Ever have a trip to the emergency room? Here is my experience from this week….
At 8:30 PM on Saturday, January 29, Embry made the call to Kaiser Permanente, our health care provider, to determine if my condition was serious enough to visit an emergency room. I had started feeling nauseous that afternoon and by late afternoon had a bad stomachache and was throwing up black liquid with small particles. Must have been something I had eaten I figured and had neglected to even mention it to her, thinking that a good night’s sleep should clear it all up. But then that evening just as I had decided to call it a day, I hesitated, “Come and take a look at this,” I called out; and within a minute or two after examining the vile evidence, Embry was on it. She consulted the internet first, looking for “black vomit.” It turns out that there is a lot of stuff on the internet about black vomit and none of it good. She reported that the internet recommendation was to go immediately to the emergency room.
“It’s even worse than you think,” she said. “It says one cause could be disintegration of the liver. You may have to say goodbye to your predinner cocktail.”
This is serious, I thought.
I listened to her end of the conversation with the Kaiser people. It consisted of one serious “yes” after another. We have been members of Kaiser for over ten years and have had pretty good experience; and since they are an HMO, the health care delivery cost is on them. That is why you must get their approval first before going to an emergency room and why they tell you which one to go to. Not a perfect situation but understandable, given that it is on their nickel. If Kaiser says you need a procedure, you know you need it.
Embry reported back. “Emergency room. Immediately. Let’s go!”
We raced down to the car; and given my condition, Embry, who never drives at night because of her eyesight, jumped in the driver’s seat. When I asked her which emergency room we were going to, the answer was the Medstar Washington Hospital Center.
“Great,” I responded sarcastically. Why couldn’t it have been Sibley? That hospital is the closest to us, located in a fancy DC neighborhood, and recently renovated to resemble a palace with original art on the walls, plenty of luxurious lounge areas, private rooms, and a country club atmosphere. I had even heard rumors of classical music in the hallways, English high teas at four every afternoon, and meals prepared by a five-star chef.
“Kaiser has a deal with the Washington Hospital Center,” she replied.
We had both been to the emergency room before at the Washington Hospital Center. We had taken Embry’s brother, Mike, there a few years ago due to a urinary track infection. That day the situation was chaotic with ambulances backed up waiting to deposit people with drug overdoses, gun or knife wounds, along with routine car accidents, broken bones, strokes and heart attacks. It is Washington’s largest hospital with almost 1,000 beds and one of the few remaining hospitals that still serve the District’s most troubled neighborhoods. There were patients on stretchers hooked up with IVs, occupying almost every available inch surrounding work stations with computers and all kinds of medical devices, some making whirring sounds. Nurses and doctors were scampering everywhere as best as they could through the crowded space along with a number of DC police officers keeping a watchful eye on patients, some of whom were in handcuffs. I concluded at the time that it could be the only hospital in DC where in the emergency room, cops outnumbered doctors. This was a far cry from Sibley where I visioned you would be greeted in the emergency room by someone wearing a doorman’s outfit, offering you a beverage.
But that was where we were headed, and it was a Saturday night, the busiest of the week. What was I in for?
The Washington Hospital Campus is enormous and contains not only that hospital but Children’s Hospital, the National Rehab Hospital and the VA Hospital. Signage is poor, and it took a couple of mistakes to finally get on the road leading to the ER. Since there was no place to park nearby, Embry dropped me off and then went in search of parking. The idea was that I would wait in line, get seen by a doctor, get a prescription for some pills, and would be back in the car and home in a couple of hours. Embry would wait for me in the waiting room, and we would be done with it.
My first surprise was that there did not seem to be anyone waiting in the handful of empty chairs in front of the door to the ER. That was good sign though I did remember from our visit before that most of the patients arrived by ambulance. Within a minute or two the door opened, and I was invited in by two technicians, who gave me a covid test, took blood samples, and asked me a bunch of medical questions like why was I there and what was wrong with me. When I told them my disease was “black vomit,” the lady taking notes shrugged and gave me a funny look. They took down all the information, gave me a blue “vomit bag,” and ushered me into another waiting room, a dark and somewhat dismal place, with about 10 chairs and only four other masked patients waiting—one athletic man in his twenties with a blanket mostly over his head, his mask pulled down to his chin, and sleeping with a blue vomit bag beside him, an old guy in a wheelchair, and two older women, one asleep and the other on her cell phone. I figured the wait would be short with only four people ahead of me, and texted Embry that I should be out soon. I received no reply since she was still trying to find a parking spot in a mostly disserted area since for some reason parking had been restricted around the ER.
I patiently waited for a while, then checked my watch to discover that I had been there almost an hour, and only one person had been called. At this rate, it would be well after midnight before my name was called. I texted Embry in the waiting room to tell her to go home, only to receive her response that she was already home since they kicked her out of the waiting room due to covid restrictions. I texted her back that I would get an Uber home. It was not that long after that that my name was called, about 11:30, though the three others in the waiting room before me were still there.
When I entered the main emergency room, the chaos and bustling were the same as they had been years before though not as many cops and not quite as crowded. I did not get a chance to take it all in because I was told to follow a young man in a blue uniform, who escorted me rapidly around people on stretchers. The small room where he deposited me had been designed for one patient but had been subdivided into two spots, each surrounded by a curtain. The tiny spot I was assigned to was next to a wall with no windows and barely large enough for just one stretcher. I sat down on the stretcher waiting for someone to show up.
For about 15 minutes nothing happened, and then came the onslaught. I do not know how many doctors and RNs there were in the ER that night, but a whole bunch descended upon me in sequence, though separately. I counted at least five whose badge said “Physician” and probably even more that said “RN,” and they all asked me the same questions: “What is your name? How old are you? Why are you here? What are your symptoms?”
“Hey, don’t you guys talk to each other? I have told the doctors before you all that,” I commented to the third or fourth doctor to interview me. When I told them I was suffering from “black vomiting,” I got some blank stares.
All this took about 20 minutes, and they were gone. I was left alone, staring at the wall. Then after about another 15 minutes, an RN appeared with a hospital gown in her hand and told me to take off my clothes and put on the gown and wait for further instructions. Another RN appeared shortly after that and took more blood samples, then another who hooked up an IV system. Then two more who inserted a suction tube into my nose, down my throat and into my stomach, assuring me that it would not hurt but I could expect “minor discomfort,” an assertion that I was soon to learn was highly optimistic. By midnight I was hooked up, plugged in, and ready to be cured though all this seemed to happen so fast I had difficulty figuring out what was going on or where it was all headed. By that time it had become increasingly evident that I would not be going home this evening.
While my initial encounter may sound impersonal and abrupt, it was not. The doctors and nurses were friendly, seemed to take me seriously and to see me as a person, not as victim. I had had polio as a child and remember the feeling of being treated like an object or a “case” and not as a human being. I knew what that felt like. This was different.
One doctor returned a few minutes after everyone had left and admitted they were a bit stumped and that I needed a CT scan. After that a guy came in and started to push me on my stretcher, which, it turned out, was too wide to go through the door. After he took down the side rails and pushed hard, it squeezed through; and we were off to the scan, then returned, squeezing back through the door to my tiny spot. I recall commenting as we were trying to squeeze through the door opening, “Who designed this hospital anyway?”
A voice from somewhere answered, “An idiot.”
By this time, it was past 1:00 AM, and I was completely exhausted but unable to go to sleep due to the “mild discomfort” of the suction tube, which made it unable to swallow without horrific pain. The suction tube seemed to be doing what it was supposed to, however, as I watched dark liquid flow up through it into a container.
Then arrived the Guardian Angel dressed in her hospital blues and disguised as an RN.
“Feeling any pain, Mr. Howell?”
I nodded. While I did not have any pain in my stomach, in my throat where the tube was rubbing, the pain was killing me.
“How much pain, from one to ten?”
“Ok, I will sweeten the IV with a little morphine.”
“Yes, really.” And in a matter of a very few minutes, I was in la-la land, sleeping peacefully in a golden palace. This was the first of my three “level seven” answers to the pain question over the next 24 hours. It was all I could do to keep from pleading for a prescription for a year.
My Nirvana was interrupted, however, around 3:00 AM by what appeared in my hazy mind to be several physicians, one of whom, a woman in her 40s, was enthusiastically saying, “Mr. Howell, Mr. Howell. We know what is wrong with you! We have figured it out.”
There was a pause, then she said, “You’ve got ‘Blocked Bowel Obstruction!’ “
“Oh,” I said, then paused, letting it sink in.
“Wow, sounds like terrific news! You can fix that, right?”
“Yes, we can fix that.”
Before collapsing back into my dreams, I heard a soft voice from one of the other physicians, a man, “Dodged the bullet on this one, Mr. Howell.” As I dozed off again, for the first time I felt a kind of peace. I knew I was in good hands, and that they were going to get me through this ordeal.
Which they did.
A doctor, a bald, older guy, wearing a long white coat, who appeared to be more or less coordinating the myriad activities affecting me, woke me up at seven and said that matters were under control. The suction tube was working and draining out the vile black stuff out of my stomach, and the infection was diminishing. If that continued, as he thought it would, I would not have to have an operation and could leave the hospital in a day or two. Otherwise, it would probably be a week. I would be transferred to the main hospital as soon as a bed was available. “Could be awhile, shortage of beds due to covid, you know.”
It took almost 12 hours. Were it not for the morphine sweeteners administered by the Guardian Angel, I do not know how I could have gotten through this period. From the time that my situation was under control, the army of doctors and RNs who had rushed to my aid were attacking the demons affecting scores of other desperate people, many far worse off than me.
I was now in solitary confinement in limited space, with poor lighting, no windows, and little contact with the outside world except for occasional visits by my Guardian angel and another RN sticking her head inside my tent to verify I was still alive. There was a small TV next to the stretcher, but it did not work. My main activity was sleeping and occasionally checking my iPhone for messages, news, the football playoff scores, and updating Embry and our kids. But at that point I was too exhausted to do much besides try to sleep.
At 8:52 PM, however, a “transport” miraculously arrived to take me to the main hospital, pushing hard and fast along the dismal gray corridors of the hospital, as if we were off to a race, and passing by others pushing stretchers in the other direction, just as fast and as hard, carrying patients, or dead bodies under sheets.
At 9:00 PM I arrived at building 3C20A, almost exactly 24 hours from the time I entered the ER.
The second 24 hours was now underway at 9:01 PM on Sunday, January 30.
The highlight of my arrival in this crowded and busy “Kaiser ward” in the hospital was the appearance of yet another Guardian Angel also masquerading as an RN, who in hooking me up to the IV and all the other connections asked me “straightaway,” as the Brits say, what pain are you experiencing, to which I yelled “SEVEN!” That occurred around 9:30 PM and paved the way for a peaceful and restful evening, alas, the last help I would receive from pain management.
The Kaiser ward was buzzing with activity with RNs and LPNs, all women, and various assistants helping with food service and other items. While I knew I would not likely get a private room, I had hoped for a window position, but that was not in the cards. I was wheeled into a very small, double unit, which did not give me much more room than I had in the ER. There was a wall TV, however, which supposedly would work and a small bathroom (toilet only, no wash basin), and that was about it, no space even for a single chair. Before the visiting prohibitions required by covid, I wondered where a visitor would even stand. The bed next to me on the other side of a curtain also had a TV, and the question immediately came to mind—who was this person. There was a Western movie showing on his TV, which I could barely see, because the curtain separated us, and I had no idea as to who this unseen person might be, so close I could reach out and touch him but yet so far. That would have to wait until the next morning. I collapsed dreaming of Nirvana; and even though I was waked up twice by nurses checking vital signs, I got a much needed sleep.
I woke up around 6:00 AM feeling pretty good and noticed on the wall a white board with pertinent patient information. Besides my name all it said was, “no food or liquids by mouth!” followed by another warning, “bed alarm activated.” They had me. If I even got up from the bed to stretch, or to go to the bathroom, an alarm would go off. Good heavens, I thought, I am in prison.
Then around 7:00 AM, a youngish, masked, female doctor appeared, who seemed to be on top of everything. She said she had reviewed my records and concluded that I was out of the danger zone, which had turned out to be very serious, but that the doctors still had not figured out what triggered the blockage; and until they got on top of that, I would remain in the hospital as long as it took to understand the causes, but probably no more than a week. Since there were still vestiges of pain medication in my system, at the time I did not panic. That happened about an hour later: Another week in this hospital? I would go crazy!
I took a deep breath and told myself, one day at a time, one day at a time.
I was still suffering from the pain of swallowing with the tube going down my throat, a situation which changed dramatically when another doctor entered my room around 10:00 AM and announced that the tube could come out. Eureka! About an hour later an RN appeared, and out it came. Free at last, free at last! That is when for the first time I felt like calling or emailing friends and letting them know where I was and that I was on the mend. I immediately called out to my mysterious roommate behind the curtain, “Hey, roommate, I am Joe. Glad to meet you. How are you?”
I started to wonder again how I could manage to get through the rest of the day. I thought of the TV and looked around for a remote, unable to find one. Then I tried the nurse call button and waited for an hour. No one came. Ok, I said to myself, I will get their attention. I will stand up and get off the bed. Immediately an alarm blasted, and one nurse and two attendants charged in to grab me and tackle me back to my bed. I immediately sat back down before they could reach me, but it had worked. I had gotten their attention. They all three laughed and apologized. In fact, it turned out there was no remote for the TV and no nursing call system near my bed. What I thought was a nurse call button was for the telephone. They fixed that problem, and the rest of the afternoon I amused myself by watching television, first looking at MSNBC and CNN and then switching to the same Western movie channel that my mysterious roommate was watching—a movie with John Wayne and Kris Kristopherson.
The thing that continued to intrigue me was who was this mysterious roommate. I had some clues. I heard him talk to his wife and son and he seemed to have a gentle voice and to be a kind and gentle person. I guessed he was pretty old, but was he White or Black and why was he there? There seemed to be something I could barely read on his white board having to do with a minor stroke. The breakthrough came when someone from rehab came to interview him to see if he could benefit from that service. I could overhear that he was born in 1943, almost my age, that he used a walker, and that his job before he retired was a recreational therapist. I guessed African American but that did not seem to jibe with his obsession for Western movies. After the rehab person left, I peered around the curtain, being careful not to get out of the bed and sound the alarm, and said “Hi, great movies you are watching.” He smiled and said, “Glad to meet you, brother.” I was right. African American. I could not help wondering how many people go for days or longer in these hospital, double occupancy rooms with curtains separating them without ever seeing, talking to, or knowing anything about their mysterious roommate.
As the day wore on, there was still the open question of when I would get out of here. One doctor had said yesterday that I would probably be able to leave today. He appeared again just after lunchtime and confirmed that. But that did not jibe with what the other doctor had said earlier in the morning, which could mean as much as a week here. Who was right?
It was after six in the evening when I got word I could actually have a “soft meal,” which was delivered at 6:30 and possibly the worst meal I have ever had. Even after missing a whole day of meals, I could only eat a few bites. I called and told Embry to go ahead with a supper that had been planned with two friends at the KW, our apartment house, but be ready to pick me up just in case. At 7:30 PM a new doctor who volunteered she was “just a Resident,” appeared to inform me that I would be discharged tomorrow morning. When I protested, she said it was definite because they had to wait to see how I handle food before they could discharge me. I called Embry to let her know that she did not have to pick me up after all, but before I could hang up, the “Resident Doctor” reappeared and confirmed—probably blushing under her mask– that the paperwork was ready and I could leave immediately after signing.
As I started to put on my clothes and get my stuff, a kind voice from the other side of the curtain said, “Good luck, brother, good knowing you.”
“Good luck to you too, brother.”
A “transport” appeared at 7:45 PM with a wheelchair and rushed me down to the deserted, main lobby through the long, dark corridors. Since Embry would not arrive much before 8:30, I suggested he just let me walk out by myself. Impossible, he replied, against all hospital regs. He then remarked that he was supposed to get off at 8:00, said he was pissed off that I was forcing him to work overtime, and then just disappeared. I waited alone in the lobby in the wheelchair for another 30 minutes, then against all hospital regulations, got up and walked out on my own as Embry arrived, almost to the minute of my ER arrival 48 hours before.
My 48-hour hospital ordeal was over.
I was the lucky one. The ER doc’s figured out what was wrong and fixed it. I was a short-timer. I was treated with kindness and respect. But as I patiently waited for Embry in the deserted, main lobby to the Washington Hospital Center, I could not help thinking about all the others—the desperate people in the emergency room, some stumbling into the room with gunshot and knife wounds, some moaning, and the hundreds of people in the hospital with covid cases still festering, some who will never make it out alive. I thought about my kind roommate with a walker and a recent stroke victim, all the others suffering alone, with no visitors, no family or friends to comfort them and help get them through their ordeal or make their death less frightening.
And then what about the people who deliver the care day in and day out, the front-liners? I have never seen people work any harder or more focused. You can start with the doctors and the RNs, but at every level, people come to work every day helping people, many in desperate need, and in covid-time risking their own life—the LPNs, CNA’s, janitors, attendants, med techs, rehab specialists, food service people, transports and more. And in this hospital the people were overwhelmingly people of color. The list is long. How do they do it? How do they keep doing it day after day, not making all that much money, and trying to deal with their own health issues, childcare, school, aging parents, and paying bills? How to they have the strength to comfort dying people who are complete strangers? How do they just keep doing it? But they do. They have to. It is their job. No one else is around.
They are the American heroes of our time. They are saints. For them we should be profoundly grateful.