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What the ER?

Emergency Room - The department of a hospital responsible for the provision of medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department personnel may also respond to certain situations within the hospital such cardiac arrests.


The emergency department is also called the emergency room or ER.


“In need of immediate care”…Last Monday at around 5:30am I decided that I was in need of immediate care so I went to one of my local ERs. My neck had been a solid 10/10 on the stupid pain scale since that Saturday. The pain had started late that Friday afternoon. Whatever was causing this pain was not allowing me to sleep, I literally could not lay down in my own bed without extreme pain. I also had almost no range of motion with my neck and was starting to get horrible headaches. Needless to say, I was on no sleep for 48 hours and counting. If that does not qualify as “in need of immediate care” I’m not sure what does. 


Let me back track a little bit. That Thursday I had cervical spine injections into my C2 - C4 vertebra, a total of 12 shots. My ER pain was coming from this area on my neck but it was much worse and felt different than the pain that led to those injections. This procedure was my third and final week of injections for that area. Now, I’ve had these type of injections multiple times before without any side effects or issues. I wasn’t sure but logic would suggest that I was finally having my first side effect from spinal epidurals. 


Back to the morning at the ER. There were 2 girls at the front desk of the ER as I walked in. Both of them could tell within minutes that I was barely hanging on mentally. My inability to turn my head to answer questions quickly alerted them to how severe my neck pain was. I was sent back to a room within minutes of arriving. 


Once in a room, lucky number 13 actually, the nurse asked me to change into a gown. She began to ask for my story. I began to explain in great detail how laying in my bed, regardless if I was on my back or side, was causing extreme amounts of pain. Since I could not lay down nor sleep I told her that I had not slept since that Friday night. This entire process of telling my current patient story only took 3 to 5 minutes I’m guessing. Once I was done explaining why I was there, the nurse asked me to lay on the bed and wait for the doctor whom she did not know how long it might be before he would be in. 


What the ER? Yes, after explaining in great detail how I had not slept for 48 straight hours the nurse asked me to lay down on the obviously “to short for me” hospital bed while I waited for the doctor. Anger is not good for pain control I quickly found out. 


For as many times as I’ve been in an E.R., and its been a bunch, it seems like every staff believes those cheap curtains that surround every room are also sound proof. I don’t understand this. This is not an attempt at a joke or sarcasm either, this comes from listening to belly laughs, stories about employee parties, someone’s date that had gone wrong, and what I think was an eventful Saturday night in that E.R. (I’m not exactly sure on when the highlights actually took place, I had to time infer some based on the loud employee conversations I could hear). St. Al’s needs a sound proof break room for their employees if there are not going to treat patients. 


I listened to these employee conversations for 43 minutes before the doctor came to my room. Many might be asking how I know it was 43 minutes, well I had decided that if I hit 60 minutes of listening without seeing the doctor I was going to walk out the front door and go to the other ER in Boise. The only reason I had choose this particular ER was because that hospital is where I had my neck surgery and I absolutely loved my neck surgeon. As many of you know, my brother and I had been treated horribly by the staff at St. Al’s as our Dad was dying in their care. To say I had mixed emotions being there that Monday morning was an understatement. 


The doctor came in with a medical student. He did not apologize for the 43 minute wait or even acknowledge it. This med student, probably in his early 20s, was trying hard to ask me probative and inquiring questions as to why I was in the ER but was so timid I thought. My answers got short and curt unintentionally, if I was in less pain I would have been more than happy to talk to the med student. My pain required immediate attention, not education. To the ER doctors credit, he took over the exam fairly quickly in an attempt to keep the peace, and by peace I mean keep me from yelling at everyone. 


Now, as a chronic pain patient with a rheumatoid arthritis diagnosis, I’m on constant opiates for my pain. For the record, I started with baby aspirin and worked my way through many different pain management control options before arriving on opiates. I realize that due to the current political and social climate many, if not most, assume I’m a drug abuser. Nothing could be further from the truth on that Monday morning. I was not in the ER for any form of opiate or other pain relief, I wanted either some x-rays or MRI done on my neck. My pain level were such that I would have been o.k. if they told me that I needed to go in for emergency neck surgery. Understanding and knowing the why behind any chronic pain can be a great comfort both physically and mentally. (Also for the record, my absolute worse day of pain, before that Monday, was when I fell off a cliff rock climbing and required 10 screws/plate to put my left arm back together. So that means I was equating my neck pain at that moment to that same pain as the night I fell). 


As the ER doctor checked my strength and for any neurological issues, I started to calm down some. My strength was normal and although I was having brain fog due to the pain and no sleep there were no other indictions of neurological issues. This convinced the ER doctor that I was in no immediate danger. I still wanted an MRI or X-rays, something to tell me what was causing all this pain, answering the why should be apart of every exam or am I just another arrogant epatient disrespecting paternalistic medicine??


The ER doctor was not going to answer this question for me. Not only wasn’t he going to answer the big “why was I hurting” question, he wasn’t even going to try. What the ER? I received some crap explanation about how I needed to go back to my pain management doctor because he was the one that had completed the cervical injections. 

There was something about stepping on the toes of a specialist I think, I’m not really sure because I was back to being angry again and not really paying much attention at this point.


This leads me to my final What the ER? Despite not knowing why I was in pain, nor having any desire to diagnose the why, he told me that he was more than happy to treat my pain. Of course I got some lecture on the biochemical engineering of the dopamine receptors and why my opiate use was bad for them first but he did write me 2 prescriptions for pain and prescribed me a toradol shot. So healthcare, you won’t help me discover the why, will lecture me on my current opiate use, but will prescribe pain relief anyway. WHAT THE ER? 


It is now 6 days later. I was able to get into my pain management doctor on that Tuesday who is not entirely sure as to why I’m hurting. He prescribed a 5 day prednisone pack in the hopes of getting me some immediate relief. I’m happy to report that with the help of Benadryl, Percocet, prednisone, Flexeril, and my regular meds that my pain is now a 5/10 and I can sleep without extreme pain, I’m still in pain mind you. Sure wish I had some idea as to what is going on in my neck but maybe I’m just to greedy??


“In need of immediate care”…I still strongly believe that going to the ER that morning meet the definition of “in need of immediate care”. My body was rapidly losing the ability to heal itself and since I live alone, this could have led to more serious and scary issues like hallucinations or heart issues. I needed sleep and breakthrough pain control immediately, in hindsight, driving myself to the ER was probably stupid. That said, I have this feeling that healthcare would have preferred I stayed home in pain and not sleeping. Healthcare thought I was still a ”bankers hours” patient and not someone in need of immediate care. Is healthcare right?


One final thought, I currently have good health insurance and enough cash on hand to cover the cost of my ER visit without any change to my current lifestyle. Money is not a factor in my What the ER? experience, this is definitely symptom of something larger than its “big insurance” or “big hospitals” fault. Healthcare needs to be a human right, not a checkbook right. My checkbook is currently working well and I’m still asking What the ER?

Alan Brewington