16 hours in the ER; 16 hours well spent

Long wait times in hospital emergency departments are a persistent problem around the world. The American College of Emergency Physicians in a paper on ER overcrowding reported:

"The news media have given great attention to the crowding “crisis” in emergency departments as if this were a recent development. However, as far back as 1987, after sustained and unsolvable problems with crowding, the first statewide conference on crowding was held in New York City. . ."

Recently, The London Free Press ran a story reporting that ER wait times at London Health Sciences Centre (LHSC) University Hospital (UH) have been as long as 19 hours. The newspaper went on to bemoan the fact that patients with serious conditions were "spending hours in the ER." Although this is all true, this is not the whole story.

Less than two weeks ago I spent 16 hours in emergency at UH. Those 16 hours may well have been the most import block of time in my entire life. Those 16 hours led directly to my undergoing emergency surgery for a life-threatening bowel obstruction.

Two mornings earlier I had awakened with a severe pain in my gut. By mid-afternoon I was at the St. Joseph Urgent Care Centre. The service was fast but that is all I can say for it. When nothing concrete could be found to explain my pain before the centre closed at six p.m., I was told an unnamed virus was the probable cause, given a shot of morphine for pain and sent home. I asked to stay overnight for observation but was told that St. Joe's does not have any rooms for that purpose.

An interesting aside: This lack of rooms is a main reason St. Joe's fared so well in the CBC Rate Your Hospital report. Patients appearing on St. Joe's doorstep who are exceedingly ill, possibly dying, are  shipped off to University Hospital. UH takes the patients, the responsibility and the risks. Meanwhile, St. Joe's accepts the accolades for its lower than usual mortality rates.

Now, back to my story. As soon as the morphine wore off, the pain returned. I suffered all night. My difficulty with keeping stuff down, a problem dismissed by the doctor at St. Joe's, was now a constant. As I take meds for my heart and other meds to prevent stroke, I feared I was losing these all-important pills when I got violently ill. By late afternoon I called the doctor at UH who monitors my meds. I was instructed to get to the UH emergency department immediately. This was serious.

I arrived by ambulance at the ER shortly before five in the afternoon. I was parked in a hallway but I was not parked and forgotten. An EKG was done and I believe blood was taken for testing. I'm not sure how long I was in the hallway. I really didn't care. The pain had been so severe that I was just grateful to be in the hospital where I was receiving something for the pain.

At some point in the early evening an ER cubicle became free and I was moved to a small bed in the ER. I met with an ER doctor who immediately ordered x-rays. He was concerned I might have a bowel obstruction. I did.

It seems a tight band had formed around part of my small intestine. Why it formed was not clear but what was clear was that it had to be removed and soon. The tight band was shutting off blood flow to a section of my intestine and if not removed soon would irreparably damage the constricted intestine. If the band was not removed soon, surgical removal of the damaged section of intestine would be necessary.

But the doctors in ER faced another complication. I take Pradaxa. This is an anti-coagulant or a blood-thinner in common parlance. Unlike coumadin, there is no easy way to reverse the effect Pradaxa has on blood's ability to clot. Major surgery can result in life-threatening bleeding in patients taking Pradaxa. Discontinuing Pradaxa a day or two before surgery is the usual answer but my doctors did not have that luxury.

A CT scan was ordered. A couple of hours before the procedure I was given a litre of a contrast-enhancing fluid to drink. The surgeons needed to know exactly what it was that they were up against. A CT scan was the answer. An MRI might have been another option but not in my case. I have an ICD/pacemaker in my chest. For me, MRIs are not an option.

Served cold the contrast liquid was not all that difficult to drink. The nurse divided my dose into two 500ml portions. I slowly consumed the first 500ml during the first hour. The nurse thoughtfully put my second dose on ice.

Normally, I was told, I would have been given close to two litres of the contrast-enhancing fluid but as I was slated for surgery first thing in the morning the volume of the dose was kept to a minimum. One never has anything by mouth before surgery and here I was drinking a full litre of liquid. As soon as the CT scan was complete, a young doctor threaded a tube through my nose and down my throat into my stomach. He pumped what he could of the contrast-enhancing fluid out of my stomach.

At 9 a.m. I was in the operating room. Thanks to the CT scan the surgical team had determined the exact location of the offending intestinal band. The lead surgeon, an expert in laparoscopic surgery, a minimally invasive surgical approach that does not require splitting the abdomen open, led the team down a surgical path that would skirt the Pradaxa bleeding risk. Brilliant.

After about three and a half hours I was wheeled into the recovery room. When I was asked if I needed another shot of painkiller, I said, "No. The pain is gone."

I had spent 16 hours in emergency. A reporter searching ER records would learn a patient at LHSC University Hospital spent 16 hours in the ER but would not learn that those 16 hours saved the patient's life.

I send my heartfelt thanks to the young doctors, the team-leading surgeon and to the nurses in the ER, the nurses in the recovery room and the nurses on the eighth floor where I eventually found a room. What a fine team! They saved my life.

Thank you!

Understanding ER Wait Times Information

What does “ER Wait Times” mean?

An ER Wait Time is the total time that someone who visits an ER looking for immediate, unscheduled care spends in the ER. The measurement of wait time :

• Starts when a patient registers or is triaged (“triage” is the process for deciding which ER patients need, or are likely to benefit from, immediate treatment).
• Ends when the patient is discharged from the ER or is admitted to a hospital bed.

During the time that a patient is in the ER, doctors and nurses may be treating the patient's condition or ordering tests and waiting for test results so they can decide on  the best course of treatment/

Some months after I wrote the above post, I had another event. This time I had a severe chest pain that left me doubled up. The pain then moved from my chest to my back and eventually settled in my chest. I spend all day in emergency. I was given another CAT scan and when nothing was found I was pushed to the side but not forgotten. It took a full day but before I was released I was given a three page document detailing the findings of the CAT scan.

Again, the wait times information looks bad. Eight or more hours in emergency seems unbelievable on the surface. A reporter might roast the hospital for this. Me? As the patient who has spent these on-the-surface unreasonable times in the ER, I'd still give the ER staff a big thumbs up. I feel my time spent in ER was time well spent. In fact, I'm alive on account of it.

Babies and where to have 'em_Part Two

This blog updated and expanded Friday, September 4, 2009
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She's here. A beautiful baby girl. Such a joy. Such a wonder. A miracle. And no small miracle at that, despite her diminutive size: 19-inches, six and a half pounds.

It is almost midnight but we got home around five. It has been family, food, talk and wine every since. Well, maybe wine, family, food and talk to be more accurate.

If you read yesterday's blog, my wife and I arrived at the hospital around eight thirty this morning. It is an old hospital with some wings dating back to the early years of the last century and some sections may be even older. There are recent additions and some not so recent additions but the overall look on arrival is one of a vibrant, aging well, facility. I dropped off my wife and went to park our car.

The parking garage is just across the street and after parking the car I hiked down the five flights of stairs. I had heart surgery some years ago and so I like to do everything to squeeze a little exercise out of life. No elevators for me.

The birthing suite was on the third floor of the hospital and I again took the stairs. The balusters, handrails, etc. were wood with the finish chipped and worn from decades of use. "Ancient," I thought.

On reaching the third floor, I had a long corridor stretching out in both directions. I thought the birthing rooms were in the east end of the building and turned left. I noticed lots of stored stuff lining the walls. When I walked past a row of portable cribs for newborns, I knew I was getting close. The hospital had been built before a lot of this stuff lining the walls had been invented, or even imagined, and I thought that storage space must be at a premium in such a building. (Also, there is a lot of construction going on and the congestion in the halls could well be partially a result of the construction.)

I came to an intersection of corridors and I was lost. The information and sign-in office was empty. A sign next to a wall phone said to call for assistance. A very pregnant woman entered the office, picked up the phone and called. Watching this I felt that the hospital might be a little understaffed but within moments a woman appeared to assist the caller.

I felt a tap on my shoulder, it was my son-in-law. He guided me to the birthing room wing, which was down two of halls and through a couple of sets of fire doors.

Entering our daughter's room I heard a heart beat — a loud, strong heart beat. It was the heart beat of my still unborn granddaughter. A sensor on her tummy was both recording and broadcasting the unborn infant's heart beat.

At first the sound was loud and clear and then it weakened. I must have looked panicked as my son-in-law stepped over and explained that the sensor was on his wife's belly and so, as the infant moved, the strength of the signal changed.

My wife was already in the room. She took the elevator. It was more direct and there were signs pointing the way. The world is designed for wusses. I'll teach my granddaughter to be an adventurer, a risk taker, an urban explorer and take stairs.

Beside the bed sat my daughter's nurse. Her nurse? Yes, expectant mothers are assigned their own nurse upon arrival. This woman would stay with my daughter throughout the day. She would monitor both mom's progress and the progress of the baby. There was some high tech equipment beside the bed and the nurse was checking a printout.

The monitoring equipment was connected to the main nursing station and the nurses on duty were also monitoring our daughter and soon-to-be-born child.

By 9:00 a.m. our daughter had dilated to 5 cm (about 2-inches). I believe the goal was 10 cm. The nurse told our daughter the first five is the difficult five. Our daughter smiled, leaned back and with a casual wave of her hand replied, "It was nothing."

Well, the first five may be the hardest but the last five were the longest. she was not dilated to a full 10 cm until early afternoon. And then, as they say, the hard part began. I wasn't there. My wife was there; her husband was there; and an increasing number of nurses and doctors were there.

By the time my granddaughter was born, there were five nurses in the room and two doctors. Both mom and child were being checked and both were looking good!

Later, sometime after the excitement had subsided, Dr. John Stoffman stopped by the room. Stoffman was the pediatrician conducting rounds at the hospital that day. Coincidentally he was the pediatrician who cared for both our daughters when they were both young. He remembered our daughter as having been once his patient and he will be the doctor doing the follow-up on our granddaughter. We all hope he will be able to be our granddaughter's doctor.

Little Fiona already has an OHIP (Ontario Hospital Insurance Plan) number. Someone has to pay Dr. Stoffman.
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Do all births go so smoothly. No, of course not. Stories like this are interesting but they are not the whole story. Good stories and bad stories are always there to be found. More important are the overall figures.

Let's look at the CIA World Factbook and deaths/1000 live births: Singapore 2.31, Bermuda 2.46, Sweden 2.75 . . . Canada was in about 36th place with 5.04. The much maligned, at least recently in the United States, health care systems of Great Britain (4.95), France (3.33) and others all sported better numbers than Canada.

And the United States, where did it land on the CIA list? Well, the U.S. came in lower than Canada. The United States rated about 45 with 6.26 infant deaths per 1000 live births. This is one notch worse than Cuba.

Americans are being so badly served, not only by their health care system but by their media. It would be so easy to write "fools like Rush Limbaugh, Pat Buchanan, Glenn Beck, Bill O'Reilly and Lou Dobbs" but they are not fools. Why they don't report with more thoughtful maturity, more journalistic integrity, encouraging more productive discourse, I'll leave up that up to you.

The United States deserves a better health care system. Rating well behind Macau, Andorra, Slovenia and South Korea on the CIA infant mortality rate list is just not acceptable. But, the U.S. also deserves, and desperately needs, a better media. It is impossible to run a successful democracy when so much of the voting populace is being misinformed.

Cheers,
Rockinon.

Babies and where to have 'em

It is 5:22 a.m. and I'm awake and my mind is racing. Our daughter called minutes ago to tell us she and her husband are off for the hospital, for the maternity ward; I'm about to become a grandpa!

One of my first thoughts was, "Oh how glad I am to be living in Canada." Our local hospitals are excellent but for a number of reasons one specializes in babies and births; they're the experts at delivering nine-month-miracles.

My second thought was how dangerous is this? I'm a worrier. (There's the telephone. It's our daughter. She's at the hospital and everyone is relaxed. Man, they're acting like this is an everyday occurrence! Wait. It is!)

Gotta be safe, right?

First hit from Google reads: U.S. has second worst newborn death rate in modern world, report says:

"American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births."

This is not an attack on the U.S. medical system. I'm sure that folk, like those in the American congress, do not have to fear for their newborn children or grandchildren. My guess is that if you calculated the infant mortality rate for those folk, and other well-off American folk, all would be fine. It would not surprise me to learn that those figures are among the best in the world.

What drags down American averages is the folk without proper medical care, at least that is my bet. And what this means is that millions of Americans would be far better off giving birth in Hungary, Malta, Poland and Slovakia.

I'm not rich. I'm not sure where on the American medical pecking order my family and I would fall. It is just so comforting at times like this to be a Canadian.

I'm not suggesting that the U.S. should adopt the Canadian system or any other country's system. I'm suggesting that the U.S. should examine what is being done in other countries and go us all one better. Show us the imagination and the leadership for which the United States is so famous. Watch the following YouTube video, it gives one pause to think.

Cheers,

Rockinon