No clowns but lots of spectacle at Emergency

Pillar to post by Craig Westcott

Everyone has heard horror stories about the emergency room at the Health Sciences Centre. But like everything, they don’t really register unless you see it yourself.

This month, it registered on my family. On Monday, March 13, my wife Aggi suffered a heart attack. She complained of pain and discomfort in the chest, back, neck and under her left arm. Initially, she tried to ally her own, and my worries, by saying it’s probably just gas. But given the history of heart disease in her family, I said, “Let’s go.” And so, we headed to Emergency.

We got there about 11 a.m. It was full, with the lineup to see the triage nurse stretching back to the door. Once she got to the nurse, they took blood and did an E.K.G. That was around Noon. She was sent back to the waiting room to await the results.

About four hours later she finally got called in to see a doctor. Dr. Mandy Peach was great. She looked tired and she was clearly overworked, but she was humane, and thorough. She explained that after a heart attack, the heart releases something into the blood (excuse my technical explanation) that indicates it has been damaged. Aggi’s blood work had come back showing everything was okay. But the doctor was worried the test might have been done too early to pick up the heart attack markers. So, she asked Aggi to get another blood test.

It’s a good thing she did. It took another hour or two to get the results, but it clearly showed the markers of a heart attack. Dr. Peach’s thoroughness paid off, and preparations were made to admit my wife into hospital. Thus began an interesting journey.

It turned out Aggi’s bed for the night, and for five nights in fact, was a gurney in the hallway of the Emergency Department. There were five to eight other people, depending on the night, similarly stretched out in the corridors that converged on a busy nursing station. Patients suffering from every kind of ailment and in every kind of condition, were all waiting for a real bed, lying there like the two Michaels in the Chinese prison under 24-hour lighting, with bongs and dings and alerts going every few minutes from the monitoring equipment in the nurses’ station.

Visiting Aggi every night, I had to pass through the Emergency waiting room. It was almost always full. One evening the lineup to the triage nurse went right to the back wall with every chair in the waiting room taken.

In the corridor, meanwhile, where Aggi was staying, there was no privacy, little space, nowhere to store clothes, and nowhere to get a wash. It was Friday evening before she managed to get a shower, thanks to a tip from an enterprising fellow heart patient from CBS who was also on a gurney and had sniffed out a bathroom in a different corridor where you could lock the door. You couldn’t lock the door on the main bathroom in Aggi’s hallway.

But Newfoundlanders being Newfoundlanders, there were few complaints. A couple of times the place almost had that air of camaraderie found at gravel pit camps and door stoops in downtown St. John’s. Patients and relatives swapped stories, commiserated, and pitied the staff, who work so hard.

By Friday evening, with no more space left in the corridor for more gurney patients, the doctors tried shifting some patients to Carbonear Hospital, to warehouse them until beds became available in St. John’s. Aggi wouldn’t leave. Our oldest daughter was coming home from Labrador to be with her, and Aggi was afraid she wouldn’t see much of her if she was transferred around the bay. Come Saturday, a bed finally opened up on the cardiac unit and Aggi was moved upstairs. By Monday afternoon, she got a dye test and was fitted with a long stent in one of her main arteries. The next day she came home. She had spent eight days in hospital, but was lucky. She had survived a heart attack and got out in eight days. One of the fellows on the same unit had already been there more than 20 days.

Here’s a few things I learned from Aggi’s experience:

• Lack of space is as much a problem as lack of staff. This could have been avoided. Newfoundland blew it’s chance during the Williams years to prepare for the coming explosion in hospital demand. Back then the treasury was bursting with oil royalties and there was a decade left before the brown stuff would hit the fan. Instead the government blew the wad, and went even deeper into hock to finance Muskrat Falls.

When Eastern Health tore down the Grace Hospital in 2000, it failed to make provision for a replacement. St. John’s long had three hospitals and needed all of them, especially during the years when the baby boomers were being born. It seems nobody had enough sense to consider those boomers would eventually age and need even more care as they grew older.

• Big changes are needed in the shiftwork of nurses and doctors. Twelve-hour shifts are too long. Often, because many nurses are burnt out and are taking too much sick leave, those 12 hour shifts turn into 16-hour shifts or even doubles. I often work 12, 14 sometimes even 19 hours a day. But I’m self-employed and have to. I am certainly not the same bright Craigie 10 or 15 hours in as I am at Hour 3 or Hour 8. That’s when mistakes creep in. Twice while I was visiting, nurses were unsure what meds Aggi had been given earlier in the day. Fortunately, both times they carefully checked and doubled checked, and in one case triple checked, so that no mistakes were made. That’s dedication.

Eastern Health and the nurses union have to get over this 12-hour shift mentality. There would be less burnout, higher productivity and a lot less sick leave if nurses worked four 8-hour shifts a week, or five 6-hour shifts. It would also be a lot easier to replace someone who calls in sick.

• Finally, there’s too much stuff already going on at the Health Sciences Centre. It’s more like a busy Toronto subway station than a hospital. There isn’t enough space for the privacy or dignity of patients, and the whole atmosphere is not conducive to healing. It’s hard to fathom bureaucrats and politicians would situate the new mental hospital there too, and in the middle of a flood plain to boot.

Oftentimes, the Emergency Room at the Health Sciences Centre is the place where anyone experiencing a mental health emergency has to go. I pity the people who have to face it. I ran into one young woman two nights in a row who showed up at the hospital but couldn’t bring herself to go in and line up in front of a crowded room to wait for a triage nurse.

Our health system is broken in places and limping along in others. And parts of it still work remarkably well. But it is surviving thanks to the dedication of its doctors, nurses, technicians and cleaning staff and in spite of the bad decisions made 10 and 20 years ago. It costs more now to keep the whole thing going than it ever did, so more money isn’t the answer. But common sense and better thinking might be.