By Andrea Judson

Last Tuesday as I was leaving my office, I fell down on the sidewalk and fractured my ankle. I was unable to walk and asked a coworker if she could drive me to the local hospital emergency department.

Two years ago I broke the same ankle and I was told that if I had walked on it I would have needed surgery.  So when we arrived and my friend found that the Emergency Department didn’t have a wheelchair, I refused to walk in. My friend went back inside and got an employee to come outside. He seemed ready to tell me to walk inside, but when he saw my ankle, he knew I needed a wheelchair.

He had to borrow a wheelchair from another department. I was wheeled in and then put on a stretcher in the hallway so he could return the wheelchair. The man returned after he found another wheelchair that I could actually sit in for more than a minute. I got into the chair and he wheeled me out to the waiting area.

About 20 minutes later my name was called by a man behind a registration desk. I don’t have experience ‘driving’ wheelchairs and mine was actually locked, unbeknownst to me. As I was trying to figure out how to move, the man just kept yelling my name. I tried to let him know that I was on my way but he wasn’t looking up and apparently didn’t hear me.

As I waited, I thought that I should elevate my leg, get some ice on it and take some ibuprofen. I was able to roll over next to a waiting room chair and hoist my leg up on it while sitting in the wheelchair. I put my coat under my foot to raise it up a bit more. Then, I began trying to get someone’s attention to get my other needs met.

I got the attention of the lady who was sitting at an information desk and told her what I needed. She told me I would have to ask “a man wearing maroon scrubs,” who I later realized was the triage nurse. This man occasionally popped his head into the waiting area to call a name. I tried to catch his eye and yell for him each time he appeared, and finally three patients and 40 minutes later, I got his attention and he agreed to give me some ice.

About 15 minutes later, I caught his eye again and asked again. This time he gave me a small icepack which didn’t stay on the side of my ankle. It was like trying to put a beanbag over my ear and expecting it to stay. I used my coat and did my best, but, in the end my ankle didn’t get much icing.

More than an hour later, I was called to triage. The triage person asked what I had done, took a quick look without removing my sock or shoe and sent me to another waiting room. I sat there for another 20 minutes. Two different hospital employees shuttled me to and from x-ray, and, at last, a third person arrived to push me somewhere else and actually asked me how I was, if I was in pain and she wished me well. She was the first person who acknowledged me as a person, and she was a volunteer who was probably in her teens.

She tried to return me to the ‘room’ that I had been assigned to (#30) in the Emergency Department, but, when she opened the curtain to that room, it was occupied. After she finally got me settled, I asked for a pillow to prop up my leg and was told that they didn’t have any pillows!

A full hour after being x-rayed, I tried to get someone’s attention get an estimate on the wait time. I could see multiple people milling about at the nurses station but could not get anyone to make eye contact or to answer me when I repeatedly said “excuse me!” Finally a nurse acknowledged me and said “we have 27 patients and one doctor and you will need to wait your turn.”

I didn’t want special privileges, I just wanted some idea about how much longer it would be. It was approaching 9:00 PM and I had been in the ED since 5:00 PM with nothing to eat or drink, and I was in pain and I was trying to figure out how I would get home from the ER, who would feed my dog, etc.

Later, I needed to use the restroom and, again, could not get anyone’s attention. The call button was out of reach and I couldn’t walk. Finally, I had to sit up in my bed and yell “I NEED TO GO TO THE BATHROOM”. I was rolled into the bathroom and quickly discovered that there was no toilet paper. I pulled the call string was given a small Kleenex-like packet with the equivalent of 4 squares of toilet paper in it.

Around 9:30 PM, a doctor finally came to see me. He walked in and stated that my ankle was sprained – he hadn’t seen any breaks on the x-ray. He looked down at my leg and saw how swollen it was and told me he was going to go look at the x-ray again. I never saw him again. About 15 minutes later another person entered and stated that he was there to put a splint on my leg. I asked, “what did the doctor find when he re-examined my x-rays?”, and he said “I don’t know I was just told to put a splint on your leg.” I asked if he would please find out and let me know. He left and came back and told me that my ankle was not broken, and applied the splint.

15 minutes later a nurse arrived and asked me how tall I was. She left, returned, handed me crutches and a stack of papers and started to walk away. I immediately started asking her questions – what is this prescription for? Do I have to take this medicine? Turns out that the prescription was for a stronger pain medicine and I only needed to fill it/take it if I felt like I needed it. Another paper told me to see a doctor in 7 days to have my ankle re-examined. She also gave me an ibuprofen—finally!—and I asked her how much and how often I should take that medication. She said, “Just don’t take more than the back of the bottle says to take” and walked out of my room.

I gathered my stuff and proceeded to try to sort out how to ‘walk’ with crutches. I had no idea how to get out of the ED.  As I stumbled along, I quickly realized that my crutches weren’t set up right. And, fortunately, a tech of some sort saw me struggling down the hallway, stopped and volunteered to help me adjust them.

Clearly, I’m unhappy with this experience and I’m left with lingering questions – would it have been too much to have:

  • Help and a wheelchair on arrival?
  • A greeting from the person at the registration desk to ask what happened, how I’m doing, and alert the triage nurse about possible immediate needs?
  • Simple comfort measures: Ice, ibuprofen, a pillow to prop up my foot?
  • Toilet paper?
  • A greeting from the nurse to whom I was assigned in the ED to say hello, see if I needed anything and give me a rough estimate of how long I might expect to be waiting?
  • A clear diagnosis from the doctor and a chance to ask questions?
  • An explanation of the items that were given to me by the nurse—prescription, paperwork, referral etc and a chance to ask questions about them?
  • A tutorial on crutches and a check that they were set-up correctly?
  • Help in gathering/carrying my stuff?
  • And finally, someone take a moment to show me the way out of the building?

Eds Note: The experiences described in this story seem pretty typical for what one might expect out of an emergency room visit. Some of the challenges are routine (long wait times, harried staff); some are potentially harmful operational or medical deficiencies/errors (insufficient access to wheelchairs, improperly-fitted crutches).

What merits more attention is the way in which a series of small affronts to dignity pile together to become something more significant. Individual missed opportunities – greeting, listening, maximizing patient privacy, providing simple comfort measures – on their own could be easily forgiven in such a challenging setting. But, taken as whole, they represent a failure to recognize the patient not just a person, but as a person in distress – a person whose dignity is already under assault and is in more need of assistance and kindness than usual.

One response would be to blame the employees for their failure to respond with the sort of basic human decency and respect we owe one another, regardless of the context. But, context matters. This story occurs in the context of a health system that is unlikely to directly reward employees for protecting their patients’ dignity – at least, not to the same extent that they reward things that seem more directly related to profits like maximizing billable services and minimizing expenses.

Until protecting a patient’s dignity becomes as much a direct part of the job as diagnosing and treating injuries and illnesses, increasing pressures on harried employees will inevitably continue to yield troubling aggregations of the sorts of small abuses that we see here.  And patients’ dignity will continue to die by a thousand cuts.

Andrea Judson, MSW lives and works in Baltimore. She is a first-time ER user. At age 22, she spent a year volunteering in the waiting area of the ER at Detroit Children’s Hospital. Given the charge “make it nicer in there”, she spent the year talking to stressed parents and children, helping families get food or drink, holding babies so mom or dad could go use the pay phone, playing hospital bingo with groups of kids, handing out video games to teens, finding out wait times, etc.  – She never really thought much of it…until now.

7 people like this post.


Alan Regenberg

Tags: , , , , , , , ,

Leave a Reply