By Glynn Cosker
The specter of visiting an emergency room was daunting enough before the COVID-19 pandemic. Depending on their condition, most people checked in at the front desk and then sat in the waiting room for a few hours before seeing a triage nurse. How are things different these days? Unfortunately, I recently had a chance to find out during a trip to a large, municipal hospital in Virginia.
One night this month, my wife went to bed feeling a twinge in her stomach and – by the following evening – she was doubled over in pain, clutching her lower-right abdomen and pounding her fist on any available hard surface. My wife considers getting sick as an effrontery and inconvenience – and it took a stern talking to by her 97-year-old grandmother to get her into our car for a trip to the nearest hospital emergency room. We arrived at 8:00 p.m.
An Empty Waiting Room
Once there, I was overjoyed to see an empty waiting room. With my wife in obvious distress, she was ushered into the triage area. Her vitals revealed elevated blood pressure and a fever. She was also now dry-heaving into a bag. Even though I’m not a doctor, I knew before we left home that my wife had appendicitis. But, of course, confirmation at the hospital was an absolute necessity.
The nurse we saw in the triage area asked if my wife had suffered from burst ovarian cysts before. She replied in the affirmative, but she’d since had a hysterectomy. How about kidney stones? Yes, she’d had many, but this pain was in the front – not in the back. It was a much different type of pain, too. They asked my wife if she still had her appendix. “Oh, yes,” I said. “She’s quite attached to that thing.” Silence. I probably wasn’t reading the room very well.
A few seconds later, we were ushered into what I thought would be a room with a bed. Instead, we were placed in a makeshift area with one chair either side of a thin partition; my wife and I occupied one side of the partition; another family was occupying the other side. We could all hear each other’s business.
An I.V. bag was set up and some saline and antibiotics were administered. Soon, a CT-scan, some pain meds and some nausea meds were all ordered. And we’d only been there 15 minutes!
However, I soon noticed that my wife did not have the obligatory plastic bracelet with her name, date of birth and a barcode on it. So, I asked a nurse to fetch that. I didn’t want a mix-up. Thirty minutes later, a different nurse came in with the pain and nausea meds. After asking how Julia was (my wife’s name isn’t Julia) and offering up an incorrect birthdate for my wife, the nurse obviously realized something was amiss. No bracelet. “I told someone about that,” I opined. Once my wife’s identity was confirmed, the pain and nausea meds were administered. But – still no bracelet. Over the next two hours, I asked a few more people for that bracelet. Nobody brought one.
At around 10:30 p.m., a radiology tech came in with a wheelchair. “Hi Julia,” he said. My face-palm echoed around the E.R., as the tech reached for my wife’s empty wrist. “I’m here to take you to your CT-scan.” No bracelet. Fifteen minutes later, the same tech returned with one. I was grateful. As my wife was wheeled away for the CT scan, it dawned on me that no vitals had been taken for almost three hours. That seemed a bit odd to me.
A Diagnosis and a Wait
At 12:15 a.m., an E.R. doctor came in and told my wife that the diagnosis was appendicitis and that the on-call surgeon was aware and would be there soon. The doctor instructed my wife to consume nothing by mouth from this point on.” Okay, I thought. The pace will pick up now.
At 4:00 a.m., my wife was still in the E.R. – in the same chair she’d occupied for almost eight hours. We were told there were no beds available in the main hospital. Still no vitals since the first batch in the triage, and the initial I.V. bag had run dry after an hour – so my wife had not received any fluids since around 9:00 p.m. But – at around 4:15 a.m. – a room in the main hospital wing was available. My wife was transported to the fourth floor – where we passed by numerous, seemingly vacant rooms, to find that nobody at the nurses’ station was expecting her. There was a “chart” but there were no doctor’s orders or diagnosis – or any other information – on it.
After finally getting into her room, a confused nurse came in and said that he still didn’t know why my wife was there and asked her if she wanted anything to eat or drink. After clarifying with the nurse that my wife was expecting an emergency appendectomy, the nurse began asking my wife a series of questions she’d already answered in the triage when we first arrived at the emergency room. My wife was able to self-advocate. But, what if she wasn’t able to? What if she was incapacitated? Or, what if nobody else was allowed to accompany her – such as during the height of the pandemic? With hindsight, that aspect of the entire experience was worrisome.
It was 6:15 a.m. My wife was in pain and she felt hot to me. I hit the “nurse alert” button. Ten minutes later, someone replied. Our male nurse returned to the room. “She’s in pain, and I think she has a fever,” I said. He replied with “Oh, but I can’t give you anything. You’re NPO. Let me check your orders.” He left and came back 15 minutes later repeating that my wife was NPO. NPO is the medical term for “nothing by mouth.”
So, there we were. About 10 hours into our stay on the premises; nine hours since any fluid intake, a blood-pressure check, or a temperature measurement – even though I had just told the nurse that my wife likely had a fever. And – we still didn’t know when the appendectomy would be performed – 30 hours after my wife’s symptoms first surfaced – because we hadn’t received an update on when the on-call surgeon might arrive. Notwithstanding, our male nurse returned, saying there were no orders from a doctor for narcotic pain meds – or even saline – but offered my wife two regular Tylenol pills and a sip of water … For her diagnosed appendicitis.
‘Thirsty, Nauseated and In Pain’
At 7:00 a.m., there was a shift change, and we had a new nurse. At 8:00 a.m., we saw a doctor who came in while doing his “rounds.” He had an admirable bedside manner and happily told my wife “not to worry” and asked her how she was feeling. “Thirsty, nauseated and in pain,” was her response. A look of horror crossed the doctor’s face as he picked up my wife’s I.V. port on her arm and realized it wasn’t attached to anything.
“She hasn’t had an I.V. bag attached since nine o’clock last night,” I said. “I’ve mentioned it a few times to various people. One guy brought her two Tylenol a couple of hours back. But, you know, we had a bottle of those right here in her purse, so I hope they don’t show up as a $20 charge on our bill.” The doctor smiled and diplomatically stated that he would get everything fixed. He immediately ordered saline hydration, narcotic pain meds, anti-nausea meds and antibiotics via his laptop. One hour later, all of that arrived.
A Successful Surgery
Soon after that, the surgeon arrived. He was confident and ready for action. I told him that my wife had received no fluids – either intravenously or orally – and no antibiotics or pain meds since 9:00 p.m. the night before until just before his entrance. And, his mood changed. He wasn’t happy. He held back his anger, in fact. However, he ensured us that the appendectomy would take place as soon as his on-call O.R. team was onsite. It was 9:15 a.m. At 12:30 p.m., each member of the surgeon’s on-call O.R. team had arrived.
My wife’s appendectomy – which began at around 1.00 p.m. – was a complete success. However, the surgeon informed us that the appendix was “about ready to burst” when he removed it, and an overnight stay in the hospital would be prudent.
The next 18 hours in the hospital were fairly uneventful. It seemed, to me at least, that the communication between the E.R. and the main hospital was problematic – and had caused most of my concern – but things had settled down and sorted themselves out.
A Sign of our COVID-World Times
The entire 48 hours illustrated a sign of our times. I’m not sure if what we experienced is the “new-normal” for a trip to a hospital’s E.R. with suspected appendicitis in our COVID world, but it might be. I’d need to repeat the experience at a couple of other hospitals – perhaps in different states – to find out.
Whatever the reason, the medical staff, the hospital, its personnel were not at fault. Not in my book at any rate. Another person might be writing a letter to their senator about all of this, but I get it. The hospital was clearly struggling with a staff shortage – possibly with absent people or systems that hampered communication and timeliness – because of the COVID-19 pandemic and it’s trickle-down effects. But, at least there is a hospital. At least, my wife met medical personnel. For many around the world, such things are luxury items and are not to be taken for granted.
A Shortage of 200K to 450K Registered Nurses by 2025
It’s hard to quantify what the nursing and medical industries have endured since early 2020. Nurses were called “heroes” by governments when the pandemic first emerged, but miserable working conditions have led many to quit the profession. In fact, according to a McKinsey & Company report, the U.S. may see a nursing shortage of between 200,000 and 450,000 registered nurses (RNs) by 2025 if nothing is done by medical stakeholders or the federal government.
That statistic about the future of nursing in America is a scary thought – especially when I wonder what an experience identical to my wife’s might be like three years from now; and something should be done about it. Stat. But, it’s not an easy problem to solve. For now, we must keep thanking the nurses, keep thanking the doctors, the surgeons, and all the other medical personnel we encounter. We must put ourselves in their shoes, and we must all adjust our expectations from our pre-COVID world to our current COVID world.