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 V.18 No.49 | December 3 - 9, 2009 

Feature

Waiting With the Devil: Health Care or Hell?

I used to laugh at the guy on “COPS” who insists on getting a badge number. There are threats to avenge, at some future date, the injustice being done to him. It’s so stereotypical. The police must hear this stuff even more regularly than we do on TV. Does anyone ever have a valid issue? Do they ever follow up?

Michael P. D'Arco

Well, Presbyterian Health Services, I have your badge number.

Oh, I know, it’s the “system” that’s the problem. This was echoed from Urgent Care to the ER. That doesn’t make it right. And I still managed to memorize your metaphorical badge number over the 12-or-so hours I spent staring at the wall in your metaphorical holding cell the other day. Maybe I can speak with your metaphorical captain now. Then maybe we can take that information and share it with the metaphorical City Council.

This report is not for me; this is for the people. This is for the guy to my left bleeding from his anus in excruciating pain for almost 11 hours. This is for the guy to my right bleeding from his anus for hours on end. This is for the little old lady with heart palpitations who was still waiting to see a doctor even after I left, 12 hours in. This is for all those people I witnessed who arrived by ambulance, crying out in pain, to be promptly dumped off in the lobby and begin their 10-, 11-, 12- or more hour punishment for having a medical “emergency.” Surprise!

What do I hope to accomplish by sharing my story? That all the overpaid health care provider corporations and insurance companies immediately add a wing to every hospital and hire extra ER doctors at no additional cost to us. Because the only consistent explanation I heard for the long waits was a lack of rooms and doctors. I asked myself what other business in civilized society would allow a customer to sit in their lobby for an entire day. Waiting. Hour after hour. No apologies, no apparent attempt to speed things up or call in extra help. I actually thought it was normal ... for the first six hours. The next phase after that was amazement. The next phase was annoyance. The next phase was anger. The next phase was hopelessness. Sometimes the final phase is death.

What led me to this place? I have the “Swine Flu,” “H1N1,” maybe, probably. This is Day 5 of my Swine Flu Adventure in all its death-defying glory. This is my story.

*

On Sunday, I wake feeling like I'm getting a little sick. There's coughing. I have shortness of breath that's worse than my occasional overdose of cat hair. So I stay in bed and drink plenty of liquids, hoping I caught it in time to get to work on Monday. I know by Sunday night I better go to the doctor the next morning rather than work. Then comes the slight fever. By Monday morning I can barely breathe. My wife and I Google “Swine Flu” and B-I-N-G-O! I think we have a winner! Swine flu is described as the usual flu symptoms but with shortness of breath. My primary care physician is booked. They refer me to Presbyterian Urgent Care.

Monday, 9 a.m., we hurry to Presbyterian Healthcare Services Northside Urgent Care Facility. I can't breathe well at all now. The parking lot is completely full. People wait for others to leave just to get a parking space, like the mall at Christmastime. There's a line all the way from the check-in desk to the front door. I stand with them. When I'm too weak to stand, my wife stands in line for me. Upon reaching the desk, an hour and a half later, we get to the first order of business: taking my money, a $35 co-pay with my insurance.

Since the last time I'd been here was 10 years ago, I need to fill out forms. Maybe you have to fill out forms anyway? They’re unclear on that. Doesn’t my health care provider already have this info? What about my insurance carrier? We're directed around the corner to fill them out and wait for a triage nurse to call my name. At this point they issue me a face mask, mandatory for people displaying all the symptoms on a list pasted to the desk. I don't have the list’s requisite diarrhea, and the mask makes breathing that much harder, but they hand it to me anyway. I head to the car to lay down until they call my name. My wife patiently remains in this den of misery.

Eventually my wife drags me from the car. One of the first, but certainly the worst, face of Presbyterian customer service throughout this story is this nurse. You know those people who clearly chose the wrong career path? She is not happy. She makes sure we aren't happy, either.

I actually thought it was normal ... for the first six hours. The next phase was hopelessness. Sometimes the final phase is death.

Why is your mask off?”

“I couldn’t breathe.”

“Why did you go outside?”

“I couldn’t breathe with the mask on.”

“Well, you must wear the mask,” she says, stuffing oxygen tubes into my clogged nostrils despite my argument that the mouth thingy might be better.

"Why didn’t you come in yesterday?”

“I could breathe.”

“Street drug use?”

“No.”

No?”

“No.”

Do I look like a drug addict? (I am wearing a spiked belt.) Is “sneaking around outside” a more plausible cause for flu symptoms and shortness of breath? Couldn’t be Swine Flu? I notice she writes “denies” on the form. Couldn’t write “No” or “N” like the other health care workers I will go on to observe. You have a miserable day, too.

It's time to get back in the line, which is longer now. I see a very nice doctor named St. Arnold. I remember his name because it's the same as the two “Saints of Beer” I'm familiar with. There's a Saint Arnold of Soissons who miraculously multiplied barrels of beer in times of need. There’s also a Saint Arnold of Metz who cured plague victims with beer. I am thirsty. Today’s saint is very concerned about my CO2 saturation level. He says I could have died and the possibility is still there. Evidently, when your oxygen level gets down to the 70s, your vital organs will shut down. I'm at 82. For healthy individuals at this elevation, 95 is normal.

I'm given two Nebulizer breathing treatments. My CO2 levels won’t stay all the way up without oxygen, but I'm past the danger zone. At this point, they go ahead and test me for flu. This test involves a long wooden Q-tip that gets shoved all the way into your sinus until it comes out the back of your head. They also take a vial or two of my blood for testing and x-rays of my chest, which look normal.

It's 1:11 a.m. when I exit the examination room. I have orders to return the next morning for a follow up at 7:45 a.m. I'm holding what will turn out to be $200 (with insurance) in prescriptions. Soon I am napping in my cloud of Prednisone, Tamiflu, Flovent HFA, Ventolin HFA (a generic version of Claritin-D), Afrin and Primatene Mist. I am alive.

I'm lucky to have insurance, no matter how much it costs us. But I'll still have to be resourceful to cover the additional impact of the bills, steadily growing due to both the illness and lost wages. My doctor’s note says I can return to work in two days. All you can do sometimes is pray.

*

Next morning, 6:15 a.m., the alarm goes off. I'm weak but not as bad as the day before. Must … get … to … Urgent Care … by 7:45. I eventually make it out the door and we arrive to its only location, across town, by 8 a.m. The parking lot is only half-full. The line inside is also only halfway to the door. I dutifully stand in it.

“You must wear the mask,” she says, stuffing oxygen tubes into my clogged nostrils despite my argument that the mouth thingy might be better.

At 8:41 a.m., they quickly take another $35 co-pay off my hands. I have to fill out the exact same paperwork as yesterday all over again?! I get back in the line, which is longer now. When I get to the front I'm told I need stand in this line after I see the triage nurse. Oh, yeah, forgot. Great. Luckily I have a different triage nurse today, one who doesn't think I sell meth to children. Then I stand in the line again.

I eventually also see a different doctor. He's named something that seems Bavarian. I can’t place his accent, either. But he's also concerned with my CO2 level. Now I'm getting scared. “You could die,” “people die,” “die” keeps getting thrown around. “No, I don’t have asthma.” “No, never been diagnosed with asthma.” “No, no one has ever suggested I have asthma.” He scratches his head. They begin not two, but three Nebulizer treatments of 20 minutes each. This gives me more than enough time to write and post a short blog about this, complete with a not-so-flattering picture.

I get my test results—turns out it was just a general “Influenza A” test they had given me—and it comes back positive. They will not test my wife, since there's only a 30 to 50 percent chance your spouse will catch the flu from you.

By 11 a.m. it’s determined that I should go immediately to the emergency room a few miles down the street. I refuse the ambulance, signing the necessary paperwork and leaving in my own vehicle. (My wife later determines that even with insurance, the short trip would have cost us $500 out of pocket.) We're both starving, and I assume I'll only get green Jell-O at the hospital. We stop and eat at Der Wienerschnitzel. Not exactly what I had in mind for my last meal.

The purpose of this rush to the ER is so another doctor can decide if I will be OK at home or best monitored overnight at the hospital. Sound pretty simple? Not too time-consuming, right? I am about to lose 12 and a half hours of my life that I will never get back.

We arrive around noon at the ER. My BlackBerry battery is almost dead. Quite possibly so am I. My wife is ill now (from the flu, not from Der Wienerschnitzel). She hands my loaned x-rays to an ER employee and goes home.

In almost a blink of an eye, six hours pass as I watch new faces come and go. I sit here, in this waiting room, solemn, alone, quietly observing in my uncomfortable wheelchair that can only be rolled by someone else. I am on my second of three oxygen tanks. I am oddly nowhere near annoyed at this point.

The “long timers” spy each other and eventually begin to communicate. It feels like a prison break or a mutiny of some sort. The whispers, laced with profanities, of the time we’ve done in this lockup. We want out! The mind begins to race after all these hours waiting to die with no food, nothing to drink, no information. Are we being punished for not arriving by ambulance? Couldn’t be. Numerous paramedics have dumped their passengers into this same vortex and disappeared. Are we on the wrong list? No. You know they said “life threatening” right? Yes.

Every two hours I check on the guesstimate regarding my wait. I don’t want to seem like I'm too pushy. I let them know I'm smiling beneath this face mask, believe it or not. Each time the answer changes. At some points, I'm next. Each shift change brings increasingly more rude and perhaps more uncaring employees to the waiting room. Each hour security observes the “long timers” a little more closely, perhaps for increased signs of agitation.

This test involves a long wooden Q-tip that gets shoved all the way into your sinus until it comes out the back of your head.

I see everything now. I see the trails of blood across the unmopped floor. I see the deaf lady who has complained several times now that she is hallucinating. I see there is a red line that we all must step behind until called or the nurses will sic security on your deaf ass. Unlike every employee I've spoken with so far, I now know there is a snack machine outside the front door. I have some money on me for a snack, nine hours after arriving, so I can take my prescribed medication that I had the foresight to bring with me.

At least I can’t smell much; only the occasional scent of urine pierces the nose. I am in a far corner, where I seem to have escaped the other foul smells that go with an ER lobby. This could be worse, I keep telling myself. The mind continues to wander. There is nothing to do but think or sometimes chitchat. There are no magazines, and the lone television is in another part of the room, where the smells are.

*

I daydream of my ancestors, some of whom perished with 100 million others in the flu pandemic of 1918. My favorite story goes something like this. H.A. (Higinio) Mirabal, so the story was told to me, feared for the health of his wife. She had not come down with the flu, but she did have five children to take care of. Higinio was a hard working man, caring for his growing family each day as a farmer and laborer. In their little casita he prayed to St. Joseph for her health. St. Joseph is the Patron Saint of the New World, but Catholics also believe he prays especially for families, fathers, immigrants, craftsmen, engineers and working people in general, among other things. He promised St. Joseph that if his wife was spared the flu, he would hold an all-night prayer vigil to him once a year for the rest of his life. Well, his prayers were answered. His wife and children never did catch the flu. For the next 56 years he kept his promise to St. Joseph. This eventually became an event that the rest of the family came from far and wide to participate in each year. Others were not so lucky in 1918.

*

My wife shows back up around 9 p.m. Assuming I had been admitted, she has brought my overnight bag. She's amazed to find me right where she left me, in this lobby. I quietly relay the other patients' maladies to her. It's a temporary distraction from the delirium. No obvious flu victims present. I now know where they are all from. I know how long they have been here. I know they are all in pain. The night groans on.

*

Ten hours?! Are there no doctors? What's going on here? People may be dying! “E-M-E-R-G-E-N-C-Y” Room! Oh, there are no rooms? Oh, now there are four rooms? Now there are no rooms? Now there are three or four people ahead of me? On and on and on it goes as it has gone.

*

In the days of my youth, waiting at the county hospital, it was exactly like this. But I had probably just thought, Hey, I’m poor, or, Hey, I don’t have insurance, and sucked it up. Or was it really this bad? A friend tells me that she recently walked out of another hospital after waiting more than 12 hours to be seen herself.

I see few masks and hear little of H1N1. I overhear an employee state that the room occupancy rate has increased by 60 percent in the last two weeks just because of this flu. I’m now picturing some apocalyptic sci-fi movie of death. Maybe they should have a pandemic plan, then … or a better one. According to the CDC, “Groups of people at higher risk for severe illness from 2009 Influenza A infection are thought to be the same as those people at higher risk for severe illness from seasonal influenza.” Those same people can get vaccinated from the 105,510 doses that have been ordered for Bernalillo County. Forty have died in New Mexio as of Tuesday, Nov. 24, according to the state’s Department of Health.

*

I now know where they are all from. I know how long they have been here. I know they are all in pain. The night groans on.

At exactly the stroke of 11 p.m. they call my name. I'm so startled I almost rip the oxygen out of my face as I leap from my wheelchair. The people around me say, We feel like we should cheer or carry you on our shoulders! I am actually taken to an examination room. I am given a stained gown to slip into. From the board, it appears this room has not been used since the previous day. The doctor is very friendly, caring and seemingly competent. He does not seem surprised at all to hear of my 11-hour wait for a simple consult. And the nurse later comments she hears this from 300 people a day.

I am quickly removed from oxygen and my vitals are taken. My CO2 seems to be above 90 consistently. The doctor is confused as to why I've had two sets of x-rays and two sets of blood taken. He recommends I walk around a bit and then come back to check my vitals again. Fresh back from walking up and down the halls it appears to be at 94 or 95 consistently. I am given a referral to follow up with my primary care physician in the next day or two. I receive a “Work Release Form” stating I can return to my job in six days. I sign a stack of discharge papers and thank them. By 12:30 a.m., I am on my way back to bed after 18 hours in hospitals.

The cost of this (that we're aware of so far), with insurance, is roughly $1,000 in lost wages, $70 for two trips to urgent care, a $75 ER co-pay and $200 in prescriptions, for a grand total of $1,345 out of pocket. And then I'll have to pay my primary care physician a co-pay to check my CO2 level again. In the meantime, I'm trying to get my recommended recuperation in, which has proven to be difficult. For my original symptoms, the Presbyterian Healthcare Services website links to the following conflicting instructions: “Rest at home until 24 hours after the fever is gone (without the use of fever-reducing medication). Drink plenty of liquids and take fever reducers such as ibuprofen and acetaminophen.”

I still really don’t know where I stand on health care reform. That’s not where this story was heading. But this experience has certainly afforded me the time to ponder it, poke it, look at it a little. Health care does not appear to discriminate between those who pay hundreds of dollars a month and the uninsured. So if I can have better care for less money, great! I would love to see a senator sit calmly in the crowded, filthy waiting room of any local hospital for 12 hours because that’s where his physician directed him ... and then not lose his mind. Who opposes health care reform? Is it the people already getting it for free? Maybe the issue isn't so much about my tax dollars carrying other’s burdens. Maybe it's about any of us getting seen at all.

More on “Swine Flu” in the Alibi : Our resident nurse examines H1N1.

Public Comments (7)
  • Hospitals  [ Tue Dec 8 2009 6:30 PM ]

    Wow, unbelievable story. Especially for the others in the waiting room who were bleeding and hallucinating. How awful.

    I had always heard Pres was better than Lovelace. I've visited Lovelace ER several times. Wasn't bad at all. Nothing compared to this certainly.

    I've also heard horror stories about UNMH because they get a lot more traffic, and apparently they don't seem to know how to triage- someone who is vomiting profusely needs assistance immediately.

    Nurses who treat patients badly should be ashamed of themselves. It's not as if they're forced to be a nurse or are doing it for free. Caring nurses really can make all the difference for those who are ill.

    Glad you didn't die. Glad you're feeling better. Glad you're hosting happy hour 3 nights in a row!


    Last edited [12/8/09 6:31 PM]
  • lol, wow.  [ Wed Dec 9 2009 6:14 PM ]

    re: waiting, you can thank all the people who constantly abuse ER services for things that aren't emergencies for making wait times as bad as they are.

    your article is hilarious. not because of the way it's written, but because of the sense of entitlement that you managed to ooze with every sentence. it's painfully obvious that you have absolutely no concept of how emergency medicine works, or how hospitals and emergency rooms function. it's not a first-come-first-served sort of business model. an EXTREMELY WELL-TRAINED doctor or nurse with many years of school and probably many years of experience in their field evaluates your symptoms and based on that, will prioritize your care. if someone comes in and is having a massive heart attack at the same time a person comes in with the flu (as an example), they're going to give priority to the heart attack (duh.) you can't honestly claim to have any concept of what the staff of the hospital are doing behind the scenes based on what you see in the waiting room.

    yes it sucks that you had to wait. yes it sucks that you had to be out of work for a week or whatever. i still feel like your characterization of medical professionals doing their jobs is pretty crappy, and based on your experience as described in this article, is totally unwarranted.

    @greenley- what medical experience or training do you have that gives you any right to judge whether medical professionals know/don't know what they're doing? it doesn't matter where you go, pres, unmh or lovelace, you're going to be in good hands. they will take care of you. it's their job.

  • I do not have medical training  [ Wed Dec 9 2009 7:12 PM ]

    (actually I do have some basic medical training, but not ER training) but I do have the right to an opinion.

    When my boyfriend crawls into UNMH ER and is profusely vomiting and has been for an entire day and is too weak to stand and they take a person before him who sprained their hand then that is a problem with triage in my opinion. It doesn't take medical training to know that people die from dehydration and low blood pressure but not from a sprain.

    Of course the trained professionals know this, so it begs the question, do some get so burned out that they don't care? Or is there something wrong with the intake system?

    I fully agree that we do not know what is going on back in the ER. Yes they are most likely handling much greater illnesses and injuries. But we do see what is going on in the waiting room.

    I also agree that ERs get clogged with non ER situations by both people who don't have insurance (and therefore can't go to the Dr. or urgent care) and also people who are hypochondriacs.

    Hopefully the plan the current administration is working on will help with the uninsured clogging ERs as just one of many ways it will improve our health care system.

  • Emergency Rooms  [ Wed Dec 9 2009 9:27 PM ]

    I think ER doctors begin to assume that most customers without visible injuries are on drugs. That's frustrating both for the patients who aren't on drugs and the doctors treating the ones who are.

  • Not a novel article... ps. nobody checks carbon dioxide levels...  [ Fri Dec 11 2009 8:27 PM ]

    The sad thing about this article is how un-unique the story is. People wait in the ER for hours every day, sometimes with serious complaints that require medical attention, other times with minor complaints but without insurance and, as such, no access to the health care system.

    The real story in this is the lack of access to care. For example, had the author had earlier access to his primary physician, he may have received the needed medical attention and avoided the onerous process of trying to navigate the ED. However, instead of delving deeper, the author delivered a front page diatribe that comes across as petty and self-centered. Where are the figures? How will the current legislation affect New Mexico? What perspective do local politicians and health care professionals have regarding the legislation? Why am I reading about your experience and not learning anything?

    Also, it would have taken a five minute phone call to a health care professional (or one or two House episodes) to check some of the finer issues of the story. Nobody checks CO2 levels. What you're talking about is a pulse oximeter (you remember, the little red light that gets taped to your fingernail?). This device approximates the levels of oxygen bound to hemoglobin in your blood.

    Alternatively, you could have asked the professional to explain to you how the emergency rooms work. As one of the previous comments noted, you are triaged, vital signs are taken, and your complaints are addressed by their acuity. The thinking is that if you're condition rapidly deteriorates, you're in the right place. In the meantime, they'll take care of the more critical patients.

    Everyone, health care providers and the lay public, know the problems facing the health care system in the United States are extremely serious. But instead of choosing to add something substantive to the debate, you delivered a rant complaining about the amount of time and money spent on your illness. I would encourage the author to step back and look at the problem from a more global perspective. Nice try. Maybe next time you'll dig a little deeper, check your facts, and get a point of view other than your own to "report" on.

  • What!?  [ Mon Jan 25 2010 4:17 PM ]

    Well mahzzu and lolomg sure have large chips on their shoulders eh? What part of:

    "This is for the guy to my left bleeding from his anus in excruciating pain for almost 11 hours. This is for the guy to my right bleeding from his anus for hours on end. This is for the little old lady with heart palpitations who was still waiting to see a doctor even after I left, 12 hours in."

    DO YOU NOT UNDERSTAND?

    "lolomg" is the one with the entitlement. mahzzu also has quite a bit o' entitlement. Let's see how these two and others like them fare in the hospital with so much as a nose bleed? It seems eternally silly that you both could feel this way.

    Only a true nihilist could appreciate the current Health "care" system. Only because it's devoid of any usefulness. Every hospital is run by a bunch of low IQ Dr. Mengele(s).

    This is what I don't understand about the world today. There seems to be ALOT of "people" that are part of the problem, as opposed to the opposite. The solution.

    (Thanks for killing universal healthcare guys!)

    FYI: I am NOT the passive aggressive guy you meet on the street after you sneer at him. I AM the type of person that would DO something. I won't curse you under my breath and vent on the internet. I am not very nice when provoked.

    I could look up to the people that care if they just stood up for themselves. At least.

  • ???  [ Mon Feb 15 2010 1:47 PM ]

    Mikediah,

    I get the feeling you and I are on the same side. As a doctor in training, I believe that healthcare reform is of critical importance, though I didn't make the point forcefully enough in my critique (this is the case I was making in pointing out the lack of access to care for the author).

    Again, the reason I was frustrated with the author's article was that he did not present anything other than his point of view. In this climate, I think it is more important to address the obstacles to healthcare reform (insurance companies and their lobbyists chief amongst them). However, there was no attention paid to these or other issues in the article.

    Finally, as difficult as times are right now it seems silly to take try to antagonize one another when we could do much more working toward a common goal. You seem really passionate about this issue. I would stronlgy encourage you to get involved in helping move the issue forward ([link]).

 
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