What happens when your go-to hospital is overcrowded

My local hospital in an affluent suburb of New York City displays its Outstanding Patient Experience Award 2018 and Magnet Recognized status on its website. My experiences tell a different story. This hospital is located approximately five to seven minutes from my home and is my go-to in an emergency. I have multiple medical conditions, which despite my best efforts sometimes require emergency care and unfortunately admission. I was working full-time at a demanding job as a psychiatric social worker — until my stroke (see below). Currently, I’m easing back into work on a part-time basis, building my hours back up gradually.

Spring 2018

The Thursday before Memorial Day weekend, I was sent by ambulance from an urgent care center with severe vertigo. The ED did a CT scan of my brain which was clear and administered meclizine, which didn’t help. The ED physician popped into my room for five minutes and told me he would like me to stay, but did not explain why. I said I’d rather go home, wanting to return to work the next day and was discharged.

In the middle of the night on that Saturday, my left arm and leg went numb. Returning to the ED, I was first in line at the reception window explaining my symptoms and adding that I’d been there two days ago. A pregnant woman and her husband who were behind me were taken in first. I waited for about 30 minutes and was taken into triage. I don’t remember much else except I was admitted. An MRI administered about noon that day, confirmed I’d had a stroke.

Summer 2018

The last weekend in August, I returned to the same ED with symptoms of chest pain, shortness of breath, pain down one arm and sweating. I went to the window and explained my symptoms to a young woman, who put a bracelet on my wrist. I was told to take a seat. I went to the closest seat next to the door of the triage room and watched several people go in ahead of me who appeared (not to judge) to be in no apparent distress. A nurse came out and doubled over, and I begged her to take me in next.
They did an EKG, and although I was not having a heart attack (thank goodness), my heart rate was elevated. I continued to be in pain, given morphine and was admitted. One morning I was due for the morphine at about 6 a.m., and despite repeated requests and reassurances that “it was coming,” I didn’t receive the medication until after 10:30 a.m.

The problem was identified as one of medication and dosage. I’d been diagnosed with coronary artery spasms in 2015, which had been well controlled with 90 mg of nifedipine. My first night in the rehabilitation center, where I’d been transferred after the stroke, I almost passed out because my blood pressure plummeted. The doctor lowered the nifedipine to 30 mg. For some reason, that weekend, the 30 mg ceased to control the spasms and pain. When the doctor at the hospital raised the nifedipine to 60 mg, my blood pressure dropped too low for me to safely get out of bed.

The issue was resolved after I was discharged and saw my own cardiologist. She started me on a medication called Ranexa, which began to work almost immediately and eradicated my chest pain, allowing me to stay on the 30 mg. of nifedipine.

Winter 2018

I also have asthma, which is fairly well controlled by my home regimen of medications. I have a home nebulizer and of course a rescue inhaler. I try to not use the rescue inhaler unless I really need it because for me the albuterol triggers migraines. An asthma attack had slowly been building for several days, and repeated nebulizer treatments and puffs of my rescue inhaler were not resolving it. My chest was tightening up badly, and I was having a hard time breathing. Also with my asthma, I can’t hear myself wheeze. I’ve felt the same way physically, had doctors listen to my lungs and say both I’m really tight or my lungs are clear. Weird.

This ED was renovated several years ago so that all the beds are in individual rooms, instead of beds being separated by curtains. However, because of the overflow, stretchers line the hallways, each designated with a number, just like each room.

I was led to a stretcher in the hallway, which is fine because it’s interesting to watch all the bustling activity in the ED. I’m a writer, so I like to observe — even if I’m having difficulty breathing. I kept waiting for someone, a nurse to come over with a nebulizer treatment, but it was at least 30 minutes or more before a PA came over and asked me what was going on. I was having a bit of a hard time talking, but I managed to tell him, and when he listened to my lungs, he said, “Yeah, you’re definitely wheezy.” He ordered steroids, and I’m one of those people who prefer IV steroids (needles don’t bother me at all) and a nebulizer treatment.

I’m waiting and watching and waiting for a nurse. The doctor came over to confirm what the PA had found. I told him I had not received any treatment so he said he would take care of it. Waiting some more, I flagged a nurse walking down the hall. “I’m not your nurse.” Finally, I made my way to the nurse’s station, barely able to get the words out.

At first, I was told to go back to my bed. I said in the loudest voice I could muster. “Having an asthma attack. PA ordered steroids and nebulizer over an hour ago. Still haven’t gotten.” Then I had a coughing fit. That got their attention. One of the nurses looked at my bracelet and said a nurse would be right over.

It took IV Solu-Medrol, and three nebulizer treatments before the doctor let me go home. Surprisingly, I wasn’t prescribed a taper of oral steroids when I was discharged. I wasn’t breathing well all week and finally started myself on an oral taper the following Sunday. My PCP, whom I saw the next day was equally surprised, said it was the right thing to do.

I have no ready solution to my dilemma. EDs and hospitals all over the country are overcrowded. I wanted to add a patient voice to a problem I’m sure many others are experiencing.

Andrea Rosenhaft is a social worker.

Image credit: Shutterstock.com

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