OUT OF THE OFFICE: Experiencing the ED from the ‘Other Side’

Sal Iaquinta, MD

The doctor as patient is nothing new. In fact, it’s impossible to avoid. But, boy, can it be an eye-opening experience.

Without going into too many details, let me start with “The bicycle helmet did its job.” I managed to crack both the front and back of it, but I didn’t pass out or get a concussion or even a headache. In other words, I was lucid for the entire hospital experience.

The first lesson learned was one I’d heard a thousand times. It’s hard to overcome first impressions. This is sometimes reworded to the front desk staff as You are the first face a patient sees. You shape  their care experience. Unfortunately, the man at the ER entrance, when asked by my girlfriend to help me out of the car, replied with exasperation, “Well, how did he get into the car?”

Fail.

The point of this article is not to malign the very place I work for, but it would be disingenuous to mention only the bright spots. My experience also helped me realize that as a physician I never spent much time thinking about what happens before and after I’m in the room with a patient. As a patient, however, I got to witness the entirety of the experience.

Perhaps the second lesson of the adventure is that of Patient Personality. During medical training we are told that “the hypochondriac will die of something . . . take every complaint seriously until proven otherwise.” The Stoic Patient is almost the opposite: “The patient that complains of nothing will die of something . . . so what are they here for?”

I add the joker element to stoicism. I’m guilty of keeping quiet, even in severe pain, and I’m guilty of bad jokes. Yes, I confess I told the nurse who asked if I was willing to accept a blood transfusion, “No, because then I can’t time travel back to yesterday and undo this.” It only makes sense if you’ve seen Edge of Tomorrow and latch onto the nerdy time travel rules. Like I said— “bad jokes.” Antics like these, along with otherwise keeping quiet, meant I slowed the discovery of my internal bleeding and numerous fractures. In my situation, time was not of the essence, so no big deal. But it did make me realize that I’ve seen a number of jokesters. And  even more minimizers, some to such a degree that their chief reason for coming to the hospital is “because my wife sent me.” Sometimes it’s “husband,” but in my experience wives do more of the sending. Regardless, these patients demonstrate that the medical history might not be as fruitful as the medical exam.

The third lesson is that of empathy and caregiving. I interacted with no fewer than 15 health care workers in the first few hours of my hospitalization. One of the standouts was a young phlebotomist— her visit epitomized the ideal health care interaction. She was efficient without rushing. She was focused on me; there was no one else in the universe waiting for blood to be drawn. She expressed regret that I was there that day. She explained every step of what she was doing—no surprise needle pokes. I felt she took pride in her job and actually cared about me. Whatever it is that gave her those qualities, I wish I could bottle it and sprinkle it over the entire planet. There had to be something more than focus and patience, but those are two good places to start. Can I walk into a patient’s room and leave the rest of the busy world outside the door? She showed me it’s worth trying.

My next observation isn’t really a lesson. But I realized how much of an art nursing is. It takes empathy plus a whole lot more to care for a group of unwell people. My nurse was part cheerleader (“You can do this.”), part coach (“OK. This is how you can get out of bed without hurting your ribs.”), part negotiator (“If you don’t get out of bed, you have to use this bedpan.” I got out.), part servant (“Is there anything I can get for you?”), part drill sergeant (“Stop! And give me 20 on the incentive spirometer.”). And it’s all delivered with kindness, all day long, to multiple patients. I thought my fatigue was a side effect of the narcotics, but the more I think about it, the more I believe it was from watching the nurses run around.

Whenyouputitalltogether, yourealize that the delivery of health care isn’t a well-oiled machine. It needs to function like one, but really it is a play with an ensemble cast taking place at a dinner theater. The patients are both participants and audience, watching the entire time. Every second. And just like a play and its actors, the hospital staff can’t drop out of character, forget their lines, or be dismissive of their patrons.

This sounds like a lot of pressure, being “on” all the time, but that’s what it is. And the stakes are higher and harder to accomplish than those of a dinner theater; we aren’t wowing people out to have a good time with well-timed jokes and good food. We are trying to help people having a rough time . . . perhaps the worst of times.

But all that said, it’s worth the effort to put a smile on their faces. That’s why you went into medicine.

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Dr. Iaquinta is a San Rafael otolaryngologist
Email: Salvatore.iaquinta@kp.org