before you start buzzing the nurse for a cup of juice for the tenth time, think about how you'd want other patients to be if you were in need of immediate help and/ or croaking.

I think this is also worth calling out: as scary as it is, medicine is not an exact science. No two people are alike, nor are the ways in which their particular ailment will be managed.

Glenn Beck may be an individual snowflake regarding body chemistry, and it may be true that his system did not know how to manage the meds he was given in order to help him. When you enter the hospital, they are making the best decisions they can based upon the best info available as it relates to the most people. Any time you take a pill, it can have unknown side-effects or known side-effects.

I don't think I'm telling anyone anything that you don't already know.

What I find ridiculous is that it took Beck having a bad few days of health to take notice that people can't be cured with a pill or that their problem won't be resolved in an hour, as if they were dropping clothes off at the dry-cleaner. Further, he's asking each and every hospital worker to care as much about his woes as he does, and, Leaguers... that isn't going to happen. Hospital staff do care or they wouldn't be there. The pay isn't good enough to put up with the day-to-day insanity of healthcare work if they didn't care (and I've personally talked to one young nurse who confessed he couldn't take it any more and was quitting after years of schooling).

I find it a bit unrealistic that Beck identifies the necessary emotional detachment required to work in stressful conditions day-after-day as a sign of a failing healthcare system. There's probably some grain of truth in that insofar as there are not enough hospitals and too many people going into ERs who could just as easily head to the local minor emergency center. And, yeah, the ER nurse didn't do everything exactly to Mr. Beck's satisfaction. The ER's are overcrowded, but it doesn't sound like Beck was seen any faster or slower than when you see other folks fast-tracked. The delays he experienced weren't done out of spite, they were part of procedure so each person is seen and given full attention. Further, "doctor's orders" isn't just a term from the movies. It's what nurses and techs must wait in before doing anything. It's procedural, and not always lightning fast. 40 minutes is fast.

The League doles out more advice:
If you're as jacked up as Beck claims he was (and I believe he was that bad), call an ambulance. Beck has a lot of money and no doubt decent insurance. If you can get into an ER under your own power, the ER staff are going to make their own decisions. They aren't always the right ones.

But what Beck experienced was "Fast Tracking". That's the coveted position of the ER visitor. They saw he was messed up. They got him back second. He doesn't know how long the person who was seen before him was there, he doesn't know which nurse or doctor that person was going to see. Most often you do NOT go from triage into the back. That's what they do with you when they actually care ow you're doing.

If his wife had to hoist him, its because neither of them asked for a wheel-chair or help. Which is... not a great choice and doesn't tell anyone you're in the level of pain Beck was in.

They have these charts at the hospital with a pain scale of 0-10. They even have little descriptions and/ or faces for you to match your level of pain. I'm not sure "I'd lost all hope and wanted to die" is exactly how they put a 10 on the chart, but it also doesn't sound like they avoided trying to help beck outright. It sounds like he got the same treatment I see everyone else getting.

For an interesting response to Beck's rant, check out this nursing forum.

Of course a lot of what the nurses have to say about orders, side-effects of meds, etc... is going to get ignored by Beck, lest he admit he just had a bad experience as a side-effect of surgery and medication and not get a new cause to rant about.


Anonymous said...

Clearly gorked out of his head on meds while he wrote this. Okay, so the dude strained too hard a few times and got some hemmies. Had surgery and poor pain management period. Urinary retention from narcotics. Not anything surprising or earth shattering, Glenn. Whaah..poor baby.

I actually like Glenn Beck, but gesh. Does he seriously want people with actual emergencies to wait for him to get a pain pill and a Foley placed. Grow up dude.


The League said...

What Beck doesn't mention is that it sounds like he was in a very good hospital. Possibly even a private hospital if its the place the CEO of GE goes.

I don't envy him his experience, but I think its mostly a case of Beck believing "it can never happen to me" when it comes to complications, mixed with unrealistic expectations as to how the ER works.

Anonymous said...

The time I spent working in an Emergency Room was trying for me. At the most basic level it was antiseptic, efficient and the faces of the doctors I worked with were crusted with professionalism. This did not mean that they were genuinely detached. You have to get really close to these people to notice it, but the stress they (and I) learned to keep beneath the surface would pull wrinkles into your face. I would get yelled at over the lack of staff, patients would pass, 90 year old women would scream streams of profanities. You are right, they do care and I don't think it's for lack of money that they don't do a better job. These people (in my humble estimation) are heroic, but put on such a face of brutal efficiency that it's hard to even see. I made more than one tearful phone call from outside the hospital as I tried to wrap my mind around what a terrifically big mess the health care industry is in - underfunding, bad planning, insurance/bureaucratic quagmires. The physicians I worked with seemed to spend equal time on paperwork than with patients. To pin this (not you, Ryan, good sir) on the staff shows a callousness in the observer, not the staff.

The League said...

I agree that my choice of the word "detachment" was not entirely accurate. As I see it, it's a wall put up to deal with the day-to-day stress of life and death responsibilities squarely in their hands.

And I did see people get yelled at. Frequently. Occasionally I did some yelling, knowing that the noise level was so great that night that unless I advocated for Jamie, we'd continue to get shuffled down the list. But after dozens and dozens of visits to ER and hospital, it has been many years since I've been under the impression that its a lack of caring. Its a matter of trying to do your best in an impossible situation and making tough choices when everyone needs help.

Basic education regarding when its a good time to hit the ER vs. going to the Urgent Care Center would help (especially in almost every case where I saw children brought in). City planning to prepare for potential patients vs. building hospitals and clinics after the number of patients has greatly exceeded capacity is another option.

A lot of issues with ER and urgent care require even more money, not less, I suspect. And who wants to hear that?