I was working the night shift when I received a call from someone in the emergency room. “I’m going to need you to come down to see a patient. It’s a tough one.”
“Tough” was putting it mildly. Two young newlyweds had come to our resort town, the words “Just Married!” scrawled in big letters across the back window of their car. For fun, they had decided to check out one of the many live theaters in our area that thrill guests with elaborate, grandiose shows. This particular performance featured armored knights on horseback, jousting and displaying the skills of an era long gone.
Soon after entering the theater, the young husband complained of shortness of breath. When his condition worsened, someone called 911. Before an emergency crew could arrive, the man collapsed, his lips turning blue.
A crowd gathered, unsure of what to do until the ambulance arrived. The frantic wife knelt by his head and whispered in his ear as her tears fell on his face. The scene was chaotic, the sense of panic increasing with each passing moment.
The new bride, who I later learned was pregnant, could only stand by helplessly as paramedics worked feverishly to get an airway into the husband’s swollen trachea (commonly known as the windpipe).
As the ambulance doors closed, she saw them frantically administering CPR. She wasn’t allowed to ride in the ambulance—the EMTs couldn’t afford to be distracted. We would learn later that dander from the horses in the show had triggered a severe allergic reaction.
The kindly theater manager drove her to the hospital himself. Upon arriving at the ER, the young husband was placed immediately on life support. His scared, solitary wife was ushered into a room to wait.
As I hung up the phone and headed downstairs, my heart broke for this young couple. I could only imagine the wife’s shock and disbelief in those horrifying moments.
In the ER, I consulted again with the staff who were attending this young man. They were visibly shaken by the tragedy unfolding in their midst.
“Has he had any sedation?” I asked.
“No. Nothing. Not even in the field.”
This was not good news given the fact that the only movement I witnessed was the patient’s chest rising and falling with each artificially supplied breath. He wasn’t struggling against the ventilator. His pupils were fixed and dilated, and no reflexes were noted. As I continued my exam, I began processing internally the gravity of the situation. I thought about the waiting bride and what I would say to her. In my mind, I asked the same questions that she must have been asking. How can this be happening? Is this real?
Taking a deep breath, I entered the tiny consultation room. It contained two chairs and a young woman who was sitting on the end of a couch, her knees drawn tightly to her chest. She looked up expectantly, tears streaming down her face. “Is he okay? Is he okay?” she asked, searching my face for any hint of good news.
I sat down next to her and held her hands, hoping my eyes didn’t convey my deep concern.
“He has had an allergic reaction called anaphylaxis. We’re concerned that his brain didn’t receive enough oxygen, and so he’s on life support … but he’s not waking up. We’re going to bring him to the ICU [intensive care unit] and hope we see some change over the next 24 hours.”
“But … but, he will wake up, right?” she asked plaintively.
“I don’t know. It’s too early to tell,” I quietly said. “We can hope things will change. Would you like me to call his family, or would you?”
She hugged her knees tighter and began to sob uncontrollably. I put my arms around her the way a mother hugs a scared child. As I did, she melted into me.
Afterward, I called his family and said the words that no mother or father wants to hear. “Come now!”
Timing an Emergency
The experience in your local emergency department can vary widely based on your presenting symptoms. If you arrive by ambulance, you are quickly evaluated. Chest pain or stroke symptoms initiate a time stamp from which is measured the timeliness of care from the moment of entry to the facility.
Another time stamp is started for symptoms such as temperature dysregulation (high or low), low blood pressure, or other symptoms and findings consistent with sepsis (an infection that has systemic or whole-body effects).
With the advent of electronic medical records, metrics of time are evaluated. This becomes one of the key performance indicators for quality of care and how hospitals and their staff are assessed.
These changes improve patient experience by reducing adverse drug reactions, adverse surgical events, and—with proper training and usage—they can also reduce mistakes in patient electronic orders.
Yet, because of the level of activity and stress present, the emergency department can sometimes feel like a war zone. The enemy is time.
This part of the hospital can feature ongoing flurries of activity by staff who are laser-focused on delivering care with speed. The clock is ticking. The fewer the ticks, the better the outcome.
With trauma patients, physicians once used the term the “golden hour” to speak of the critical need to administer proper care during the first sixty minutes. Now some speak of the “golden time,” indicating a shift to a more modern approach to emergency care following trauma. Whichever phrase is used, the fact is that the fewer minutes that elapse from injury or medical event until care begins, the better.
Timely care can prevent tissue damage in stroke and heart attack victims. It can be the difference between surviving a serious infection or succumbing to one. If you’re a patient or a scared family member at the center of an ER or ICU flurry, take comfort in knowing that these medical warriors are racing the clock on your behalf.
And if while waiting in the ER you’re not at the center of a medical whirlwind, you can take comfort in the fact that your problem must not be life-threatening. Perspective is everything.
Anticipating the Emergency
How can you be prepared for a war zone in which you may not understand the rules for engagement, the battlefield, or even the seriousness of the battle?
The first step is to gather knowledge. This would be evaluating health care facilities in your area. Which facilities are covered by your insurance? Are there ambulatory facilities or fast-track ERs that can manage simpler problems? Are there hospitals that specialize in stroke or cardiology, trauma, and so on? Would you have a choice of where you want to go if you call 911?
The second step is to gain wisdom. After gathering your knowledge, wisdom is its application to your personal circumstance.
Step one is to learn about your local hospitals, especially if you’re older or have an older loved one and a hospital visit seems likely sooner or later. It is exponentially better to have a plan and not need it than to need one and not have it.
Survey Your Health Care Environment
- Visit the fire station closest to your house so that you can learn where you would be taken if you had to call 911.
- Visit local hospitals in your area. Evaluate their emergency departments.
- Try to find out about wait times at local facilities. While average wait times can vary wildly, most hospitals measure, monitor, and publicize how quickly they’re able to deliver care. Whenever possible, choose health care systems that value their patients’ time. At www.medicare.gov/care-compare/ you can find one such assessment.
- Ask other medical professionals on their choice of hospital and why. This could be your dentist, your doctor (although bias may be built in), and other trusted members of your community.
- Discuss with your primary care doctor if he or she still “makes rounds” (i.e., visits hospitalized patients). If not (and chances, are he or she does not), ask their opinion on the quality of the hospitalists or physician groups at area hospitals.
Knowing the best hospitals in your area, or those that may specialize in conditions you’re more concerned about is a great step in preparing for any medical emergency. There are also things you can do at home if you or a loved one is likely to require care.
Prepare for a Hospital Stay
- Identify an advocate. This is someone who will be with you as you navigate a hospital stay. It’s important to have your health care advocate or proxy with you so you have a second set of ears to hear words that may sound like a foreign language, ask questions, and record information.
- Develop (with family members) an acute-illness plan. For example, always keep an accurate list of medications, current doctors’ names, prior surgeries and illnesses, current disease processes, emergency contacts, and your advance care plan.
- Create a medical “waiting bag.” This bag can include anything that will help you pass the time if you must spend an excessive amount of time waiting while you or a family member is assessed. For example, you could include a notepad or a book of puzzles. Keep hand sanitizer, bottles of water, snacks, and at least a 24-hour supply of your routine medications in your bag. Remember to rotate these medications regularly as medicine does expire.
- Since most ERs are busy and allow only one or two family members or friends to be with a patient at any given time, have a plan in place to reliably receive and relay information to other loved ones. Write notes, and if you’re unsure of the medical terminology, ask the clinician to spell it out for you.
- Don’t be afraid to ask questions. As mentioned previously, always ask, “If this were your loved one, what would you do?” Make sure you ask about quality of life after any suggested surgeries.
- If a hospital physician recommends a transfer to another medical facility, recognize that this is in the best interest of the patient. Very specific laws guide inter-facility transfers, the most specific being that a patient’s unmet need at the current hospital can be met at the receiving facility.
No one wants to think about something terrible happening to a loved one. Unfortunately, illness is an inevitable consequence of age for nearly everyone. The more you can prepare for a medical emergency, the better you are likely to navigate it.