My emergency room experience

When I fainted and hit my head, I went to the emergency room at Sunnybrook.

Upon arriving at the emergency room, you swipe your health card in an automated kiosk, select a category into which your complaint falls, and describe it in a few words. The kiosk then issues you a number.

You sit down in the waiting room chairs, and the numbers come up on these big screens above small glassed-off offices. When your number comes up, you go talk to a triage nurse. It took less than 10 minutes (and perhaps even less than 5) for my number to come up.

The triage nurse listens to your problem, asks questions, takes your vitals, takes down all the information, takes your vital signs, and enters everything into the computer so you can be appropriately triaged.  Then I was sent back to the waiting room. Some other patients were sent into the other "zones", which have different waiting rooms, and I don't know what happens to them after that. (You can google Sunnybrook emergency room zones for more information - no point in me trying to explain it here when I don't have any information that hasn't already been put on the internet from more reliable sources.)

Soon after speaking to the triage nurse (maybe 5-10 minutes, definitely under half an hour), the receptionist calls your name, and you check in. They scan your health card, take your information, emergency contact, name of primary care physician, and issue you a wristband.  Then it's back to the waiting room.

What happens next depends on the particulars of the patient's condition. For me, another nurse called my name, and took me into a room (two examining tables/beds divided by a curtain) where he took my blood and took an EKG. This was about an hour after I arrived.  Then I was sent back to the waiting room for the longest wait of the day.  I later learned that this blood work was the primary diagnostic tool in my case, so even though I was sitting around for four hours, my blood work was at the lab.

After four more hours of waiting, they finally called my name and brought me into the "orange zone", where I was seated in another small waiting area. This made me nervous, because a lot of the patients in this area were in beds with machines and/or IVs hooked up to them. I could overhear that one patient had had a stroke, and another patient's family members were crying. It turned out this was a kind of mixed-use area - the people in beds were ER patients who were going to be staying in the hospital overnight, waiting for a bed to open up in the appropriate ward. They were also using this zone for patients who didn't need actual treatment, which is why I was there.

After sitting around in the orange zone waiting area for a bit, a nurse talked to me, asked me to tell my story again, re-took my vitals, and told me that my tests had come back normal so I just had to talk to the doctor and then I'd be discharged.  Then he sent me back to the orange zone waiting area.

After some more time waiting, the doctor called me and took me to a stretcher in the hallway that could be curtained off.  He asked for my story again, asked me questions, talked to me about my test results, did some non-invasive clothed physical exams (including stroke screening and palpating my abdomen). Then he gave me discharge instructions about how to take care of the bump on my head and what signs to seek further medical attention for, answered my questions, and sent me home.

My total time in the orange zone was 1-2 hours, my total time in the ER was about 6 hours. This was on the Saturday afternoon of a long weekend.

***

A bit about the physical environment:

The Sunnybrook ER is on the ground floor. The main entrance is on the first floor (which is one storey higher than the ground floor), so you have to go down a storey if you come in the main entrance. I don't know whether there was another easier way to access the ER.

The waiting room chairs are padded (with a vinyl-like upholstery that appears to be easy to clean) and have high backs. I can't tell you if they're comfortable to lean back on because I had an enormous bump on the back of my head. They were more comfortable than classroom chairs, church pews, or the chairs in my doctor's waiting room. I've previously blogged that ER waiting rooms should be sleepable, so I was surprised to notice that there was one (but only one) recliner-style chair that appeared to be sleepable. I'm not sure if it was there intentionally for sleepability or it was just an extra chair that they put there for more seating. In any case, I didn't try it out since other patients needed it more than me, and I couldn't lean my head back anyway.

The waiting room was very crowded (on the Saturday afternoon of a long weekend), and some patients' family members were sitting on the floor, or standing. I suspect some patients took those wheelchairs by the entrance so they'd have somewhere to sit, and after a while uncomfortable-looking folding chairs started materializing from somewhere.

There are washrooms right in the ER waiting room - two accessible family-style washrooms (i.e. with the toilet and sink behind the same door). They weren't always perfectly clean - sometimes there were puddles of water or bits of paper towel on the floor - but they were always well-stocked with toilet paper, soap, paper towels, sanitizer, etc. so our washroom experience could be as hygienic as possible. Despite the crowded waiting room, I never noticed a line for the washrooms. There is also sanitizer available in the waiting area.

There are vending machines selling water, juice and pop (just inside the doors of the ambulance entrance, by the security booth). I didn't notice anywhere where you could get food within the immediate vicinity of the ER waiting room, but I didn't ask either. There is a food court on the main floor between the main entrance and the elevators, and Google suggests that there are other sources of food elsewhere in the hospital, although I didn't investigate. Some patients' family members went and fetched food from the food court, and I suspect one person somehow had food delivered.

There are multiple password-protected wifi networks with "Sunnybrook" in the name, and no open networks. I didn't inquire about whether we were allowed to use any of them, or try to guess any of the passwords. I googled around the idea after the fact and the internet suggests that one is intended for patients and visitors, but I have no firsthand information.

There are a few wall outlets in the waiting room, but the waiting room was not designed with the assumption that everyone will have a device to charge.

I saw the triage nurses give a basin-like thing to one patient who thought he might vomit, and a blanket to another patient who was shivering, so it's possible other items for the patient's comfort might be available upon request.  No one gave me ice for my head bump, but I didn't ask either.

***

The best thing about this ER visit is that every single person I dealt with had outstanding bedside manner.

The triage nurse, young enough to see me as non-young, who squeezed my hand reassuringly when I confided that I had never been in a hospital before and was frightened, even though she's in a hospital every day and, I'm sure, sees hundreds of people with more cause to be frightened than I have.

The nurse who did my blood work and EKG, diligently requiring me to remove only the minimum clothing necessary and exposing only the minimum skin necessary (and covering exposed skin up as soon as the procedure permitted, even when the body part in question was just my calf), despite the fact that we were behind a curtain and my style of dress makes it apparent that I don't come from a more-modest-than-average cultural tradition.

The orange zone nurse, who patiently answered all my questions about what test result numbers mean even though they were normal and I didn't have to worry about them, and took the time to explain to me why I was in this section with stroke patients and people on tubes and machines.

The doctor, who sat down with me, looked me in the eye as though I had his full attention, and patiently answered every single question about what might have happened and what do I do next and how fainting works and how head lumps work and what they tested for and how they ruled out certain things, even though he was also in charge of all the stroke patients and people on tubes and machines - and even took the time to reassure me that I had done the right thing by coming to the hospital and when I should go to the hospital under similar circumstances, even though we could both see that I was the least important patient he was treating that day.

Even the security guards, who were kindly and patiently giving people directions and answering questions about where you can get food and drink and bathrooms and how the sign-in kiosks work, in between actual security guard emergencies.

Several years ago, I fell down an internet rabbit hole of reading ER nurse blogs, and I found that some of them were kind of . . . contemptuous, I suppose, of their patients. On their blogs, they dissed patients for being frightened when their condition wasn't serious, or for coming to the ER for something that isn't an emergency, or for bringing their mother even though they're a grown-ass adult. As someone who met these criteria (I didn't bring my mother, but I was considering calling her because sometimes I want my mommy when things are scary), I was kind of worried about how I might be treated in the ER. So I am quite pleased that every single person I dealt with at Sunnybrook was outstandingly kind and caring. This makes me feel far safer and more confident for next time I need hospital care.

And I sincerely hope there isn't ever a next time.

Books read in March 2018

New:

1. Medicine Walk by Richard Wagamese
2. Secrets in Death by J.D. Robb
3. 25 Days that Changed Toronto edited by Dylan Reid & Matthew Blackett 

Reread:

1. Treachery in Death
2. New York to Dallas
3. Chaos in Death

Schroedinger's concussion

My contemplations of whether I underassess my own pain aren't purely academic.

A few weeks ago, I fainted and hit my head.

At the hospital, they seemed much more interested in the cause of my fainting, but ruled out a concussion because I did not report any of the symptoms on the list.

And I did not report any of the symptoms on the list because I did not perceive myself to be experiencing any of the symptoms on the list.

Nor did I perceive myself to be experiencing any of the symptoms that I was told to seek medical attention for if I should experience them in the days that follow.

But I wasn't functioning at 100%. I was moody and my eyes got tired easily. Focusing visually was harder work than usual.

About a week after the incident, I found myself crying myself to sleep because I hadn't been diagnosed with a concussion - if they'd told me I had a concussion, I reasoned, I would have rested my brain and probably felt better by then!

Then I realized I didn't need a diagnosis to rest, so I spent my weekend doing strict brain rest like you're supposed to do after you have a concussion.

It helped enormously, but didn't completely fix my problems.

So I scaled back my work and other responsibilities and made myself a program of brain rest that could fit around my work and other responsibilities. (Working from home was a lifesaver here!)

And it helped, slowly but surely.

It's been a month. I'm doing significantly better, and I'm still not completely 100% yet. Most days are better than the day before, although sometimes there's weird slippage. (For example, today my eyes were extremely fatigued in the morning, and I haven't a clue why.)

I have no idea if I had a concussion or not, and I don't know if I can ever know.  I can't blame the doctors for not diagnosing me, because they asked me if I was experiencing symptoms, and I reported what I perceived. I wasn't trying to be brave or tough or heroic by minimizng what I was experiencing, I was accurately reporting what I perceived.

And I can't help but wonder if my own perception has been skewed by my experiences with menstrual pain. And if it hadn't been skewed, might I have reported symptoms and been diagnosed with a concussion? And gone home with doctor's orders to rest, taken a few days off work, and been completely better by now?

What if societal minimization of menstrual pain causes women to underassess their own pain?

Recently tweeted into my timeline: menstrual cramps can be as painful as heart attacks.

We've all heard of doctors taking women's pain less seriously. But this makes me wonder if the fact that menstrual cramps are considered just something you have to deal with make us underassess our own pain?

The first time I got menstrual cramps, at the age of 11, I was curled up on the floor unable to move.  But it's part of being a woman, and everyone deals with it. So I eventually learned how to work through it. The pain was the same, but, in those horrible years between menarche and birth control pills, I learned how to stand and walk and pay attention in class and pull in straight As while experiencing that same pain that left my 11-year-old self immobile on the floor.

And because it's so ingrained in me that it's just part of regular life, it would never have occurred to me before reading this article to see medical attention for something that's "only" as bad as those menstrual cramps that left me immobile on the floor. Even if it was debilitating, I'd try to work through it, maybe take an Advil if it was particularly bad.  It would never have crossed my mind that pain comparable to menstrual cramps could even be something serious!

Now I think back to all the times I've experienced something I didn't perceive as pain: "I wouldn't call it pain, I'm just weirdly...aware of it." "It feels like it needs to stretch, but when I stretch it, it doesn't feel better." "I can feel it pulsing. I wouldn't call it throbbing because that implies pain, but I can feel a pulse there." "My body is telling me not to move it that way, but it doesn't hurt when I do move it that way." "It's uncomfortable." I would never have sought medical attention, I would never have taken painkillers, because I didn't perceive them as pain.

But what if they were?

Just a couple of years ago, it occurred to me for the first time in my life to take Advil (which is an anti-inflammatory) for something (I forget what) that was inflamed. I perceived it as "uncomfortable", but would never have described it as pain.  The Advil got rid of the inflammation, and the discomfort never came back.  Prior to that, from the point of view of Advil = painkiller, I would have lived with the inflammation and discomfort for a couple of days, because I didn't perceive what I was experiencing as pain.

How much other needed, helpful medical treatment might I be missing out on because I wouldn't have characterized my experience as pain? And might I have characterized these experiences as pain if I hadn't internalized the idea that we're supposed to be able to cope with menstrual cramps?

Books read in February 2018

New:

1. Life on the Ground Floor by James Maskalyk
2. The Mask That Sang by Susan Currie

Reread:

1. Indulgence in Death
2. Possession in Death

Technobabble

When watching both Star Trek: Discovery and The Orville, I've had moments when I find the technobabble unconvincing.  My visceral reaction is sometimes "No, that will never work!" or even "WTF? It doesn't work that way!"

Which is ridiculous, because it's technobabble - it doesn't reflect any aspect of reality, and if the writers say it works that way, it's works that way. (And every technobabble I've questioned did end up working on screen.)

Nevertheless, I find myself convinced that it doesn't work that way, even though I don't actually know how it works.

I wonder if this might be due to translator brain. Some of my work involves translating things that I don't fully understand - sometimes the author and the audience know exactly what they're talking about and I don't, other times I'm learning the technical terminology and how the processes work as I go. Even when I don't fully understand the text, I still need to understand its internal logic. Should this be a "however" or a "moreover"? (Sometimes the source language vocabulary is ambiguous and I need to look at the actual logical structure.) Does this sentence support the thesis of the text, or is it a counter-argument to be refuted?

It's been over a decade since I watched new-to-me Star Trek (and for the purpose of analyzing my response to technobabble, The Orville can be grouped in with Star Trek), so it's quite possible my translator brain has developed significantly since then. Of course, it's also possible that my understanding of science and technology have developed significantly, so I'm more sensitive to meaningless technobabble.

And it's also possible that Television Writers Today are simply not as good at technobabble as the Star Trek writers of my youth.

I've just started watching DS9 (which I wasn't able to watch when it first came out), so we'll see how I handle their technobabble.