Emergency Room Visits

“…all I could think about was my son’s injury and the slow trickle of blood clotting down his neck. But, then, I started to wonder about my daughter’s question, about the audacity of asking it, about the thoughts that must now be racing through the doctor’s mind…”

by Brian Bergen-Aurand

It was a Tuesday night, about dinnertime, and my seven-year-old son was lying on a gurney in a local emergency room. My wife held his hand. I held his leg. His older sister stood near the table. The attending pediatrician was cautiously checking the inch and half gash behind my son’s left ear. Some blood still oozed from the wound he had obtained playing indoor soccer.

The doctor was asking him about the accident and if he could feel where she was pinching to see if the local anesthetic had taken full effect. He mumbled that he could not feel it.

After he was lying down, she began the first of eight stitches.

“Have you ever made a mistake?” my daughter asked her.

The anxious conversation and nervous banter filling the emergency room cubicle faded away. I stopped fidgeting with some bloody gauze and held onto my son a little tighter. My wife, daughter, and I have accompanied the youngest member of our family on many such visits over the years, but my daughter seemed extra curious on this occasion.

At first, all I could think about was my son’s injury and the slow trickle of blood clotting down his neck. But, then, I started to wonder about my daughter’s question, about the audacity of asking it, about the thoughts that must now be racing through the doctor’s mind, and about the paradox of simultaneously wanting and not wanting to know about doctors, patients, emergencies, and errors.

We have been to two of Seattle’s emergency departments (their technical names)—at Seattle Children’s Hospital and Swedish Medical Center. Both visits involved blood loss and my son being stitched up after a collision with a hard surface. Before moving to Seattle, we had visited many other medical facilities around the United States and abroad. My son and daughter throw themselves—often headlong, literally—into every athletic endeavor they pursue. Yet, my son is the one who seems always to require treatment in the end.

On just about every occasion, things have run smoothly. There have sometimes been delays or a few more tears than expected, but overall the doctors, nurses, and staff have been friendly and professional no matter the locale. And, my son has always recovered—sometimes engaging in the same or similar reckless behavior with his sister hours after getting home.

I know emergency room visits do not always go this route. And I know there are other stories to tell. But, on this evening, my daughter’s question got me thinking about our family experiences and how little I know about emergency department “visits”—a word I’ve often chuckled about.

The ProPublica website ER Wait Watcher lists ten emergency departments in and around Seattle. These locations seem to be the major ones. Using data from the Center for Medicare and Medicaid Services (CMS), ER Wait Watcher charts how long, on average, patients visiting these sites have to wait to see a doctor, be sent home, be given pain medication for a broken bone, or be admitted to the hospital. They also explicitly state, “Experts caution that very small differences between hospitals for a given measure are unlikely to correspond to noticeable differences in the real world.”

Of course, they note that average wait times and current wait times may differ significantly.

As of the February 2018 survey, Swedish Medical Center has the shortest average wait to see a doctor (11 minutes) and Northwest Hospital the longest (32 minutes). Compared to the national average of 22 minutes and the Washington state average of 26, most Seattle hospitals are doing well at attending to emergency department patients in a timely manner.

When I asked Dr. Steven Mitchell, Medical Director of the Emergency Department at Harborview Medical Center and Assistant Professor of Emergency Medicine at the University of Washington School of Medicine, about such statistics, he said, “CMS measures are a good resource.”

“When patients look at a statistic like ‘how soon practitioners provide medication for a broken bone,’ they can tell the place that is more likely to take their pain seriously. So, yes. Reporting about broken bones and similar injuries is a good measure,” according to Dr. Mitchell.

He continued, “Most patients come into the hospital through the emergency department. These departments are the front door of the hospital. At the same time, emergency departments are also a mirror of the community they serve; they are the community represented in concentrated form.”

Emergency departments, according to Dr. Mitchell, are always trying to balance accurate diagnoses, efficiency, limited resources, and expenses. Much of this balance depends on the mission of the hospital, the region it serves, and legislative funding allocations.

“It is like you are choreographing a dance in a system that is chaotic by nature,” said Dr. Mitchell. “Doctors are trained to go after every last answer regarding a patient’s condition, but emergency department treatment requires a different mind frame.”

While our regional emergency departments continue to strive to improve how they treat classic situations, such as strokes and heart attacks, they are also developing new approaches to addressing opioid (narcotic) and drug addiction as well as psychiatric illness and mental health cases, where there are “massive” shortages of “thinly spread” resources, according to Dr. Mitchell.

And then, there is the issue of treating more homeless folks, those who have “nowhere to go after dismissal,” he emphasized. “We need to communicate all this to our legislative bodies, communicate the burden or the challenge of being under-resourced.”

“Washington state leadership has been strong in this area,” said Dr. Mitchell. “We are improving every aspect we can with regard to the patient’s experience—considering what is value added, what patients value, and how to measure their satisfaction. Tracking patients after they leave the emergency department, though, can be a challenge.”

This last comment made me think again about my most recent visit to the emergency room.

When we entered the facility that evening, only one other patient was waiting in the outside area, and it appeared she had already been treated. We were admitted into triage very quickly after arriving and immediately assigned a cubicle just large enough for the doctor and the four of us.

It was cramped and somewhat noisy after another patient was assigned the room next door. Resources did seem stretched—the sink in the room did not work, and the attendant had to borrow a lamp from elsewhere to provide sufficient light for the procedure. But, little seemed out of the ordinary compared to the many other emergency room visits I have made in my life.

The staff and the doctor were all friendly, kind, and professional. And, my son seemed perfectly comfortable before, during, and after they administered the local anesthetic. He and his sister were mostly happy they could watch Madagascar on the TV monitor while the doctor closed the wound behind his ear.

In response to my daughter’s question, the attending physician replied, “Well, we don’t really know how patients feel after we treat them. We don’t see very many patients after they leave the emergency room. The ones who feel better don’t come back to us. And, the ones who don’t, usually don’t come back either.”

I suppose that answer makes a lot of sense. It was something Dr. Mitchell confirmed when we spoke a few days later, and it was all the doctor said on the subject that evening.

The next morning, convalescing over a bowl of cereal for breakfast, my son declared, “I’m the family champion of stitches!” I nodded and told him we would be happy if he just let that record stand.