Thursday, July 17, 2008


I just wanted to talk about this situation real quick...

I work in a similar ER, so I'm guessing I may be able to say a little bit. And to preface: I know nothing about this situation and I don't know anybody who works there, so I am not kith and kin to any special information.

I would be good money that woman was what we called a "frequent flyer." And I would bet good money that the woman has pulled a similar stunt before. I would also bet good money that the nurses and staff were busy that day/evening and this woman was acting her typical fool self and was craving attention and, when she went down, the staff just said "oh, jeez, there she goes again."

Because that's how the staff of urban ER's are treated.

HOWEVER, this does not make it right. What was wrong about this situation is that she was ignored completely. There are standards of care put into place to watch patients, and, just because the patient acts like this all the time, does not exempt the staff from doing their job. Why didn't anyone check on her? That's where it was awful and wrong. Patient goes down, or patient is down, someone should check to make sure that they are OK, and check on them occasionally so long as they are down.

There are two tragedies here, ultimately:

1) That we have allowed our healthcare system, and people that frequently access the healthcare system, to come to this. That somehow it's ok that ER's across the country are nothing more than recepticles for people with no insurance. That psych wards emergency rooms around the country are filled with people that should be monitored on a daily basis because of debilitating mental health concerns and without the proper social support to truly help them. If this was "business as usual" for this woman, this angry family (that's now suing the hospital -- that's fun; you can't take care of your family member, put it off on someone else, and then get angry about someone else not caring for her) should have been finding better ways to help her than letting her wander into the ER occasionally complaining about her own personal insanities. She sounds like she should have had 24 mental health support.

And, if my guess is right, I'll bet the staff was thinking she was just looking for a nice place to stay/sleep so she didn't have to be on the street that night. Because that's what happens. New York is filled with homeless people with mental health problems... I'll bet that she was OK except for the basic needs of living (out of the streets where there's food), and they let her sit that long because her needs were not as pressing as others that were presenting.

So she sat. And that's a problem, because there needed to be more care for her, and we can't provide it to her... and she has to use the waiting room of the emergency room to feel OK. That is tragedy number one.

2) That the staff would get to the point where they would feel so glib. There are a couple of sub-points:

A) This kind of setting is rough and tough and takes a special kind of person to work in. Not just anyone can deal with the problems that arise in an urban ER, let along the psych ER. No doubt, the insanity of the setting has long calloused the staff to feel distant, and probably quite a bit burnt out.

B) Patients treat staff like crap, yelling, screaming, hitting, biting, spitting, spewing off random crap. Again, who would want to deal with that kind of stuff? Especially for long periods of time...

C) There probably weren't enough people to handle the ER that night, and I'll bet she wasn't pressing. So the nurses were busy, burnt out, just feeling over the "I need attention" moves their regulars were pulling and just shrugged it off as no big thing.

D) That we would allow people to continue to work in situations long after they were effective, and unable to provide any relief except more money. (Here's the secret: nurses are paid like they are because they are often asked to double their work load, add extra hours, etc., etc., etc.)

So we have these horrendous working conditions with patients that treat them like crap -- I'll bet they were just over it that day. And I'm sorry for them that this had to happen on their shift. They did not do right by this patient, but I'll bet anything it wasn't malicious or purposeful ignorance -- I'll bet they were just done that day with all the crap they had to put up with (a clue for this: they found her at 6:30p? normal shifts end at 7:00pm, and a lot of people work 12-hour shifts... how would you feel after dealing with psych patients, on your feet all day, after 10+ hours?)

It's their fault, yes, but I sympathize in a way, because I bet they were just plum tired and busy and could do nothing else. But it also sickens me because I've heard nurses here say some disgusting words -- "oh, it's just another drug user" "just another junkie" "just another psych patient" -- and, at that point, it's time to pack it up and go somewhere else, guys (too bad, if they did leave, I'll bet they won't get paid as well anywhere else, and it will take weeks to fill their shifts, which will further burden the ER).

Does it make it right? No, but don't get frustrated and sickened by it. Realize that this is the state of healthcare in this country. We have an aging population -- hello baby boomers -- we have, increasingly, more people without health insurance; we have fewer people entering the healthcare field; and we have situations like this lady, people who are not being provided for regularly.

We'll try to blame a couple people for this, but we need to look at the wider problem and stop expecting a couple of people to carry the burden for the rest of us.

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