ER visit -- part vent, should I complain? Long, as usual

In article qwmab.41254$n94.40553@fed1read04, says...

me to the hospital (they kept trying to treat me with things like oxygen and
more of the nebulizer than I couldn't breathe instead of just putting me in
the damn ambulance and driving hell-bent-for-leather to the hospital) that
my husband thinks if the same sort of thing were to happen again, he'd just
toss me in the car and drive me to the hospital himself. But we both wonder
whether we'd be taken as seriously if we showed up in a private car as we
were when I came in the ambulance. It's a tough call, because the minutes

That's what my SO and I will do - we have two hospitals within a mile
area and we are each under the understanding to get the h*ll to the
hospital ourselves if need be without waiting for an ambulance.

Of course, thankfully the ambulance situation is different in other
places, but the Detroit ambulance service is, for the most part,
pathetic. You can wait forever in a *real* emergency (heart attack in
progress, for example) and if you're out of it when the ambulance gets
there, you better hope you have no jewelry or cash on you because it
won't be there when you get to the hospital.

From what we've heard around here, people who come in in an ambulance
are treated the same as those who come in by a car, because so very
often people who don't have a car and "have a cold" call an ambulance to
take them to the hospital. (which is part of the whole reason that
people are dying in REAL emergencies - because all the nearby ambulances
are playing taxi service)




Courtney

"Lina" wrote in message news:

Okay... Yes... It's a long time to wait for a head injury with obvious
symptoms!
The wait time, if there had been bleeding on the brain could have killed
her! (I dealt with this when my dad was injured.) They sent you for a
catscan to make sure. With bleeding on the brain, it depends on the
severity. Unfortunately, there's no way to tell until a scan is done.


Thanks, it seemed dangerously long to wait, to me. Then again, the
half hour car ride there seemed 'too long', also! We're very glad it
didn't end up having serious repercussions.

Tina.

"toypup" wrote in message et...

I don't know the answer to all your questions, but from a layperson's POV, I
do think your DD's case sounds quite serious. Maybe the nurse didn't know
what VW is. Though they have medical training, they aren't MD's and they do
err quite a bit with the diagnostics. Some MD's I know personally complain
about the emergency cases they get in urgent care or in their office that
should obviously have been sent to the ER next door. These are patients who
are triaged by a nurse. I remember once, I was very ill and my lungs
started to feel like they were collapsing right as I was talking to the
nurse. She told me I was just anxious. Of course I was anxious, I wasn't
getting air, though not to the point of passing out or turning blue, but
it's alarming just the same. Never happened before or since. Anyway, they
don't always know what they are talking about.

I had a similar situation happen to me -- I know I have asthma, and
after a particularly severe bout with bronchitis, I was visiting my
parents, and started to feel like my lungs were just not working
anymore. I called my doc, and he sent me to the urgent care near
their house, where a lovely nurse told me that new studies have shown
that most of the problems with breathing experienced by asthmatics
were really anxiety! I did get anxious then! Thank goodness the
Doctor believed otherwise!

When you have your doubts,
make a fuss. At least have the nurse's opinion of the severity your child's
problem assessed by the MD on duty. Then, if he concurs, you have at least
a second opinion and would feel more at ease with the wait.

Thanks for the advice. I worry about making a fuss, because I fear it
will come back on my child when they're in there. I know that no
medical personnel should respond badly to a child because their parent
is a pain, but I bet some of them do.

Tina.

"Laurie" wrote in message ...

I was hoping you'd respond, Laurie!

This is horrible an inexcusable. I'm a critical care nurse, and I'm seeing
red right now. Your child should have been first priority. Yes, a delay
could have certainly been detrimental had there been bleeding in her head.

Thanks for this info.. I was thinking it might be a situation where
the damage would be done, and they'd just need to see how bad it was,
but knowing that something could be done promptly if there was
bleeding .... it makes me angrier that I didn't barge in there.
Hopefully there won't be a next time, but if there is, I won't be
waiting that long again!


I would document EVERYTHING while it's fresh in your head regarding times
and what you said to the triage nurse. I would also call the nurse manager
in the ER *today*, and if that gets you no where, go directly to the vice
president of nursing in the hospital. The fact that the hematologist was
rightly concerned is your backup. He of course would be noncomittal on the
length of time it took for you to be seen, but maybe he is doing something
about it quietly.


I will document it. I'll call tomorrow (it's 11 PM now). Thanks for
the titles of the people I have to talk to, also. That'll help. I
got the impression the hematologist was not surprised at the wait, but
he was distressed by it. If anyone would do something about it, this
guy would. He's been the best medical professional we've dealt with
thus far.


I do want to say that while there may have been minor issues with the kids
in the waiting room, you don't know what kinds of emergencies were brought
in by ambulance. Those always get first priority and people in the waiting
room never even see those patients. However, your daughter still should have
received prompt care.


I appreciate this, because it makes sense, but we are able to see the
ambulance traffic from where we were sitting, and there was only one
peds case from ambulance while we were there. Because it was a baby
in a carrier, and the mom was there (I think that's why -- because
they could move around easily, and weren't confined to a gurney), they
used the same triage room, so I do know that the only ambulance case
in those hours was a baby with a fever. I couldn't tell how old the
baby was -- not a newborn, but no more than 3 months old. Certainly
more serious than the walk-in/waiting room people, but how much more
serious I don't know. They also waited.

Thanks a lot Laurie, I'll call them tomorrow.

Tina.





laurie
mommy to Jessica, 2.5 years
and Christopher, 5 months

*This email address is now valid*
(and the still sleepy, kind of grumpy but OK Solana, and Sage, who
loved school and almost didn't notice that I'd just tossed her in
there and run back out)

(Mary Gordon) wrote in message . com...
Yeah, I'd complain, and in writing to .

I'm kind of dumbfounded at the way the ER treated you. My middle kid
has no medical conditions that make high risk like your child. He's a
pretty healthy kid. When he was in Grade 1 he got wonked twice on the
head in the school yard and got a concussion - and I should mention,
he never lost consciousness, but he did throw up and was dizzy, drowsy
and very pale (he looked really awful). We took him to Sick Kids
hospital here in Toronto, where there usually is really long wait in
the ER (if what's wrong is not immediately life threatening, you can
be there for a loooooong time, even with broken bones). Because it was
a head injury and poor Con was looking so green-grey, they took him in
immediately - we jumped the queue, they examined him immediately and
sent us off for a scan right away.

In the case of your child, who has a known medical problem that makes
this kind of injury particularly dangerous AND a specialist called
ahead, whoever did the triage when you came in should be fired. Just
plain inexcusable.

Mary G.

Thanks, Mary. I hope it's not a firing issue .. but then again, I
hope she doesn't miss a hemmorage in someone else because she's a bit
dull. Maybe she needs to go to a workshop about bleeding disorders ;
)

Tina.

Jenn wrote in message ...


you might also want to refer to this condition as 'hemophilia' next time
-- VW is a mild form of this illness and people might respond more
quickly to something they recognize

I feel like they'd think I was lying to get better treatment, and they
might think I was crazy, too, since Solana's a girl, and there are
*very* few girls with hemophilia. This hospital contains the only
hemophilia treatment center in this part of the state, and that's
where Solana goes, and all bleeding disordered kids go here, I'm
really surprised that the ER staff doesn't just jump when a
hematologist calls ahead for any of their patients. It's neat that
you knew that, though. People often draw back in horror if I describe
it like that to them (non-medical people).

My mother mentioned that the reason we and another head injury (I
don't know if I mentioned that in my OP -- a 10 mo. baby fell down a
flight of stairs, they waited longer than we did by about 40 minutes,
and I don't know when the doc actually got to them) waited so long
could've been because they suspected 'foul play' of some type, and
were waiting on social workers or something. We didn't meet with
anyone there, but if that was part of the problem, we're already
assigned a social worker, along with the hematologists office, so I
don't know what would've happened. I'm expecting a call from her to
follow up on the injury anyway, so I may ask her if that's possible.

Tina.

"Circe" wrote in message news:rWkab.40989$n94.40634@fed1read04...
"Tina" wrote in message
om...
Does anyone else think it's exceptionally slow to wait three and a
half hours after a head injury with symptoms (sleeping, uneven gait,
pain moving around her head) in a child with a bleeding disorder to
get a catscan? I'm still angry (obviously), but I don't know how
angry to get, if I complain. That nurse definitely lied, I know that
for sure.

I agree with everyone that 3.5 hours seems like far too long to have to wait
to be seen after an incident like this, particularly if the child has a
known clotting disorder. OTOH, I have to say that my experience suggests
it's not at all uncommon and might even be normal.

When Julian cut his finger open with a pair of scissors on a Sunday, we too
him to the ER. It was very busy, and we eventually ended up going to an
urgent care center because the wait was 6+ hours. However, it was an hour
(and maybe 1.5 hours) before we were even triaged. And during that hour, we
met a couple with a son a little over than Solana who'd had a garden tool
fall on his head at a local home improvement warehouse. He had a significant
laceration on the top of his head and had been exhibiting other potential
symptoms of concussion/brain-bleed like Solana (sleepiness, nausea). They
had been there at 3 hours by the time we met them and they had still not
been seen by the doctor when we left, so they must have waited a good 4
hours before they were seen!


I think I remember reading about Julian cutting himself. I would be
irate at an hour plus prior to triage.

The thing that I wonder, with reports of more people waiting that long
with head injuries -- what is the actual warning sign of serious
injury? My husband's lost consciousness from a fall before, and never
had any other symptoms, and they were not worried. Solana is a
special case, so they always 'worry', but not necessarily too much,
obviously. I wonder what it would take for that nurse to have been
worried. Is there some secret symptom?

Solana's also thrown up after hitting her head before, and when I
called (this was prior to her Dx of VWD), they said she'd need to
throw up three times to need an ER visit. Even this Sunday night, she
fell off the dining room table, backwards onto her head, and I spoke
with a hematologist on the phone,and he said since she just fell on
hardwood flooring, not to worry too much. But other times, when she
falls on concrete, that's the only issue they worry about -- she
doesn't need to have symptoms, they just want to see her because it
was concrete. I'm really thinking about going over to the medical
school and getting a textbook about head injuries.


Similarly, when we went to the ER after Julian broke his arm, we waited a
good 6 hours and during that time, I met a woman whose son was exhibiting
symptoms of meningitis and he had not been seen in over 2 hours!


It's infuriating, isn't it?
And if none of us talked to one another in the waiting room, we'd
think it was just us ; )!


The problem, as I understand it, is that the ER's are *way* understaffed.
Even if they have rooms available, they don't have enough doctors and nurses
to care for people occupying them. So they really have to do their best to
figure out which cases are truly critical and which can wait a little longer
without being life-threatening. Another think you have to remember is that
you don't know whether any truly serious and life-threatening cases came in
via ambulance. (That's the way I arrived at the ER, and I bypassed the
triage nurses altogether so people waiting in the waiting room didn't even
know I was there.)

We could see the ambulance bay from our seats, and they're visible as
they enter the peds side. The bay is attached to the adult side, and
you can get to the peds from back there, but they don't always do it
that way. We saw the only pediatric ambulance case come into triage
while we waited, and it was a baby with a fever. Not that it isn't
serious, but I'm sure there was only that one case. I'm like a spy in
there. Other times we've been there and even if the child or parent
doesn't make it to the triage room, the EMTs or paramedics go there to
turn in papers. I could practically run this place with the amount of
time I've spent observing in there!


All of that said, I think the nurse in your case made a mistake when
triaging Solana and classified the seriousness of her case incorrectly. I
think it would probably be a good idea to carry with you some sort of
information from her hematologist explaining her clotting disorder and that
any time she has an injury which might be associated with bleeding, she
needs to be treated as considerably more "critical" than the average child
with a similar injury.

I'm definitely going to do this. And then maybe I can go to the local
ER instead of driving all the way down to the Children's hospital.
I'll have to see what her hematologist thinks. We met a couple at our
bleeding disorders parenting weekend who carried letters about their
son's bleeding disorder everywhere because the mother had actually
been confronted in stores by people accusing her of child abuse
because her son was bruised. No one's ever approached me like that,
but if they did, I doubt I'd be showing them a letter about anything!


I also think when you feel you're getting the
brush-off, it never hurts to say something like, "I understand that you are
very busy, but I feel my child's condition is more critical than you are
suggesting. I am willing to wait, but I want it understood that if my child
suffers harm because you did not take my concerns seriously, I *will* bring
a lawsuit for medical malpractice." I hate it that I believe I have to
threaten lawsuits to get action, but it *does* tend to get attention!
--

That sounds pretty good. It does make me nervous, but I'm sure it
would get attention! You gotta do what you gotta do!

Thanks Barbara!

Tina.



Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
See us at http://photos.yahoo.com/guavaln

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Jenn wrote in message ...
In article rWkab.40989$n94.40634@fed1read04,
"Circe" wrote:

"Tina" wrote in message
om...
Does anyone else think it's exceptionally slow to wait three and a
half hours after a head injury with symptoms (sleeping, uneven gait,
pain moving around her head) in a child with a bleeding disorder to
get a catscan? I'm still angry (obviously), but I don't know how
angry to get, if I complain. That nurse definitely lied, I know that
for sure.

I agree with everyone that 3.5 hours seems like far too long to have to wait
to be seen after an incident like this, particularly if the child has a
known clotting disorder. OTOH, I have to say that my experience suggests
it's not at all uncommon and might even be normal.

When Julian cut his finger open with a pair of scissors on a Sunday, we too
him to the ER. It was very busy, and we eventually ended up going to an
urgent care center because the wait was 6+ hours. However, it was an hour
(and maybe 1.5 hours) before we were even triaged. And during that hour, we
met a couple with a son a little over than Solana who'd had a garden tool
fall on his head at a local home improvement warehouse. He had a significant
laceration on the top of his head and had been exhibiting other potential
symptoms of concussion/brain-bleed like Solana (sleepiness, nausea). They
had been there at 3 hours by the time we met them and they had still not
been seen by the doctor when we left, so they must have waited a good 4
hours before they were seen!

one of the reasons for this is that people take kids with cut fingers to
the ER -- it is this great surge of trivial problems that clog things up

part of the reason is that ERs are used as primary care by those without
insurance, and pediatricians who routinely worked with patients with
minor problems e.g. broken arms, cut fingers etc in the past, now don't
work after hours and send people to ERs and part of it is the judgment
of people who think it appropriate to use an ER for a trivial problem.


But remember, 'cut finger' can mean a lot of things. My brother cut
his hand and finger when we were little, and he ended up almost losing
the finger, and getting over 50 stitches. Just an accident playing
outside -- he fell off his bike, and cut himself trying to catch
himself as he fell. But it was still a cut. And still a definite
emergency.

Tina.

Jenn wrote in message ...
In article ,
(Mary Gordon) wrote:

Yeah, I'd complain, and in writing to .

I'm kind of dumbfounded at the way the ER treated you. My middle kid
has no medical conditions that make high risk like your child. He's a
pretty healthy kid. When he was in Grade 1 he got wonked twice on the
head in the school yard and got a concussion - and I should mention,
he never lost consciousness, but he did throw up and was dizzy, drowsy
and very pale (he looked really awful). We took him to Sick Kids
hospital here in Toronto, where there usually is really long wait in
the ER (if what's wrong is not immediately life threatening, you can
be there for a loooooong time, even with broken bones). Because it was
a head injury and poor Con was looking so green-grey, they took him in
immediately - we jumped the queue, they examined him immediately and
sent us off for a scan right away.

In the case of your child, who has a known medical problem that makes
this kind of injury particularly dangerous AND a specialist called
ahead, whoever did the triage when you came in should be fired. Just
plain inexcusable.

Mary G.



you might also want to refer to this condition as 'hemophilia' next time
-- VW is a mild form of this illness and people might respond more
quickly to something they recognize

Except this could backfire, as typical "hemophilia" is only associated with
boys, so the ER nurse may think she's mistaken. While VW is a deficiency
of factor 8, as is hemophilia (A), they have different characteristics and
treatment results.

laurie
mommy to Jessica, 2.5 years
and Christopher, 5 months

*This email address is now valid*

"Circe" wrote in message news:

I remember reading about both of Julian's trips to the ER, and
regardless of the fact that you were going on trusted medical advice,
I think they both made perfect sense. What were they if not
emergencies?

And also --

Well, I agree, there are plenty of "trivial" problems in the ER. (There was
the lady my husband ran into in the ER when I was in cardiac arrest who was
there because she'd taken too many diet pills and felt funny. Well, stop
taking too many diet pills!) Notwithstanding, there are times when the ER is
the *only* option--weekends, nights, etc.--and a condition is emergent
enough to require treatment before the regular pediatrician's office and/or
the urgent care center is open.

I almost started crying the last time my husband was in the ER. He
was taken by ambulance, he'd hurt his back and needed to be moved by
the EMTs (He'd been trying to get up for 6 hours, and I'd been trying
to help him for 1.5) , who took him to the hospital. He threw up for
20 minutes straight in the ambulance, and was being rehydrated by IV
when I got there (after waking my sister in law to come sit with the
kids). He stayed in the hall for hours, and was moved to a room
around 2:30 or 3AM. In the hall, I watched a young man get an EEG
because he'd taken 5mg of Haldol -- his girlfriends prescription --
and then got scared and came to the hospital. He didn't even feel
'funny'!

I needed to leave, (DH hadn't seen a Dr. yet) because our sitter
needed to go to work at 6, so I was standing by his door, waiting to
tell the nurse I'd be leaving (DH was asleep), and I heard an argument
in the next room. A young girl was upset that it would take an hour
to get the results of her pregnancy test back. Her nurse said "Well,
we can check out whatever else is bothering you while you wait" and
the girl said "That's the only thing I came here for, a pregnancy
test" and the nurse said "Did you know you can get this test at the
drugstore? It's about ten dollars!" and the girl said "Well, my
friends were over, and they were asking me, and I wanted to know
tonight." She apparently went to the ER sometime after midnight just
to get a pregnancy test!

My husband was never examined that night, and his regular doctor filed
a complaint. Our massotherapist thought, just by looking at his back
the next day, that he had a ruptured disk (He didn't end up having
that, but according to the therapists, and his Dr., something was
obviously wrong, and there's no way anyone could have even known that
with the cursory 'triage' exam they gave him)


It is not the fault of parents that the ER
is their only option in these situations, and given that the limitations for
off-hours care are well-known, it seems to be that the ERs ought to be
staffed appropriately to handle the load (though, of course, I realize that
is easier said than done given the shortage of qualified nurses and doctors
willing to do ER duty).
--

Is it considered not good to work in the ER? Seems to me that'd be a
good place to work! Maybe I'm just so familiar with it ...

Tina.