Tuesday, May 10, 2016

The psycho-social dynamics of an Emergency Room's waiting area

Last September I had to take my wife to the local hospital's emergency room due to severe pain associated with a kidney stone.  We arrived at around 1000 am.  Being a Registered Nurse, I calculated that we may be arriving at a decent time for we were well past the witching hours for cardiac arrest, but would severe lower back pain give us an inside move for a quicker visit?  I was doubtful and silently girded my self for the long haul.

I checked her in at the desk and provided a brief description for the visit.  After providing the obligatory demographic and insurance information, we were "invited" to find a seat in the waiting area.

Best count that I had was that 25 to 30 people were occupying seats in the waiting area.  I assumed that not all were patients as there would have been family members there also. It was an eclectic mixture of people.  Young, old, male, female, white, black, Hispanic and some that were Asian to round out the mix.  All were in some various stages of distress.  A few with blankets covering them.  Some talking with family, others merely staring into the distance.

My wife, being in her own world of pain and distress gave nary a good damn about the others.  Pain is a sensation that makes even the best of us descend into a world lacking of civility and empathy.  She expected that her husband would smooth the path for her to be seen quicker as I was an RN and I would have knowledge of a secret code or handshake. In this she was sadly mistaken as I would be equally held hostage to the triage system.

1100 am, my wife is pacing about the waiting room.  Back pain appears to be increasing. It's "10" on the standard pain rating scale.  She feels nauseous and she stumbles into the woman's restroom to vomit.  I have one of the CNAs check on her.  An ER RN meets her and provides her a dissolving tablet of Zofran to relieve the nausea and she is shown back to the waiting area.

1115 am, my wife's name is called.  It seems the vomiting episode got her to the first level of triage.  Some of the waiting room multitude look on with either envy or out right loathing. An RN quietly types into a computer while my wife is stuttering about her pain sensations and locations.  Brevity is not one of my wife's strong points. Vital signs are taken.  An emergency room doctor walks into the small triage room and after briefly looking at her he orders a dose of hydrocodone (Vicodin) which my wife accepts like it was a wafer handed out during Communion.  Then she is politely shown back to the waiting room.

1130 am, we're both still seated in the waiting room.  My wife is still waiting for the full effect of the Vicodin.  Slightly agitated that nothing else is being done.  I calmly tell her that she will be seen in the next layer of the triage system when its her turn.  Meanwhile, the rest of the crowd waiting has changed in number.  Familiar faces are no longer seen as they have progress to the next level and had disappeared behind the double doors of the main emergency room.

1200 noon, still waiting.  A small trickle of our co-waiters have made it through the double doors.  More people have filtered in through the main entrance to take their place in the waiting area.  A murmur starts to ripple through the waiting room.  I hear one person tell another, "Fucking multiple car crash on hwy 78, they're sending ambulances our way."  I sigh, my wife utters a few choice words as she has grasped that we will all have to wait longer for the double doors.

1 pm, I'm hungry and buy what ever crap is available in the vending machine.  Trip to the men's room.  Whoever is in the stall sounds as if he is either vomiting or crapping himself...perhaps both.  I quickly finish my business and get the hell out.  I tell the man waiting outside, a friend of "stall man" that he should check on him.   Empathy has totally left the building.

2 pm,  the queuing line has slowly started up and the "hopeful" are now making it through the double doors.  My wife's pain appears to be manageable, but her aggravation is not.  A man stumbles through the entrance door holding his hand yelling, "I've been bitten by a rattlesnake!"  A collective groan is heard from the waiting multitude.  The agitation levels of those waiting is increasing as "snakebite man" is quickly taken back through the double doors.  There is no pity left in the waiting crowd.  Meanwhile others slowly migrate through the ER's entrance to dutifully take their place in the waiting room.

3 pm, still waiting.  Light conversation is heard in the area.  Someone is chuckling.  Names are being called off in quick succession.  Then, two men enter the ER holding up another man who is bleeding profusely from a head/face wound wrapped in towels.  "He took a chainsaw to the face!," screams out one of the supporting friends.  The groans and moans from the waiting crowd reaches a crescendo as all know that their time for the double doors has been put on hold. "Chainsaw man" has upended the flow and dynamics of the waiting area.

430 pm,  wife's name is called and it's off to the back via the double doors.  Lab work, CT scan, and the repeating of the same history leading to the ER visit is accomplished in under 2 hours.  Final diagnosis was a renal stone still lodged in the right kidney.  

630 pm, freedom as my wife and I depart the ER.  A quick glance show that new faces now occupy the waiting area and others now start trickling in.  We spent a little over 8 hours waiting to for her to be seen and treated.

As a closing comment on the above, I abhor going to the ER either as a patient or a supporting family member.  I try my best to avoid the mind numbing wait, yet sometimes it's necessary.  Acute care clinics have been a good answer to the overloading of the ER system, but at times the hours of operation are a limiting factor.

The emergency waiting room is a good example of the herd mentality.  There is a weak bond that develops within a small core group.  It offers a means to distract away from ills or pain that they are experiencing, but that bond can easily be broken.  Empathy is a commodity that easily waxes and wanes.  

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