A long evening in the Emergency Department

It took me several days to recover from my recent long evening in the ED. I have a harder time staying up till 2:00 am on weekdays than I used to. My old body and brain do better on seven hours sleep than on four. The night started when my sister called at 6:30 pm, saying she had been unable to keep anything in her stomach for three and a half days. Not even sips of water. She’d been unable to take her usual medications. Her abdomen hurt. But no fever.

“OK,” I told her, “we’ll come pick you up and take you to the ED. I don’t think this should wait till tomorrow.” My wife and I had her at the ED triage window at 7:15. A competent but brusque ED nurse fired quick questions at my sister.

“Why are you here?”

“I can’t keep anything on my stomach.”

“Have you traveled to west Africa in the last 21 days?”

“No.”

“Any fever?”

“No.”

“When did this start?”

“Three or four days ago.”

“Do you need a vomit bag?”

“Yes.”

“Here it is. Have a seat.”

We all sat down to wait. In about 10 minutes, another nurse emerged from a door and ushered us in to a screening room. She warmly elicited a more detailed history from my sister, took her vital signs, and asked us to wait in another waiting area until an ED room was available.

Within 10 minutes, the three of us were ushered into the ED itself.  My sister changed into a gown and lay on the gurney. After another 10 minutes, an ED nurse came in, took some additional history, then said the doctor would be coming in shortly.

We then waited, not saying much. My wife and I chatted a bit about our respective days, but my sister was too nauseated to socialize. After about an hour, the ED doctor swept briskly into the room. The doctor was all-business. No eye contact was made with my wife and me and the doctor appeared unaware of our presence. With no smile or empathy manifest, the physician asked my sister, “Why are you here?”

My sister started to explain, but after seven or eight words, shortly after saying “vomit,” the doctor interrupted her with another question. What followed could not accurately be called a dialogue. It certainly was not a demonstration of compassionate history-taking. Nor was it very astute. I was considering interrupting the doctor to tell them to slow down and let my sister actually answer the questions being asked, but I wanted to see how this would unfold. The history-taking concluded after about a minute. Notably, the doctor never asked my sister if she was able to keep anything down. They did not ask if she had been able to get in her chronic prescription meds. They did not ask whether her pain radiated to her back. They did not ask if my sister drank alcohol (she drinks virtually none, but it seemed to me to be a reasonable question). In the 10 questions fired at my sister during the one minute of history-taking, the ED doctor asked twice if she had had any fevers. I had to restrain myself from pointing out that my sister had already answered that question about 40 seconds earlier.

The doctor then proceeded to what was intended as a physical exam. This took maybe 90 seconds. Tops. The entire abdominal exam consisted of three quick pokes from the doctor’s hand.

As the doctor turned to leave, they said, “We’ll get some labs and start an IV, then see where to go next.” The doctor swept out the door, still with no acknowledgement of my wife and me. No mention of what the doctor thought might be going on. No asking if the patient or these two other people – were we family? maybe friends? – had any questions.

I could at this point bore you with more details, but we’ve all got other things to do, so let’s cut to the chase. After the blood was drawn and the IV started, we ended up waiting for another three and a half hours. Just waiting. The nurse came in periodically to check on things. Eventually we asked how long it would take for the labs to return. The nurse went to check, said the labs were all back, and the doctor should be in soon.

Another hour went by. The doctor finally swept in briskly. No apologies for us having waited so long. Interestingly, though, the doctor now was smiling and warm. The doctor said all the tests were normal except for signs of dehydration. The doctor went into some degree of explanation of what was likely going on – gastritis – and what the treatment options were. Also, interestingly, the doctor directed most of these comments at me. The doctor never asked who I was or who was sitting next to me. But clearly someone in the ED knew I was a physician and had advised the ED doc that I was part of the club and knew the secret handshake. So the ED doc had decided to play nice.

Bottom line, and most importantly, we were then able to go home and my sister made a gradual recovery over the next few days. I finally caught up on my missing sleep.

But I was left with a bad taste in my mouth. Why do doctors do this? I am sure the ED doctor was busy that night. But does showing a modicum of empathy take that much time? Is taking an accurate history that taxing? What if my sister was an alcoholic? What if she had been taking NSAIDs? What if she had been throwing up blood? What if her brother was not a physician?

All doctors are busy. All of us are overworked. But hey, that is in our job description. When I was getting my medical education, I still remember the advice to treat every patient as though they were a family member. Perhaps another way to phrase this advice is: Treat every patient you see as though their brother or sister is a physician, sitting at the bedside as you provide your care.

Richard Fleming, MD

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