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Originally published on October 6, 2015

Lessons from a Health Care Emergency: Praise and Opportunity

by Emily Friedman

Theoreticians and policy wonks can pontificate endlessly, but there is nothing like being a patient to learn about what is right and wrong with our health care system.

I admit it; I'm a klutz. I may be one of the clumsiest people on the planet. So the following story will not come as a surprise to anyone who knows me.

It was the evening of my birthday party, which I hold so that I can visit with all the friends I don't see very often, because my speaking and other activities keep me on the road so much. One of my guests was an old friend who is a widow and a little slip of a thing, and when she said she would go get a cab, I had my doubts. My street had been sealed off from traffic for a block party that didn't happen because it rained all day, and it was a summer Saturday night in Chicago. My neighborhood isn't exactly dangerous, but it ain't the Hamptons, either. So, rather than have her wander around looking for a cab, I said I would walk her to the corner to get one.

Oops

I put her in a cab; started walking back to my house; slipped on the wet, uneven sidewalk; and bashed my face into the curb. Fortunately, I wear glasses, so my eyes were protected, to a degree.

So I'm sitting on the curb, a bit dazed, and dripping blood all over my apron (I don't know what eventually happened to the apron; I suspect it's in a hazmat dump somewhere), and thinking that I should probably get up and go home. And just then — I am not making this up; no one could make this up — comes walking down the street, in full camo uniform, a Navy combat medic who turned out to have 21 years of experience. He and a friend were coming back from some event or another. He sent his friend to the building where he lives — very near mine — and the friend came back with the medic's Official Navy Combat First Aid Kit, and they administered first aid.

About then, two friends from my party — one an executive with a noted health care organization, the other a cancer researcher — came down the street, wondering what had ever become of me. They, the medic and his friend walked me back to the house.

Both the medic and the cancer researcher were convinced that I had a concussion, and the laceration on my face, although not very long, needed to be stitched, so I thanked the medic and his friend and promised chocolate chip cookies to them, and they went back to their place. Another friend sent the rest of my guests home, which wasn't a hard sell, given that I apparently looked like I had been hit with a blackjack.

Saturday Night at the Hospital

And off the cancer researcher, the health care executive and I went to the local hospital emergency department, which is only three blocks away. I have had experience with this ED before; at my birthday party eight years earlier, a very elderly guest began suffering symptoms of severe dehydration, so I spent the rest of that night stewarding her in the same ED, and I was very impressed with the care she received. (Obviously, I should stop having birthday parties unless I want yet another tour of the local emergency service offerings.) A few years later, a friend went there after two days of severe headaches; it turned out that she had a brain aneurysm, and the ED staff immediately sent her by ambulance to an academic medical center, where she received superb surgical care and recovered completely. So I have faith in this place, not only because its staff does such a great job, but also because they know their limits. Would that more health care providers did.

Well, a summer Saturday night in a Chicago ED can be a pretty festive time. I had to wait my turn because other people were coming in who were in much worse shape than I was. My two friends had whipped out their ID cards from their respective health care organizations and convinced the front desk folks to allow them to join me in my cubicle, where I was lying around, wondering what had happened to my apron.

I was tended by two very kind emergency techs and, eventually, the emergency physician showed up. She ordered a CT scan, which revealed no concussion (and, as I have been joking since, no more brain damage than was already present before the injury), and, once assured she wasn't going to be dealing with brain swelling or other major complications, she invited two medical students to join her and stitched me up while she instructed them in suturing.

Wow. I was a teaching case. I have never been a teaching case.

Because I do public speaking, and because I scar easily, I kept offering handy hints while she was doing the suturing until she asked me gently to keep quiet so she could teach her students. I did so, and learned a lot about sutures.

After the teaching session was over, the physician went off to check out my CT results, then one of the emergency techs arrived and told me, "You're not going to like this, but we think you have a broken eye socket." I knew I didn't, just as I knew I didn't have a concussion, because I've been through this before. I had not suffered any pain during any of this. But my other eye socket was broken in a childhood incident decades earlier, and that hurts. I realized later that whoever was reading the first CT, at midnight in an ED, probably saw evidence of the old injury and just wanted to check. I have no complaints about this. Patients often know more than providers think they do, but patients also often know less than they think they do.

So, off I went for another CT, which found nothing.

I sent my cancer researcher friend home sometime after midnight, and the ED staff were kind enough to set up a couple of chairs so my other friend could get some sleep, and we waited while the second CT was read.

Hotel ED

As I have written in this column before, I am something of an emergency department junkie, largely because I have very high regard for people who work so skillfully in such a stressful environment. But I also know they have a soft side, and while my friend was sleeping and I was lying there being bored, I was reminded how our hospital ED staff members do their best to address social ills that are often ignored.

An older African-American woman wandered in — a regular in that ED, I imagine — demented and disheveled and probably suffering from dehydration in the summer heat. The ED staff discreetly gave her water to drink, produced a screen, rolled out an unused gurney, gave her a pillow and a blanket, and put her to bed. This happens in virtually every hospital in this country that has an ED.

As a physician friend of mine says, "It's the world's most expensive social service program." And an act of compassion for those about whom few people care.

I was liberated from the ED around 3 a.m. The radiologic staff gave me CDs of my CTs, in case something happened later on. (And just to put in a plug for electronic health records, those CTs can be accessed widely, as long as I give permission. And, probably, even if I don't. But it would prevent my having to undergo another CT.)

My friend drove me home, and my other friend who had shooed away my birthday guests was there on the couch, waiting for me (she had come in from New York for the party, and was exhausted, but she stayed up, anyway). She had tidied everything up and had put the perishable food in the fridge. I have some very cool friends. We both hit the hay.

The Bride of Frankenstein

The next morning, the first signs of what was coming began to appear. I bleed easily. I have a long clotting time (it's hereditary). And I was developing the Black Eye from Hell.

One of my neighbors, who is a pediatrician, came over and checked me out. Two days later, I went to see my eye doctor, who said that — surprisingly — there was no retinal detachment or any other serious damage, and that it would just take time for the inflammation to go down and for my eyesight to resume its usual abysmal state.

I asked everyone who had cared for me if I was able to travel. They cleared me, and three days later I flew out to San Francisco to speak at the multicultural breakfast at the AHA Summit. By then, the entire side of my face was black, blue and purple, and I was frightening small children and dogs on the street. I explained my appearance to the folks at the breakfast by saying I had gotten into a discussion with someone about the Affordable Care Act, and they should have seen the other guy.

However, by then, the stitches had been in for seven days, and they had to come out. I asked the hotel concierges if there was some way to avoid using an ED, especially because the closest one to the hotel is a major trauma center, whose staff have better things to do than to remove stitches from a klutzy policy wonk.

A Clinic for Klutzy Travelers

The concierges said, "No problem. Just go over to the Traveler Medical Clinic." The what? It's a primary care practice, located in the downtown hotel district of San Francisco, and it has a relationship with many hotels in the area. Half of the practice is primary care (many of the hotel's employees are patients), and half specializes in taking care of patients who get sick or injured while on the road.

Pure genius! Every hospital, community health center and medical group in an urban area should seek to set up such an arrangement. Our trauma center staff members have more important things to do.

I cabbed it over to the clinic. I was seen within minutes, I was given a miniphysical (blood pressure, weight and so forth) and the physician removed the stitches and the Steri-Strips with no bleeding and no pain; he didn't even have to use lidocaine. (I had developed a great deal of respect for lidocaine in the ED in Chicago; good stuff, that.)

As someone who has been on the road for most of her adult life, I think the idea of clinics like this is really wonderful — and, of course, it's an opportunity for a little revenue enhancement for providers.

Lessons of the Fall

I flew back to Chicago and have had some time to contemplate my experience. I still look like I did 10 rounds with Godzilla, but it's getting better. And here are the lessons I have learned.

I have two complaints, one minor, one major. The minor one is that I was not asked if I wanted to be a teaching case. I would have readily agreed, but I should have been asked. However, at 1 a.m. or whatever time it was on a weekend in an ED, I can understand that they forgot to ask.

The major complaint was more of an issue. No one asked me how I sustained this injury.

Yes, I was accompanied by two distinguished health care professionals, and I had the cool story about the sidewalk and the Navy medic and all, but the kind of damage I was sporting is also a classic symptom of domestic violence. And I can tell you, from bitter personal experience, that victims of domestic violence are told to lie by their abusers, or are threatened with worse things if they tell. "Just say you walked into a door." "Daddy will lose his job if you tell." "You deserved it." "It was an accident." "I didn't mean it." And so many other lies and threats and accusations.

As a dear friend and colleague said to me after all this happened, "If it's good enough for Homeland Security, it's good enough for possible victims of domestic violence: If you see something, say something."

Throughout this entire episode, as, day by day, I looked more and more like death warmed over, only two people asked me if I had been abused and needed assistance. One was a grocery store clerk. The other was a customer in a candy store (I figured I had earned some dark chocolate truffles by then), who looked absolutely stricken when she saw me and was deeply concerned. It took me a bit of time to convince her that I had been attacked by a sidewalk, not a person.

If you see something, say something. The worst that happens is that you will be told to mind your own business. On the other hand, you might save a life.

Domestic violence is a scourge on our society, and it is up to all of us to stop it. The victims are often children, women and elderly people who are afraid of their abusers and don't know what to do to protect themselves.

A Toast to the Team

I am starting to look a little less awful, and I continue to go about my business, doing my Bride of Frankenstein imitation, scaring dogs and small children, tolerating the stares from strangers, and being extremely grateful for the care I received.

I have now been checked out by one Navy medic, two emergency techs, an emergency physician, two medical students, a radiologic tech named Kate, a lovely nurse named Angela, a pediatrician, my eye doctor (twice), a primary care physician in San Francisco and an internist in Chicago. I then called a halt to medical visits.

But here's to them all — the overnight shift workers in emergency departments, physicians who see you on short notice, neighbors who look in on you, friends who stay up all night to make sure you're all right, and everyone else in and out of our health care system who takes care of strangers who trip and fall or get fevers or whose kids fall off a swing or who suffer any of the random events to which we human beings are vulnerable. And a special thanks to those who have the courage, when they see someone with a suspicious injury, to ask if they can be of help in case domestic violence is involved.

There are a great many things wrong with our health care system, but those on the front lines will always have my everlasting respect.

Chocolate chip cookies all round. I will have to deliver them to the hospital around midnight on a Saturday night, and I will be glad to do so.


Copyright 2015 by Emily Friedman.

Emily Friedman is an independent writer, speaker and health policy and ethics analyst based in Chicago. Her website is EmilyFriedman.com.

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