‘There is an air of peril in New York ER that’s not present in Ir­ish A&E’

Visit to US emer­gency room with a nose­bleed re­veals a sys­tem brought to its knees by health in­sur­ance in­dus­try

The Irish Times - Tuesday - Health - - Emergency Medicine - Lisa Tier­ney-Keogh

The bleed­ing from my nose started three days af­ter surgery. For a year, I’d been strug­gling with the af­ter­math of hav­ing part of my nose re­moved and re­built fol­low­ing the ex­ci­sion of a non life-threat­en­ing but ag­gres­sive tu­mour. This op­er­a­tion was to be the last be­fore I moved home from New York to Ire­land.

There was no warn­ing, no ad­vance trickle of blood, but an in­stan­ta­neous gush of blood pump­ing from my nose. Stand­ing in my bed­room, still weak from anes­the­sia and pow­er­ful opi­oids, I did what my bas­ket­ball coaches trained me to do and pinched hard be­low the bridge of my nose. The pain of this pres­sure on my freshly stitched and swollen nose was im­mense. Af­ter 15 min­utes, the blood stopped.

The next night, it started again. This time it didn’t stop. Fif­teen min­utes turned into 20 (the med­i­cally rec­om­mended time to seek help), which turned into an hour that turned into two hours. By this point, the blood was flow­ing so fast it was com­ing down the back of my nose and out my mouth. It was time to go to a hospi­tal. I was hav­ing a med­i­cal emer­gency.

There are many hos­pi­tals and emer­gency rooms in New York. Some are good and some are re­ally, re­ally bad. Our lo­cal hospi­tal had a rep­u­ta­tion some­where in be­tween, but I didn’t care. I needed some­one to stop the bleed­ing.

I ar­rived into the hospi­tal wait­ing area to an empty re­cep­tion desk. Af­ter a few mo­ments, a woman wan­dered in and sat down. She was not fazed by the blood gush­ing from my nose and mouth. Restau­rants have taken take-away or­ders faster than this per­son took some ba­sic de­tails from me. She banged on a door be­hind her, sum­mon­ing, I hoped, a nurse. As she leaned back on her chair, bang­ing on the door, I half ex­pected her to blurt out, “Marge, we’ve got a bleeder!”

What’s the prob­lem?

Even­tu­ally, Marge emerged from her room and beck­oned me in­side. Tap­ping on her com­puter, com­pletely dis­en­gaged, she asked: “What’s the prob­lem?”

The large, plas­tic Mardi Gras cup I was car­ry­ing was al­most full of blood. I was still hem­or­rhag­ing from the face. “My nose is bleed­ing,” I re­sponded, calmly, go­ing deep into my happy place to cope with what was al­ready a bad start.

I was too weak to walk so a wheel­chair was found and I was pushed through a grim scene of the sick, in­jured and drunk. An Amer­i­can ER and an Ir­ish A&E are sim­i­lar on first glance. There are beeps, cur­tains, moan­ing, groan­ing and shout­ing. No­body wants to be there. Rel­a­tives slump in un­com­fort­able chairs, has­sling any­one who walks past in a uni­form about see­ing a doc­tor. But there is an air of peril in a New York ER not present in an Ir­ish A&E. Be­cause there are guns ev­ery­where in Amer­ica, and it is a more vi­o­lent cul­ture, there’s a par­tic­u­lar edge to be­ing in a med­i­cal emer­gency there that I have not felt in Ire­land.

As I slumped in the wheel­chair, dazed, with blood caked on my face, hands and arms, I knew im­me­di­ately I needed to get out of there as fast as pos­si­ble. I could tell in­stantly that I was not go­ing to get good care. My en­tire fo­cus sharp­ened to find­ing some­one who could stop the bleed, wher­ever in my head it was com­ing from.

We ar­rived at the bed I was as­signed to. The place was packed to ca­pac­ity with two or three vis­i­tors per pa­tient. There were so many beds the cur­tains that pro­vide pri­vacy could not be closed. A care as­sis­tant flung two hospi­tal gowns on the bed. One for the front, one for the back. I de­clined to put them on.

An­other care as­sis­tant ar­rived with a pri­vacy screen and placed it around the bed. The woman in the bed next to me groaned, and her daugh­ter started yelling, “So she gets a screen be­cause she’s white?” She was right. I hadn’t asked for it, but I was of­fered pri­vacy when oth­ers weren’t.

A man wan­dered by in a bright, green gown, singing at the top of his voice. He turned to us, lifted his gown, and ex­posed him­self. A woman on the other side of the room started shout­ing. My nose kept bleed­ing. Fi­nally, a doc­tor ar­rived to de­ter­mine if I was hav­ing an an­te­rior bleed (okay) or a pos­te­rior bleed (not okay). Though the doc­tor was kind, she was not pay­ing full at­ten­tion to me. How could she, the place was bed­lam. The singing man ex­pos­ing him­self was a psych pa­tient. A man in a bed op­po­site me was groan­ing loudly in pain. The woman who com­plained about the pri­vacy screen had reached the thresh­old of her pa­tience and be­gan scream­ing at the staff. You could cut the air with a knife.

And in that mo­ment, I was afraid some­body might ac­tu­ally do that.

Nasty busi­ness

The doc­tor wanted to pack my nose – a com­pli­cated, nasty busi­ness. If she’d looked at my case in the hospi­tal sys­tem, she’d have known not to do that. She’d have known to call an ENT. She had all the in­for­ma­tion at her fin­ger­tips, but she was too stretched to do any­thing about it.

I re­sisted fiercely. I knew a packed nose could po­ten­tially undo sev­eral surg­eries and do more harm than good. I fol­lowed and trusted my gut, a ter­ri­fy­ing thing to do when you are los­ing blood and scared out of your mind.

At 3.30am, the bleed­ing stopped and I left, barely stop­ping to sign my­self out. I couldn’t bear to be in that room a minute longer. In a coun­try as big as the US, in a city as rich as New York, emer­gency rooms are still strug­gling. The Amer­i­can health in­sur­ance in­dus­try has the med­i­cal pro­fes­sion on its knees. Try­ing their ut­most to of­fer good care, while be­ing nickel and dimed for ev­ery square inch of the hu­man bod­ies they treat.

The end re­sult of this is in­dig­nity: for pa­tients, and doc­tors, and nurses.

The se­cu­rity guard nod­ded to me as I left the build­ing. It was a quiet mo­ment of ac­knowl­edge­ment be­tween us. I was leav­ing. He had to stay and stand guard. I wasn’t out of the woods yet, but I was go­ing home.

And I was lucky to do so.

The doc­tor was not pay­ing full at­ten­tion to me. How could she, the place was bed­lam


In a coun­try as big as the US, in a city as rich as New York, emer­gency rooms are still strug­gling.

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