The Spoils of War

 I’ll be  adding to this as I think of things-

If you find yourself in the unfortunate circumstance of being in the ER/admitted to the hospital, here are a few things to consider:

1) A. Go early in the day if you can- or in the wee hours of the morning. It will fill up as the day progresses- it is no fun waiting and the receptionist may have all the speed and concern for your suffering of a grazing Holstein. She will purposely not look  or acknowledge you until she feels  the ‘moment is right’ and/or she has  gone through her little routine. Again, another reason to have someone with you. You may wonder, was  ’Daisy’ hired for this particular quality or did this or another place make her like that? In my misery waiting , I thought of the study I stumbled upon when writing about the dairy farmers last year that said if a farmer names a cow, the cow produces more.  I can’t remember her name, if I even saw it. She looked somewhat like Sally Struthers.

Something I noticed ishow hiearchical a hospital is, and how far from the advertisement’s characterization  “I’m Brenda, a nurse’s aide, and I’m part  of  X hospital”  “I’m Consuelo and I feed you!”  “I’m Dr. SoandSo and I’m an awesome dude! check me out with ” – you know, the whole we’re all psyched to be here and we’re all part of a team, there’s no pecking order, everyone treats everyone super. You’re great. We’re all great. Ha. Everyone knows those ads don’t portray reality, but when you see something for yourself, you actually can estimate  how big  the lie is. 

B.  Look Sick.  

Don’t bother with any lipstick or fix your hair. Of course, if you are truly feeling lousy you probably wouldn’t bother with that. They seem to believe they can tell by just looking at you how bad off you are. If you made any effort to not look as bad as you feel , it will count against you. If you are lucky enough to look like you are not officially homeless, but maybe a step up from that, like you have been up most of the night, or slept in your clothes in your car, so much the better. I heard different ‘people in charge’ use expressions involving not what patients vital’s were, but rather how they looked. Relatives would make comments about how someone looked as opposed to what test results were or what their blood pressure was. 

 ”Look at him, he looks really bad” .I definitely saw cultural/racial differences in stating someone looked bad. In some cases it was perhaps just  as an observation, in other cases it seemed a not-so-subtle plea for more help to those in charge or a way to either passively confirm the worst and show acceptance of it maybe to the doctor, or other family that might be there.

 Doctors too: ” He’s got some kind of infection or issue, but  he doesn’t look that bad”  This last stated about an old guy who hadn’t been able to pee for 12 hours but seemed chipper and not at all worried about the idea of having his privates intubated.  This seemed to be put together by some kind of quick assessment ; if a person seemed listless,  their color was off, if  they appeared dehydrated  and their attitude, whether they were talkative or quiet, the ER people seemed to be able to judge a lot by a cursory look.  There’s a lot to be learned simply by observing- just because someone was more vocal did not necessarily mean they got more or faster attention. The thinking probably was they were better off than the person who couldn’t yell about it.  Unless there was some kind of special code on the intercom, people pretty much proceeded at the same pace, relying heavily on forms and schedules.

2) Don’t drive yourself.  They might ask how you got there and might not let you drive your own car back. If you don’t have anyone picking you up, and feel like you can drive yourself, you can try to BS them about being picked up on the other side of the building. Depending on your situation, they might buy it. This doesn’t work once you have been admitted , as upon release there is usually some orderly who will wheel you out to where you are being picked up and they won’t let you drive yourself. It’s usually best to get a ride anyway, just because you might still not feel great.

3) Try to get whoever drove you or someone else to stay with you,  especially if you know your problem is not going to be fixed quickly- Once you are in there and bracelet ‘UPC’  tagged, they won’t let you go anywhere-you can’t get a paper, they might not  let you  drink  anything  but the barium lemonade- often times they don’t want you using a cell phone if you have one.  They might have a cordless phone but they will not tell you about it unless you state that you need to call someone.  When you need something from them- be that pain meds or any small thing you might ask for- another blanket, a pen- whatever- having the attention span of a goldfish, they may  instantly forget about it the second something else happens, or it is treated like the biggest deal on earth ” well… ok but there are 4 people ahead of you waiting.” 

These are some of the reasons to get someone to either stay or at least stick around near the hospital and check you every so often, if they don’t like being ‘where the action is’, because face it, it sucks there and the longer you are in there, the busier and more horrible it gets.  I used to hear people were ‘called’ into certain professions, but many are going  into health care just because this is an aging population, a growing industry and an ever-increasing need for various lower-wage positions. Bed-changers, shot-givers. Maintenance. Body janitors. Yard-duty teachers for the elderly. Jobs one need not attend an inordinate amount of schooling/English/writing skills  to get.

Give valuable stuff to to whoever drove you/staying with you and have them put it in the trunk of their car . You don’t want your wallet , watch or other items in a plastic bag floating around the place. The form you sign might mention the hospital having a safe, but right after that it will say they are not reponsible for anything lost or stolen. Better to give whatever you have to whoever you came with or a visitor. Look at it this way, the worst case scenario is you die,  and  wouldn’t you rather your friend or family get whatever it is you have than some hospital worker or  visitor? Even if you don’t come anywhere close to that scenario, chances are you will be taken to other places in the hospital, given stuff to whack you out.

It’s better to tell whoever brought you to take any stuff you don’t want ripped off or lost  to their car and lock it up   rather than simply sit with your things because your friend or family will get distracted, tired, put stuff down unwittingly, or walk away from stuff they said they would watch-so your things are just a curtain, coffee break or bathroom visit away from staff or someone coming to visit a patient snagging a purse, wallet, jacket. People really will take just about anything that isn’t nailed down if it is of perceived use/value.

4) This is not a Democracy

 Do not expect any lower-level staff  to know anything, to answer anything. Not just the first question- any question.  Do not be surprised if staff looks at you with annoyance if you actually want to read things you sign. Do not be surprised if their policies don’t make sense. You can try to mentally insert the Philipino accent.

“This is just that we treated you here, sign this,” they say.

                     “What is this about ‘Do I want privacy?’ checkbox? ” one might ask.

  ”Oh , well that’s just something if people call, we don’t tell them you’re here.”

                       “Ok, but that doesn’t count for family, right, like if my mother should call?”  (reasonable question)

    ”No, sorreee, Ma’am, you cannot  pick and choose, you have to either check the box to or not, but you cannot choose, it is all or nothing. But we don’t tell details.”

            “Ok so if I check the box, then you say you can’t  tell them whether I’m here or not, right?”   Blank look.

“No, that would be lying to them. So we just say you’re not here.”

       “Umm, but that is lying to them. Isn’t it?”  Again, blank stare.

“So do you want to check box or not?” 

 The ER is not a place where anything gets discussed or debated. They want one-word, one-number answers. They don’t want to explain stuff.  Everyone is in a hurry, and that is another reason to have a person with you. If you are really bad off  and need something- that person can advocate for you and raise hell when you can’t.  Of course, there are people who are incapable of such, and by turn, people who don’t want anyone around . From observation, something I read a while back appears to be true: people in the hospital -or any other care-related place-who have family or friends around them get more care than those alone.

 Makes sense. The hospital looks at it pragmatically- just like the “I don’t knows” they hire. If someone has people there watching out for the patient- they are in essence a third party and witness. I overheard more than once doctors bringing up the advanced directive papers. I felt bad for the old man who looked and sounded as if he might be suffering from dementia. “Oh, no, he doesn’t want to be on machines.” I heard someone say through the curtain.

5) ” What number is your pain?”

Don’t try using metaphor or analogy- forget it- they don’t grasp that,  they just want something to write on their sheet. Pick a number higher than what your pain actually is if you have any hope of getting relief.  If you waste time trying to describe how it feels, you will be met with “OK, Ma’am, but what number?”- which brings us to …

6) Pain Meds: Just Say Yes-

Don’t go halfway on the pain meds when you have the chance, just go for it. When you are hurting and miserable and you make your 7th trip to the bathroom and see the other guy in la la land asleep, you will wish you had taken the whole shot. By now you probably have an IV. If you are in pain, don’t say you want to try half and don’t want to get overmedicated. . Morphine sounds like a big deal, but the amount they are giving doesn’t really do a hell of a lot.  They are right when they say if you hit pain early and hard, it helps more than if you try to ’pay as you go’.  When they first give it to you, you might feel a little gross for a minute, but it goes away quickly. Pain-lessening- maybe- pain-killer- not so much.  When you are in pain, or have anxiety just being there on top of that, it slows down the effect of the pain medication. If they offer you valium or ativan in your IV, take it. It probably isn’t all that much

If you didn’t take the whole amount they offered, it might be harder to get more from them- they are not allowed to save what you didn’t use, they have to throw it away- so it wastes it -the nurse  has to track them down and get them to write up a new order for more, which doesn’t sound like much, but takes forever. After watching one of the nurses running after a doctor as she swept by, not turning to acknowledge anyone, you begin to see how it is not always the nurses fault. The Dr might be snotty about your not taking the whole shot of whatever they ordered-” I’ve been doing this X amount of years, do you think I would give you more than you could handle?”  said  Dr. Hyde- she appeared white, but I suspected she actually wasn’t after looking up the name.  Some doctors are all right, but many are dicks, women included.  If you  come in and your blood pressure is low, they won’t be as apt to give you any kind of pain-killer, no matter how miserable you are. If your BP is low they will IV you until they think you won’t keel over. Also, when they say they are going to take blood, they don’t mean  one little vial. They mean like five or more.

7)The Know-Nothings: ” What IS this stuff you want me to drink anyway? ”

Be prepared for whoever is giving you shots/asking you to drink stuff for them not to know anything about what they are giving you.   ”So, most people are fine with this stuff?”  you will get a generic “I don’t know, you have to ask the doctor, everyone is different.”   Don’t bother trying to rephrase it or acknowledge their covering themselves with  non-answers

“Just between you and me, Barbara”  a la Connie Chung,  ” most people are not allergic or have strong reactions to this?”

  You will not get a straight answer. It’s better to have a cursory knowledge beforehand than bother asking the person giving it to you. As a test, you can ask the “I don’t know” people about what is in the lemonade when they hand it to you in a pitcher with a cup with ‘barium’ printed on it, and they still won’t tell you anything. “I’m not a pharmacist, Ma’am .” 

They will also bring by random forms  “It’s just some paperwork to ask you these things .”   They will ask what religion you are,  all kinds of nosy questions-sometimes they will not even give you the form , they will just stand there with their clipboard and read off questions. The question for you to ask them is “Do I have to answer/sign this? May I see that paper? “  If they try what I have come to understand as the Vague Philipino Stonewall Method “I don’t know, Ma’am, this is just a paper for you to sign, OK?”   you can either play the game of asking them again if you have to or just  say you don’t want to sign/answer and see what happens. They may get a superior who  will come over and act like you are a problem. It is clear they are suspicious of anyone who asks about medicaton put in them or reads papers they are asked to sign. It is clear they are so used to people just going along with the program that anyone who asks “hey what is that you are putting in my IV, what is in this crap you want me to drink? Let me read that before I sign anything” sets off a monitor in their head.  Don’t expect them to be even fake-nice after you ask them about a few things. They look at it like you are just making their job more difficult or  like you are picking on them/ being a jerk rather than just concerned what you are signing or what drugs they are giving you.

 Some of these broken-English/Philpino conversations are somewhat funny, if frustrating. While the answer may be obvious, and on file, they ask anyway.   ”It means.. what do you consider yourself to be? are you white, black..”  as if I didn’t understand the question. ’How old are you?’ They already know that if you are somewhere they have your records computerized. ‘Is English your first language?’ Why they need ask these things at an institution that has one’s records- I know not. Perhaps those  questions are there to offset/distract from the religion questions- which no doubt either piss people off for being nosy or scare them because it  suggests last rites and deathbeds.

  These helper/nurse people were  mostly all Philipino/Asians, a couple eastern European short, heavyset girls who looked like they could beat the crap out of Tony Siragusa . Someone called one of them when they had to hold down the old guy in the next bed. The Philipinos or whatever they were didn’t seem get any kind of sarcasm, joke or irony- it just seems to either piss them off or confuse them. They have their own type of humor, as I heard them giggling and gossiping about doctors, ex-patients, “Ooh he was a fireman?” , “She works at busy nails, too?” “I can’t believe he said that!”

 8) Procedures:/Privacy  The  Dr will try to do as much to you in the room you are already in as he/she can. They are going to want every bodily product from you they can get, and if they can’t get it bedside, they will send you to collect it.   No matter if only a thin curtain separates you from grandpa yelling in the next bed they will do it  right there-they are not moving you to another room unless they need special equipment. Privacy ? Fuggetaboudit. Just hope they are quick . They will announce it and then they will do it, you can get an idea by looking at the tray. Kick anyone out staying with you, tell them to go take a walk or get lunch and come back in a while as you may be feeling somewhat  ’socially inept’ afterwards. 

In general : Keep an eye on your IV, what staff is doing with it, and try to get your pain meds/more pain meds before they send you to the next place. Usually after whatever they do to you at this level, you are ready for one of those anyway.

 Be aware though you may have heard about the ‘dye’ injected when one has a catscan, it is not simple ‘dye’  as in food color, it is iodine, which is fine as long as one doesn’t have seafood allergies, though the tech told me they have taken that warning off the bottles, she still asks people if they have seafood allergies asthis increases the chances for bad reactions. Be aware that when they put that stuff in, it will cause this strange warm sensation as it courses around your body and though it only lasts a minute- it could be worrisome if one wasn’t expecting it. At least the machine is quiet-unlike an MRI- as it tells you to breathe in, hold your breath, exhale as it shuffles you in and out of the tube.

The techs there say they use the catscan more often rather than the MRI because the procedure is much quicker, though the cost is about the same- one would think having someone have to sit around taking up an ER bed for at least two hours + – people come in and get bumped ahead of you-  would cost more, but the techs say it is the time the procedure takes that is the factor in estimating cost of MRI  versus a CT scan. They can run more people through the catscan machine in the time it takes to do one MRI. I already knew they didn’t answer stuff about whatever turns up on the picture, they just operate the machines, and put stuff in the IV, but at least they did answer questions about what they themselves are doing .

9) Everything takes forever.

The worse off you started , the longer you will be there- unless of course- you kick the bucket . While you are drinking what seems to be a quart of barium lemonade , shivering from the IV, more and more people are flooding in. It’s not a quiet place, the ER.  Alarms on heart rate, blood pressure are constantly going off,  “Code blue STAT!” , the occasional screaming kid- but more often screaming elderly. By the time  you get to the stage where the RN’s have collected/sucked out bodily whatever, plugged you into the IV, drugged you up and the Dr. has violated you in Barney-purple gloves – you won’t be good for much .

 If you are lucky enough to not be in pain by now, go to sleep.  You might want to actually save half of the last bit of your  barium drink, they aren’t super worried  if you don’t finish all of it, and they still won’t give you anything else after the catscan, not even water- so if you save half a cup of the barium , yeah, it’s not great but at least you have something to drink  which you will want if you start hurting or whatever meds make you feel gross.They do have ice , they even have some food, but don’t expect they are going to offer you anything. If you are in the ER, lunch is probablynot your main concern, and they need to keep you ‘empty’ in case you might need surgery, so don’t expect jello. They may not even let you drink water, so if they give you the barium drink, save the last half a glass-pain may make you thirsty or the shots may make you feel a little sick and you will want anything to drink.

 If someone brought you and stayed with you, when they first give you the  pitcher of barium to drink “we put crystal light in it to make it taste better!” , tell your friend , family or ‘S.O.’  they can take a hike and get some coffee or food, because you already know it will be at least two hours before they will do the catscan.  Ask them to close the curtains. Tell them where the lounge/cafeteria/coffee is if they don’t know. 

 Staff will keep asking “what is your number?” in reference to the pain.  Just because you tell them doesn’t mean anything is going to be done about it any time soon, hence my previous advice to over, not underestimate the pain when they start about ‘on a scale of 1-10…’ stuff. . This is not the time to be  a tough guy, the pain might very well get worse, so whenever they check on you, if you still hurt, you better tell them because when a shift ends, it takes everyone forever to go through procedures and do and re-do everything.  Pain sucks but if they don’t see the pain as connected to anything immediately life-threatening, your suffering is not priorty, and if you  turned it down earlier or only did half and your situation gets worse,  ‘Trust Me’  you will regret it.

You will be able to pick out the one or two sharpies from the drudges after watching them, seeing who is going to who for advice, and who is answering and running things rather than doing the redundant, “I don’t know” work.  The good news is eventually a new shift will come on, and you might actually get someone who knows what they are doing, will answer stuff, and is actually kind rather than the kind that resent you. 

10)Paperwork 

` If they are not going to admit you and are letting you go or if you have been admitted and getting out the next day , get any RX’s sent to the pharmacy and Dr’s notes for work before you go or their shift is over or you are released. Have the person you came with or picking you up get the Rx’s if the ER or hospital won’t have them sent over- If you have been admitted, you might have to get the same doctor assigned to you to do the paperwork – they often will not be back to make rounds until the next day so ask for it when you see them . If you are not assigned a particular doctor, or the one who treated you is busy in another room, on break or who has gone home, as whoever is on-shift or wait until the next shift of doctors comes in. 

You have a good chance of getting the paperwork during a lull  around the commute hour through dinnertime, this is a good time to start hassling the “I don’t knows” for paperwork you need, or follow-up appointments. If you can get them to give you medication right then before you get your RX’s, so much the better. Also when you are being released, but not quite dressed and ready to go, you can say you are waiting to get the paperwork or even say someone else said they were going to get it a while ago and never came back- they will believe this because of the goldfish attention span-and because they want the bed they are more inclined to hustle. One might think of going to whoever seems to hold the keys, but it seemed the kindest ones actually seemed to get whatever you need the fastest. One wonders if that is because they care more, thus are more persistent, or simply have the ability to sustain ‘niceness’  to snarly doctors. Make sure to check paperwork to be sure dates or whatever information you need on it is present and correct before you leave.