Budget cuts in the E.R.

June 6, 2009

Look, I know we’re in a recession.

I know that times are tight, money is a problem, and hospital emergency rooms are overcrowded and underfunded.  I sympathize.  Really, I do.  But I had a very difficult experience on Thursday night as a direct result of a budget cut that eliminated the phlebotomists in the emergency room at our local hospital — one that may have put me in danger — and I’m writing to tell you about it.

I arrived at the E.R. at 8:30 p.m. with a high fever and a history of Stage IIIC inflammatory breast cancer.  When the E.R. nurse came to draw my blood 3 hours later, I told her that I had had a lot of chemo and my veins were pretty bad.  My right arm is strictly off-limits because of the lymphedema, so the veins in my left always have to be used for blood draws, and they’re not fully over the chemo yet.  The nurse scoffed and told me, “There’s no such thing as chemo veins. I’ve never had a problem.”  She put a small IV in my hand, and, 20 minutes later, picked my best vein (the only one people can usually get) for the second blood draw, a small one.

By the time the preliminary tests came back and the doctor determined that I would need a CT scan, that nurse had gone to lunch.  The doctor reached for my arm to be sure that the IV was in place, and was surprised to find that the IV stub was the wrong size.  It couldn’t be used for the CT because the contrast (iodine) couldn’t be flushed in fast enough.  She began to look for another usable vein, and was frustrated not to find one.  She called in another nurse.  No luck.  So the doctor began to try to prick new veins, but failed repeatedly to draw blood.  She decided to reuse the one that had been stuck earlier, sticking it closer to my heart in an attempt to tap it for new blood.  But it had been used already, and the blood clotted in the needle.  She jabbed a nearby vein, but it blew.  While I recoiled in pain, she tried — and blew — another vein, leaving me with two cm-sized purple scars and soreness on my arm today.

All this time, she ranted loudly about the incompetence of the first nurse, who took my good vein for a simple draw, leaving her nothing for the CT, when a CT was likely from the beginning.  Over and over she blasted her, alternating her incompetence with pronouncements on my need for, “an immediate CT, one which you should have had days ago!”  Finally, she said, “We can’t wait any longer,” and told the 6 ft tall male nurse to invert the bed, putting my head as low as it would go.  When I asked her what she was doing, she told me, “I’m going to put this needle into your neck.”

Needless, to say, I began to panic and shake, and had a very difficult time of it.  She did get the needle in, and the CT technician arrived soon after (apparently the IV only became an issue the minute my turn had arrived for the machine) to take me for my test.  He, on the other hand, was nothing but kind, with encouraging words.  The pillow on the CT table was so soft, and he talked to me like an equal, not a science experiment.  By the time my test was over, I was calm again.  He offered me the pillow and a blanket, two amenities not easy to come by in the E.R., and I was finally able to be comfortable while I waited for the test results.   Well, as comfortable as you can be with an IV in one hand, two blown veins in the elbow, and an IV sticking out from the side of my neck like Herman Munster.

Test results that would show whether or not I had cancer again and my lifestopwatch would have to be reset.  Because, you see, it wasn’t enough that the E.R. doc scared me with her jabbing and her frustration with the nurse-who-wasn’t-a-phlebotomist, but the E.R. doc also went on and on about whether or not it was cancer recurring — an occurence which my oncologist (at another hospital) has since assured me is almost never marked by a sustained high fever.

Days later, I’m still shaken by this, and when the phlebotomist came in today for a blood draw, I braced myself for a difficult time, warning her that my veins were shot in the same way that I had the original E.R. nurse.  She saw the purple clots and very carefully chose a vein nearby that I couldn’t even see.  The blood draw was quick and almost painless.  It was incredible.  I asked, “Is it because we’re on the oncology ward that you’re so good with chemo veins?”

“No,” she answered, “I’m a phlebotomist.”

I’ve since found out that the hospital fired or reassigned the phlebotomists working in the E.R. as a cost-cutting measure.  There’s not a single one down there.  And that includes the nurse who scoffed at me when I told her from an E.R. bed, “I have chemo veins.”

True friends

November 18, 2008

True friends are hard to find.  I’ve discovered this year that I have more than my share, however.  Friends to play with, friends to walk with, friends to work with.  Friends who will watch your kids at the drop of a hat.  Friends whose kids you want to watch, just cause they’re fun.  Friends who bring you goodies “just because” or surprise you on chemo day with a pink bag of sunshine.  Friends to blog with and friends to plot with.  Friends who will call you in the hospital, and come by and not blink — even if you forgot to wear your hat, and you are having a “no hair” day.

Yesterday, a friend went above and beyond for me.  A thousand thanks to my good friend R who took me to the emergency room and stayed for my tests and diagnosis, cracking jokes and telling stories, listening to mine, and just being there for me when I needed her.  It was hard to pick up the phone and ask her for help … but it would have been a thousand times harder to be alone again in the emergency room.

Thanks, R.

You’re a good patient

November 17, 2008

Just another night in the E.R.  Sigh.  Apparently it was just a muscle spasm (why make you wait for the diagnosis?), but the pain was unbelievable on Sunday, and it was difficult to get a full breath.  Something was really hurting my back ribs, and, as the day went on, I got really worried.  My primary care physician couldn’t help me on Thursday (see last post), the PT couldn’t help, and I just saw my lymphedema therapist.  Where to turn?  Out of answers and in pain, I went to the ER for a quick x-ray to check if my rib had broken with the latest manipulations.

It was easily the quickest ER experience I’ve ever had (with the exception of going with my friend L on vacation).  At check-in, I was triaged to Express Care, a new setup in the hospital for lesser problems and those needing quick radiology.  In great pain and bent over a bit, I was seen quickly; a doctor even walked up to me while I was checking in, asked me what I needed, and got me in line for an x-ray before I even got settled in an exam room.  The x-ray tech came soon, and she and a colleague even fought over me briefly in the hall.  The second tech won, and I was hustled inside for a spinal x-ray.

The second x-ray tech cracked me up.  There was a lot of “Hey, I need the practice!” and “Oops, I’ll buy you dinner later,” and “Sorry for feeling you up again!” which just made me laugh because I just totally didn’t even blink when she moved me into position and out of the various x-ray postures.  We chatted and laughed and she reassured me that it was just a little radiation, nothing like what I got last spring.  At the end, I thanked her, and she said, “Oh, sure, you’re a good patient.”

You’re a good patient.

Hmmmm.  I suppose so … but I’d rather not be a patient at all.

Ooph! And they’re gone.

August 27, 2008

I woke up rested, having not gotten up with baby in the middle of the night, or been shoved by a certain preschooler as he crawled into bed with us around midnight (having been still in the ER at midnight), and also having slept in the comfiest bed in the place (much better than either the ER stretcher OR the couch that WonderDaddy graced). The doc walked in, briefed me on what was going to happen, and had me sign a consent form for this procedure AND for a full hysterectomy if things looked wonky once he got in there and took a look around (this, despite sounding scary, was a GOOD THING).

The nurse took my vitals, the doctor wished me well, and the transport dude wheeled me down to the pre-op room.

The pre-op room was nothing like I expected.  Quiet.  Silent, even, with the ripples of nothingness broken only by my doc walking in and briefing the resident.  The anesthesiologist was friendly and calm, telling me what to expect and where to sign.  WonderDaddy and I were joking around a bit, having done this just a few months ago, for a much more serious surgery.

There were scary parts, but those parts are my own, and I’m not going to discuss them here.

The anesthesiologist put the amnesia drug in my veins, and the next thing I remember …

… was waking up, groggy, in the same room I had slept in.  My belly was distended and tender, with three patches of bandage, and my throat was sore from the tube.  But I was alive.


And no longer in the achy pain that I had been suffering with since July, or the gut-wrenching pain that had consumed me over the weekend.

The rest we could work out.  The recovery would be quick, since the oopherectomy was done laproscopically instead of with a full cut across my abdomen.  We could go home that night, in a few hours, even.  I could finish the weekend’s work from bed perhaps.  Reschedule scrap night with the girls.  Pick a new date for Widget’s birthday party.

And remember the promises I made to myself in the E.R.  No more wasting time.

Time with each other is all we have.