About What’s Wrong With America
Clara, my wife of 30 years, was hospitalized Wed. night. My son and I took her to hospital ER at 11 pm, after she was found coughing up blood and had a blood sugar level over 900, an extremely high and potentially fatal condition.
Clara had been fighting a bad respiratory infection complicated by asthma for two weeks prior to this crisis. I finally convinced her to go to the doctor on Monday, Dec. 12th. He prescribed an antibiotic and a steroidal asthma inhaler. She began having chest pain Wed. night. What we didn’t know was she had stopped taking her insulin and eating because she felt so sick and nauseated. Her weight dropped to only 95 pounds, dangerously low for a Type 1 diabetic. Once she started vomiting up blood we contacted the on call doctor who said to take her immediately to the ER.
When I admitted my wife to the hospital at 11 pm that night, we experienced expressions of contempt from several members of the hospital’s intake staff, including nurses. They did not understand why my wife, who was screaming and incoherent and having a panic attack due to her chemo-induced brain injury was in no state to answer their barrage of rapid fire questions about why she needed their help.
She was overwhelmed by all the stimuli an ER Room generates: loud beeping noises, people shouting and running about, loud TVs playing and caregivers asking rapid-fire questions too fast for her to process during her long night of pain, terror and sensory overload. They just assumed she was bad news, possibly a junkie (she certainly looked the part due to her weight loss) and that I, as her husband, was terrible person, as well, for not being able to give them what they needed off the top of my head to complete their intake procedure before they would admit her and treat her.
To them, we were a waste of space, and a waste of their valuable time, time that could be better spent on other patients. They demonstrated this contemptuous attitude in many ways, but the effect was to make us feel that that they considered themselves our superiors, people who were beneath them. Needless to say, certain individuals did not treat my wife well during that required intake process.
I know that the intake people were having a busy night, but if they had taken the time to hear me out and let me explain why all the lights, noise, and general insanity of an ER room made it impossible for her to answer their barrage of questions and demands, it would have made a big difference.
Thereafter, I made a point to explain to every nurse, technician, doctor and other member of the hospital’s staff who saw or dealt with her that night of (1) the brain trauma Clara had suffered, (2) the cognitive issues she deals with because of it, and (3) what they, as medical professionals needed to do to help her. To be specific, I asked them to please talk slowly, repeat themselves if necessary and don’t make assumptions that just because she is acting out in response to loud noises, bright lights or their interactions with her that it meant she was some drug-addled crazy person.
I also made it very clear that her brain trauma resulted from her chemotherapy for pancreatic cancer (5-FU was the medicinal culprit), so that also got people to turn up their empathy meters a little higher. It’s strange, or maybe not so strange, but using the “cancer card” usually helps a lot with getting people to listen to me when I explain why Clara has unique needs that require a different approach to her treatment for medical issues than someone else who does not have such a severe cognitive disorder.
Recently, as I reflected upon that nightmarish experience only a few days ago, I had an epiphany.
Contempt is perhaps the worst emotion one person can feel toward another. It is the one that most increases divisiveness in personal relationships. We know this to be true based on studies of marital couples and other close relationships.
And an outbreak of contempt for others has broken out in our society over the last few decades; one that I contend is exacerbating divisions among the many peoples of our country. Many of us express contempt for others daily in part because politicians propagate this attitude with the assistance of our traditional media. Such negative memes are then spread through social media, often by people paid to generate and stir up these powerful negative emotions online. It leads many of us to hide out in our own little bubbles, dismiss the opinions and beliefs of others, and hold people we know next to nothing about in contempt.
And why do we that? Because of the lies and disinformation that reinforce lazy thinking and the easy acceptance of stereotypes with which we have been inculcated from birth, lies and false narratives we have all been told about “those people,” lies fostered and spread by the people in power who wish to keep us divided.
One can forgive anger, even hate, even murder, as the families of the victims of the Dylann Roof massacre have shown.
However, contempt – the expression of disdain, disgust, revulsion and for lack of a better term, that “holier than thou attitude” by those who express it openly toward those they find unacceptable – causes tremendous emotional pain.
It is the one act that is often hardest to forget and forgive, because it is so demeaning to those who are being reviled and relegated to sub-human status. Contempt, even more than hate, contributes to the willingness of so many Americans to cheer the suffering of others, even the outright murder and abuse of innocents, because that suffering is happening to someone else they despise, i.e., “one of those people.”
Whether fostered and nurtured through factional strife, spiteful political discourse, absurd and dangerous assumptions about others based on someone’s race, religion, class or any of the many categories people use to label other people and place them in nasty little boxes where the worst thoughts and prejudices about entire communities and groups may be taken as God’s own truth, it is a great evil.
The all too frequent public expressions of contempt, revulsion, disgust and disdain for those with whom we disagree, and who in like manner may hold us in contempt, as well, is devastating our nation. The spread of this poisonous emotion, along with its attendant behaviors, throughout our society is frequently based on a single characteristic or “deplorable” political opinion. It keeps many Americans, who otherwise have so much in common, from uniting and fighting together against the powerful elites who hold the real power over us all. Wealthy elites, regardless of party affiliation, would like nothing more than to see all of us at each others throats, rather than unite in solidarity to make this a better country and a better world.
If we are to salvage this country after the disaster of 2016, this is one of the most important things that we need to eliminate from our public and private discourse. For how can you ally with other individuals and communities to achieve outcomes that are mutually beneficial to all, if so many people’s default position is to be contemptuous of the ideas, experiences and cultures of communities and individuals of whom they know nothing but what the distorted lens of prejudice and propaganda shows?
For contempt shuts off any chance of dialogue and finding common ground. It keeps us all in bondage to a greater or lesser extent. Contempt serves the interests of the rich and powerful, not the rest of us. We need to reach out to those who are different from us in any way, and not demean and despise them. We should not dismiss out of hand their grievances because we are so certain of our rightness, our moral superiority or simply our self-perceived greater knowledge and intelligence regarding the proper course of action needed to fix our country’s many, many seemingly intractable problems.
To refuse to put aside our own feelings of righteousness, and our belief that those who disagree with us are worthless, ignorant and possibly immoral idiots that deserve only our scorn, is to accept the continuation of the war of all against all. It will inevitably take us down a path that will result in furthering the pervasive corrosion and decay of society, and dash any hope for a better, more equitable and sustainable world.
For if we fail to change these inimical attitudes, fail to stop scapegoating others for the flaws inherent in our culture, and our financial and political systems, we shall surely end up living under a tyrannical and repressive government, suffering from ever worsening economic hardships, and watching our world descends into ecological and environmental collapse.
Count on it.
I hear you, Steven. I strongly regret what you and your family are going through. You, and we, deserve better. I’m hopeful that enough voting Americans can return to acting from the better angels of their nature as quickly as possible, in time for you and your family to gain relief.
You write:
Steven is writing about the evils of contempt, and they are legion. You are a centrist Democrat. I have read enough of your posts to believe that what you are saying above… “…acting from the better angels of their nature”…translates as “…return to voting for Democrats.” I am convinced that contempt is what lost this election for the Dems, centerfield. Beyond all other mistakes, beyond all other possible hustles that may have occurred from any other sources…beyond any other factor, HRC’s statement about “deplorables” was the straw that broke the donkey’s back. That was the single most powerful action that brought out the anti-Dem voters. Trump played it well, and now here we jolly well are.
I also regret what Steven D.’s family is experiencing, but for other reasons. Our entire medical system is broken. Two years ago I was thrust into it. I too was treated with contempt, but of another sort…supposedly well-meaning doctors treating me as if I knew nothing about my own body, acting like they were the masters of the universe and I was their peon. Only when I took my own treatment into my own hands did I recover.
This “contempt” epidemic starts from the top, from the criminals who have taken over both political parties. They will say and do anything to maintain power and are incapable of acting with any sense of decency or honor. The way your DNC treated Bernie Sanders illustrates this quite well. They treated him and his followers with contempt. They lied and cheated to eliminate him instead of honorably confronting his ideas with theirs in open discussion. This contempt drips downwards, into the whole society.
Contempt for human lives worldwide as evidenced by the Permanent War system of maintaining economic imperialism.
Contempt for the welfare of the people of the U.S. as evidenced by both Big Money’s massive credit fraud…a fraud that almost broke the country’s back in 2008…and the total failure of the educational system to adequately educate the children of the less fortunate among us from Appalachia, the Rust Belt and other failing, mostly white areas right on through the (Still, after all these years!!!) poverty-crippled racial ghettos of our cities.
Contempt for the health of all Americans without large amounts of money as evidenced by the whole treacherously fraudulent Big Insurance/Big Med/Big Pharma colossus and the ongoing, federally approved poisoning of the environment and food supply. The whole Flint water thing is just a symptom of this contempt…it’s happening nationwide on every level you can imagine.
Contempt, contempt and more contempt. leaching right down into the entire society.
Words of regret just won’t cut it anymore. We must take action, and soon. Every time I hear another centrist plead for voting Americans to return to the entirely discredited Dem fold I am tempted to just pack up my own tent and move as far away as possible from here before the whole construct collapses. But…I cannot do this in good conscience. My ancestors came here in search of better lives, and by and large that was what they found. I honor them by my staying. Also…there is no longer anywhere to run. This “contempt” disease has infected the whole planet.
If you mean what you say, either do everything in your power to reform the Democratic Party or start looking for a way to found another party…a party of honor. Your sig…as Frederick Douglass said of Abraham Lincoln’s efforts, we need “swift, zealous, radical, and determined” action, and soon. If we do not get this, we will sink into the ongoing morass of contempt that is opening up underneath us with the Trump administration, and that will be the end of the American dream…quite possibly a nuclear end to the human dream.
Time to wake up, America.
You been had.
It is time to wake the fuck up!!!
Later…
AG
Including contempt for the law as long as you are one of the “in” crowd: http://finance.yahoo.com/news/imfs-lagarde-found-guilty-french-tycoon-payout-trial-142520142–busine
ss.html
Guilty but no punishment.
The expression of contempt for those who are sick or injured has come from the Republican side. That video is but one example. Certainly not from anyone I’ve encountered from the Democratic Party.
You are beyond reason. Did you even listen to the whole statement? Ron Paul is not a “sadist,” he simply wants to break down the system that…in its latest incarnations…both mistreated Steven’s wife and on another level tried to foist a totally bureaucratized candidate on the American people. It fails on both levels, more often than not.
Depersonalized America.
Try to imagine how Steven’s wife would have been treated in the hospital where Dr. Paul worked as a young man, centerfield…before this robotic healthcare/insurance system was put in place by corporate drones.
At least try.
As he said…the churches helped. The neighbors helped. People who knew the patients helped. Everybody got taken care of because there were still functioning smaller societal groups…families, neighborhoods, churches, etc…that were working in an honorable manner.
And…adequate insurance for a whole family did not take some inordinate amount of money from a middle class or working class wage. Hell…when my father was going to school on the G.I. bill in the late ’40s, early /’50s and my mother was working as a manager of a university snack bar we didn’t have much money…we were living in what was essentially a tarpaper-covered shack in the middle of NY State snowbelt and my father went hunting to get us food… but when we needed healthcare it was not only there for us, but it was much better than what equivalent working class families get now.
Health care not health scare.
Paul pins it at the end.
Downsize.
Stop wasting money on middle managers and other bureaucrats.
Take a page from the Cuban healthcare model. Doctors live among the people, not sequestered in gated communities.
Doctors are not supposed to be royalty, they are supposed to be servants of the people.
Once again, I will try to warn you.
If this system does not wise up and slim down…soon…we are in for a load more trouble than we are in at the moment.
WTFU.
AG
Here, let’s learn what health care in the United States was like before 1965.
Some of the many important outcomes revealed in this reporting: “In a 1963 survey, patients from the general population were given a list of symptoms and asked whether they had been able to see a physician about them. Among those who reported “pains in the heart,” 25 percent said they did not see a physician; for “unexpected bleeding” it was 34 percent; for “shortness of breath,” it was 35 percent; for “abdominal pains,” it was 31 percent; for “repeated vomiting,” it was 40 percent; for “diarrhea for four or five days,” it was 38 percent. Meanwhile, comparing the annual rates of hospital admissions per 100 persons suggests that Medicare and Medicaid had a tangible impact on widening access to health care. In 1963, the rate of hospital admissions for patients with private insurance was 15 percent, compared to 9 percent for those without private insurance. By 1970, the rates had equalized at 13 percent each, with the rate for those without private insurance increasing due in part to expanded access through Medicare and Medicaid. “Many people in the U.S. prior to 1965 had very limited access to medical care,” said Ronald Andersen, an emeritus professor of health services and sociology at the UCLA School of Public Health who has studied this data since the 1960s and provided the data to us. “This situation improved considerably after the implementation of Medicare and Medicaid.”
Good to know that while the rest of us are fighting to defend Medicare and Medicaid in 2017, Arthur will be happily supporting Ryan and McConnell in their attempts to destroy these desperately needed programs.
As he has repeatedly revealed, Arthur is a radical libertarian who opposes civil rights, voting rights, and health care access. He is not a progressive; his moralistic lectures to this community are largely fraudulent.
Our contemporary “medical care” is less than useless. Any and all alternative approaches are viciously opposed by Big Med/Big Pharma/Big Insurance.
I do not know how old you are, centerfield, but I will bet my life…I aleady have bet my life, actually…that I will not only outlive you but will remain well-functioning way past the average effective life of most contemporary U.S. citizens.
“Y’pays yer money and y’takes yer chances,” as the old carnival barkers used to say.
Best of luck in the future.
You gonna need it.
AG
Good Lord, AG, can you just once read what someone wrote without the distorting lenses of your cynical perspective? Steven D’s experience with his wife was bloody awful, and centerfielddj expressed his wishes for better. “Better angels” is a pretty generic expression. It’s you who is layering upon centerfielddj’s remarks a whole lot of ideological baggage that just isn’t actually there.
And is utterly inappropriate in this venue.
Unbelievable.
.
If the corporate rot that has infected this country…and its two major parties…is responsible for the mistreatment that Steven’s wife and any number of others have suffered, how is bringing it up “utterly inappropriate in this venue?”
Is this…or was it, to be more precise…a “progressive” site? If so, then my own take on “progress” is such situations is totally appropriate. if it is no longer progressive but just another arm of the PermaGov media, then yes, you are right.
Time will tell. BooTrib poised on the fence between the two possibilities, right now.
We shall see, soon enough.
AG
P.S. Steven and I have had some contact outside of this site…he knows my good wishes towards him and his family, so I don’t need to restate them. But the stubborn resistance from centrists like you regarding the necessity for real, functional change at the very base of this system needs to be addressed and then addressed again until it happens.
Deal wid it.
You don’t like it?
Go jerk off on dKos.
Steven D, thanks for posting this.
You are correct that we will not recover our freedoms, our dignity, and justice as a nation by “fighting fire with fire”. The attitude that we are facing as more people are driven to hate the jobs they used to love doing and the theft going on from the top cannot be opposed either with complacency or with contempt.
Would that we were spending more time thinking through what actually might work at the level of our personal networks and local interactions to reverse the deliberate destruction of empathy and the valuing of every cultural gift monetarily.
The strength your family shows under these stresses is from an outsider to it a miracle in itself. The best to you, Clara, and the rest of your family in the coming days. That as I write it seems a pretty weak and pitiful wish, but it is the best I can muster at the moment.
I suspect that the world has changed more abruptly that any of us imagine quite yet. And not just the United States. I’m not sure that we peanuts still have the power to change the disatrous course of our blind self-assumed betters and the self-destroying echo chamber that has appeared over the past decade.
It has disoriented lots of fundamentally good people, most of us included.
A first step IMHO is pooling our local knowledge to figure out what the hell is going on. What we know from your experience is that the US health care system is still collapsing no matter how much or little the ACA prevented its very imminent collapse. We also know that the ACA was gamed to provide the worst care possible after the ink was dry on the signed act. Emergency rooms, instead of being major beneficiaries of the bill, are major losers because the deductibles and copays set by plans discourage people from going for care until the emergency room is necessary and the current financial situation means that just as many people are failing to have their bills paid off for ER services, leaving the cost-shifting from other patients quite in place. Moreso in states that failed for political reasons to expande Medicaid.
A MAJOR loss in care is in the works. http://news.morningstar.com/articlenet/article.aspx?id=784998 And don’t tell me that centrist Democrats like Schumer haven’t signed on to this or some variant.
When I was a toddler I heard the tale of the goose that laid the golden eggs. I guess the 1% never heard it. They are determined to cut open the goose and get ALL the eggs.
You can eat gold, but it does not provide balanced nutrition. Oh, that was King Midas.
Killing the real wealth producers–that was the goose who laid the golden egg.
But then, isn’t the Standard American Diet a bit like the force-feeding of geese for fois gras?
Well, the ED sees the sickest patients, since most patients come in through the ED initially via walk-ins or EMS, and then get admitted. And the way that Medicare and Medicaid pay out, is based on providing adequate care that is documented correctly, paired with whether patients come back as readmissions. A readmission within 30 days typically causes Medicare/Medicaid to reduce payment for the previous treatment.
So, the ED will see a patient with end stage renal disease that hasn’t gone to dialysis for the past week because they weren’t feeling well. Their lab numbers are all out of whack because of that, and they have a laundry list of other comorbidities like CHF, COPD, Diabetes, past MI, CVAs, etc. This patient is going to get stabilized in the ED, admitted and treated on the floor, and then sent home. And through no fault of the ED, there’s a high likelihood that this patient is going to be making a return visit in the next month, which then denies full payment from Medicare/Medicaid.
The ED is expensive, because everything is STAT. Labs that you get done in a doctors office get returned in a week. In the ED, we get them back within an hour. CT, XR, MRI, US, RT, Neuro, come to us, and give us results back within an hour. We have providers sitting there 24/7, and we have to be quick in treating and streeting. Which is why the ED is the worst possible place to get primary health care, if one of the goals of health care is to keep it cheap…which of course is one of the most important goals of providing health care to a population.
Ultimately, only universal health care paired with paying primary care providers and nurses adequately, will fix the myriad of problems with health care delivery.
For example, primary care physicians make much less than specialists, so many doctors specialize to earn more, leaving a shortage of primary care physicians, which should be the first stop for any patient in the health care system. It’s also why physician assistants and nurse practitioners are starting to pop up as mid-level providers, as they can provide primary care for patients, and don’t have to spend nearly as much time in school and accruing debt in the meantime. If you don’t have enough primary health care providers for a population, the population either waits with insurance and gets worse, or waits without insurance and gets worse. Point being, people get worse. Which drives up costs later.
Similar to primary care physicians, nurses are underpaid and overworked which is one reason why there has been and will be a shortage of nurses. Just take a look at the average wage of a nurse, and how much a nurse can make by crossing a picket line. Nurses who cross a picket line can make upwards of $1000 a day. In essence, if every single nurse in the country went on strike, and then immediately crossed the picket line to replace the coworker to their left, nurses would probably be paid over $60 an hour, which is much higher than the average nursing hourly wage. Instead, because nurses aren’t unionized everywhere, and because nurses generally want to nurse patients, we’re stuck getting paid much less than we should be. And after awhile of 12+ hour shifts, fatigue sets in, and nurses stop nursing.
Without adequate primary health care providers and nurses, not everyone can get an appointment to see a provider and get treatment to mitigate current conditions and prevent future chronic conditions. And that’s the son of a bitch. It costs money to save money. And the richest people in the solar system are able to get appointments today for their conditions, and don’t care about the rabble who are deteriorating on a daily basis, if it is going to cost them a few dollars in taxes that they wouldn’t even notice.
In short, in health care, capitalism is the problem. Almost everything else is a symptom.
My spouse had a fall leading to a broken hip. Following hip replacement surgery there was a complication – led to a stroke. I’ve shared this story elsewhere in recent days, so I will spare the details. Bottom line, I feel your pain. Anyone who is sick to the point of needing an ER deserves compassion. They deserve care. That is a human right. Nothing more. Nothing less. We as a culture are not compassionate. That much is evident (even in the frogpond). It feels very lonely at times arguing for something better when the dominant set of norms are ones that privilege greed over service, contempt over compassion. I wish you and yours the best.
Some years ago (in the ’90s IIRC) my boss, born and raised in London UK, told me this story. He had occasion to be in the ER of one of the major hospitals in our County. We had good company health insurance but he was reading a notice on the wall. He told me that in essence the notice said they were required to take a certain number of indigent patients annually and they had already met their quota, so go elsewhere if you can’t pay. He was genuinely angry as he told me that in the UK no one is turned away and that’s the way it should be in any civilized country. He admired many things about America, but not this.
I had an older German guy say something similar to me in a gynecologist’s office (he had brought his daughter there). He said in Germany, everyone had health insurance. It was paid for by employers if you had a job (no exceptions) and by the government if you didn’t. He apologized to me for criticizing my country, but I told him that I entirely agreed and that was why I was supporting Howard Dean.
I rather like the German system as described to me over the English, but either is preferable to the jerry-built non-system that we have now.
EMTLA
It could have been as early as 1988, but EMTLA would still apply. However: “EMTALA does not apply to the transfer of stable patients; however, if the patient is unstable, then the hospital may not transfer the patient unless: ” I think the requirement to treat a certain number of indigents was a state law. EMTLA only requires that you stabilize them before shipping them out. In the late ’60s the son of one of my co-workers was in an auto crash on the Eisenhower Expressway in Chicago. He was black. His father carried the same BCBS High Option Federal insurance that I did, Insurance that Obama calls “Cadillac”. He didn’t have his insurance card so Presbyterian-Saint Luke’s, the nearest hospital sent him to Cook County Hospital. Several hours later, while waiting for the X-rays to be transferred he died from a broken rib puncturing a lung and a blood vessel. “Black kid – must be poor, ship him to County.”
I’m an emergency department RN.
We’ll treat and stabilize anyone. But that is all that the emergency department does. What one individual hospital does or doesn’t do in compliance with the EMTLA can’t be projected onto all hospitals and all emergency departments.
For example, I had a 3rd degree heart block patient come in the other night. Had the patient not been brought in, she would have died at home within 20 minutes. She was circling the drain. Once she was stabilized, we sent her off to another hospital via ambulance. Not because she was indigent, or didn’t have insurance, but because sometimes other hospitals are better at treating certain medical conditions.
While the emergency department tends to be used as primary health care by indigent people, the actual purpose of the emergency department is to stabilize emergency situations, and then get the patient to an OR, cath lab, ICU, or another floor to receive necessary treatment.
The doctors, nurses, medics, techs, etc, who work at hospitals are essentially short staffed 99.9% of the time. We’re short staffed because there is a shortage of doctors and nurses in the country as a whole, and because nurses, in particular, are underpaid and overworked. I work for a 501(c)(3) non-profit hospital here in Atlanta, and probably 3/4 of the patients I see on a daily basis are paying via Medicare and Medicaid – if they’re paying at all. We turn no one away. And we’re required to keep track of LWOTs, LWOBSs, AMAs, etc. Our goal is always to have zero, but we can’t force people to stay and get treatment. You can google the abbreviations if you want.
I’d love to have universal health care here in the US, because 3/4 of the people who come into the emergency department (and are actually sick) have likely been chronically sick for a long time, and wouldn’t need emergency care had they been seen for their multiple conditions years earlier when those conditions could have been mitigated with meds and therapy. Unfortunately, FreedomTM from being forced to have health care, i.e. socialism, is still a thing.
See: Trump, President-Elect.
Thank you for your excellent post. It reminds me of my posts about Civil service and USPS. We are all convenient whipping boys. However, Cook County Hospital ( I refuse to call it Stroger) doesn’t excel at anything except maybe treating gunshot wounds. The older brother of one of my close childhood friends interned there.
Public employees and public service employees in the private sector are always underpaid, and understaffed, because while our work is publicly useful, it doesn’t provide the oligarchs who own and operate the government with additional profit.
The how and why our society/country/species are falling apart is simple, but trying to inform the people staring at their phones crushing candies and stalking ex-partners on Facebook, or correcting misinformation fed to people by the media, makes it nearly impossible to get the message out and understood.
I am very sorry to hear that about your wife, Don. And thank for your good wishes.
Thanks! I learned a lot about being her advocate this past year in particular. I’m not religious, so I don’t do the praying thing. But I will keep you and your wife in my thoughts.
I’m soon going to be accompanying my wife to the hospital, where she’ll be undergoing major surgery. We feel fortunate that the surgeon, whom we talked to at length, and the doctors who’ll be following her case post-surgically all seem to be authentically decent, compassionate people. But we’ve encountered some truly troubling problems in emergency rooms. I won’t go into the medical particulars, but my wife has had to make a lot of ER visits and has been treated as a drug seeker on more than one occasions. The first time this happened, we were slow on the uptake, but when we caught on, we told the attending nurses and physician that we were most definitely not seeking painkillers because my wife, who has chronic pain problems, already had plenty at home, thank you very much. The transformation in the way my wife was treated was rapid. On another ER visit we again ran into being treated as drug seekers, and again, telling the staff that we weren’t after painkillers effected a rapid change in attitude and treatment. Ever since then, on ER visits, about the first thing we tell the medical staff is that we are not seeking painkillers.
Best thoughts to her.
its such a difficult time of year to not have full health.
.
Steven
All my best wishes to you and yours in these trying times. I am hoping your significant other can make it home to you by Christmas, where she will be surrounded by those that obviously love her very much.
.
My post will be somewhat long, but perhaps more relevant than most. I’m actually a RN who works in the emergency department (ED) of a hospital here in Atlanta.
The initial problem you describe is that the triage in the ED you went to was clearly terrible. If you bring in your wife who is coughing up blood and unable to respond to questions, I’m going to ask you immediately about any past medical conditions. As soon as you say Type 1 Diabetes, I’m going to immediately take your wife’s blood glucose reading. Within 2 minutes of first talking to you and your wife, if I get a reading of HI or the actual number in the 900s, your wife is getting categorized as an ESI 2 and is going straight back to a room because she’s going to need fluids, IV insulin, and an insulin drip, just to begin with, nevermind all of the lab work, imaging, etc, that is going to be ordered if she has had brain trauma in the past.
So, the first problem is that the triage was god awful. Had triage been remotely competent, your wife wouldn’t have been considered a drug seeker, because the basic information of type 1 diabetes and high blood sugar in the 900s is typically diabetic ketoacidosis, which is a life-threatening condition. That she also has cancer and a past brain trauma would immediately make your wife a critical patient.
Secondly, the lack of empathy/assumption that your wife is a drug seeker/frequent flyer, is going to be hit or miss depending on the nurse and provider. For example, I’m a relatively new RN, so I take what my patients say as truth unless I can glean from their previous history and their behavior in the ED, that they’re just there to get some opioids and perhaps some food before moving on to the next hospital. Yes, this happens. Every day. A lot.
That said, a more experienced ED nurse and even the providers will be somewhat suspicious if a patient or patient’s family walks in demanding dilaudid right off the bat. While chronic pain and tolerance to pain medications make meds like dilaudid one of the few that are effective, it’s also what drug seekers are seeking.
And for better or worse, you have to understand that a provider who orders the meds and the nurse who literally pushes those meds into the patient’s veins, don’t want to enable an addict, or kill the patient. Which happens. Opioids essentially slow your breathing and can drop your BP, and if someone is already drunk and on other opioids, 1mg of dilaudid can stop their breathing and kill them.
You noticed that once you mentioned the previous medical history of your wife that everyone became much more receptive to your wife’s needs – this is what triage should have done by simply asking, “so, what medical conditions does your wife have”, right at the start.
Ultimately, empathy isn’t always doled out liberally in the ED, because the ED sees drug seekers every hour of every day, all year long. The ED I work in sees about 250+ patients a day, and almost every single patient comes in with pain. We have to be extremely careful about what types of pain medications we give, and we tend to start out with ketorlac and tramadol, and then move up to morphine, codeine, and dilaudid.
One tip that I’d give to anyone with chronic pain related to chronic medical conditions is to have a copy of all of the home medications and dosages, along with all existing medical conditions, past surgical procedures, and allergies, all printed out and on you, and the patient, at all times. Walk into an ED and hand over a sheet like that, and your wait time and initial triage should be a much more expedited and pleasant experience. Everyone sitting in that waiting room is hoping they are the next person called. The faster and more precise the information is given during triage, the more likely someone with a serious condition gets back and begins treatment quickly…assuming that the triage nurse is competent, of course.
This is an excellent and informative post. Thanks. Our last ER visit was made somewhat easier because a family friend was one of the ER nurses, and knew my spouse’s history. Meant billing and so on got handled correctly right off the bat as well. There were other facets of our experience that were less pleasant – some of that due to how rehab got handled (using a nursing home as a rehab facility was bound to go charlie foxtrot simply because we were not the typical client base). Long story.