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Tale of last 90 minutes of woman's life
June 2, 2007 10:32 PM   Subscribe

In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.
posted by bigmusic (114 comments total) 11 users marked this as a favorite

 
I hate stories like this because I feel like there's something I'm not being told. I can't imagine a situation where other human beings in a medical facility would ignore something like this, and that makes me doubt the whole story is being told. Whatever the case, it's very, very sad.
posted by katillathehun at 11:03 PM on June 2, 2007


Yeah, LA local news? Too much of the story missing to muster outrage. She had a warrant out for her arrest? For what? Perhaps her and the nurse had another history here that wasn't told.
posted by vacapinta at 11:08 PM on June 2, 2007


Wow, you people are cynical.

And even if she and the Nurse had a "history", how would that make what happened appropriate? And weren't there more then the one person at the hospital?
posted by delmoi at 11:10 PM on June 2, 2007


Sounds awful. Death by perforated large bowel. Absolutely torturous.
posted by j-urb at 11:14 PM on June 2, 2007


Wow, you people are cynical.

Oh, it was tragic either way, no doubt. Just seems like their was a backstory and I want to know more. It was in no way "appropriate." Please dont put words in my mouth.
posted by vacapinta at 11:16 PM on June 2, 2007


If she had a perforated large bowel, it's no wonder she was screaming, writhing and "complaining"... Whether she had an arrest warrant or not, she didn't deserve to die like that... But I wish we knew more of the backstory.
posted by amyms at 11:17 PM on June 2, 2007


Okay, I didn't mean to put words in your mouth. But what did you mean by saying that you couldn't "muster outrage"? That it wasn't outrageous? That it might or might not be outrageous depending on those missing details? It seems to me that no additional information could make the story somehow OK.
posted by delmoi at 11:21 PM on June 2, 2007 [4 favorites]


Are there going to be any consequences for the hospital staff at this point? Anyone know?
posted by delmoi at 11:24 PM on June 2, 2007


I'm an Icelander living in the US (New England, specifically). My experience in dealing with American ER's (always as a friend, boyfriend or husband of the patient) hasn't been very positive. Once out of the waiting room, things have generally been good, but getting through the gate can be completely absurd. The prevailing attitude has always been that the person with the complaint is probably either lying, insane or both or perhaps just out to play a malicious practical joke on the medical staff. Due to completely idiotic stunt medicine by a triage nurse my wife was stripped of her diagnosis, untreated and then rediagnosed with the same condition (four months later by a specialist). My experiences in Europe (Iceland, France and Denmark) have been much more professional. Nobody gives the patient complimentary chocolate, champagne and oral sex, but I have never been treated like a piece of shit dirt lint stuck to the pantscuffs of the ER staffs' existence.
posted by Kattullus at 11:26 PM on June 2, 2007


Due to completely idiotic stunt medicine by a triage nurse my wife was stripped of her diagnosis, untreated and then rediagnosed with the same condition (four months later by a specialist)

How did that happen?
posted by delmoi at 11:31 PM on June 2, 2007


This is hardly the first scandal for this hospital in recent months; the city's been trying to shut them down for years due to mismanagement and incompetence. Lots of scary stuff: nurses ignoring patients' heart monitors, a meningitis patient getting blasted with anti-cancer drugs for four days, people getting hit with Tasers in the psychiatric wing, etc. The place's nickname is "Killer King," and for good reason. The LA Times earned a Pulitzer for this horrifying but fascinating five-part series on the place.

The neighborhood the hospital's in has been extremely resistant to the idea of shutting the place down, however. Jesse Jackson's even gotten involved.

Horrible story, in any case, and a horrible way to go out.
posted by infinitywaltz at 11:34 PM on June 2, 2007 [5 favorites]


infinitywaltz writes 'This is hardly the first scandal for this hospital in recent months; the city's been trying to shut them down for years due to mismanagement and incompetence.'

That sounds like a backstory to me.
posted by PeterMcDermott at 11:44 PM on June 2, 2007


That sounds like a backstory to me.

I agree. Should have been in the FPP.
posted by vacapinta at 11:47 PM on June 2, 2007


But what did you mean by saying that you couldn't "muster outrage"?

Because without any other info this was: random woman dies in random emergency room oh and trust us, there's this video which if you saw, really, would cause you to be outraged, really trust us on this.

I like to have all the facts before I grab my pitchfork, delmoi.
posted by vacapinta at 11:50 PM on June 2, 2007


Seconding the stories about how hard it can be to get attention in the ER. The last time I was in an ER, I was having an anaphylactic reaction to an antibiotic I was taking. When the triage nurse saw that I was breathing on my own, it didn't matter that I had all the signs - hives, swollen face and throat, etc - I was sent to a waiting room outside the ER. I sat there for 90 minutes before I saw a nurse. Another 90 minutes later and the reaction went away on its own with the help of some Benadryl, but it could have turned nasty very quickly (at which point I assume they would have taken me in, but I was surprised they didn't at least keep me where I could be observed).

And pain, in particular, is a symptom that sometimes gets suspicion. I suppose it's a reaction to the idea, real or not, that addicts will go to an ER and fake pain to get their fix.
posted by spaceman_spiff at 11:51 PM on June 2, 2007


The history on this hospital is so bleak and awful. Sadly, this news is nothing new, whatsoever.
posted by basicchannel at 11:53 PM on June 2, 2007


To be clear: You go to King/Drew to die. That is not hyperbole.
posted by basicchannel at 11:54 PM on June 2, 2007 [1 favorite]


To add to the backstory, it seems that racial politics also play a large role in why the Board of Supervisors have let things get as bad as they have. It's all there in the LA Times article, which I've only just now gotten around to reading all the way through.
posted by infinitywaltz at 11:54 PM on June 2, 2007


OK, so far the worst scandal, narrowly beating this incident and the neglected heart monitor cases, is the woman who contracted HIV from a blood transfusion administered during a hysterectomy.
posted by infinitywaltz at 11:59 PM on June 2, 2007


OK, so far the worst scandal, narrowly beating this incident and the neglected heart monitor cases, is the woman who contracted HIV from a blood transfusion administered during a hysterectomy.

How is dying of a perforated bowel less worse than getting HIV? Don't get me wrong, they are all horrible situations, but you can live with HIV.
posted by qwip at 12:04 AM on June 3, 2007


It sounds like she died of the same condition I had in January. I had a perforation that created an abscess. It took four days of excruciating pain (and, believe me, I'm very familiar with pain, have a high tolerance, and have had five kidney stones...this was worse) before I finally went to the ER.

Even though there were many people waiting for care, it was only a few minutes before they called me back to a room. As my mother (an RN) told me, they have to take any abdominal pain very seriously. In fact, another nurse complained that there were people waiting ahead of me when I was taken back to a room. But the response was "the doctor said to take him to a room, now". Admittedly, it took hours before they CT scanned me and saw the abscess. However, once they saw the abscess, they admitted me to the hospital immediately1.

Once out of the waiting room, things have generally been good, but getting through the gate can be completely absurd. The prevailing attitude has always been that the person with the complaint is probably either lying, insane or both or perhaps just out to play a malicious practical joke on the medical staff.

Because of those kidney stones and this incident, I've had numerous experiences with emergency rooms in two different cities (Austin and Albuquerque) at several different hospitals. And I've not encountered the above mentioned attitude and in general my experiences have always been good. Also, many of those visits have been when I didn't have health insurance.

But I've known enough to avoid the hospitals which are the regional trauma centers and/or where all the uninsured people go (even though I was one of them). Once you're at the ER, a hospital can't legally send you anywhere else, if I recall correctly. So I think the amount of hassle you get at an ER is mostly a function of how overworked and poorly funded a particular hospital is. I've avoided those hospitals.

And this hospital sounds like one of the worst in the country.

And pain, in particular, is a symptom that sometimes gets suspicion.

That's not been my experience. In all cases, the triage nurse/staff has taken my reports of severe pain very seriously.

However, it's also the case that I'm an articulate, friendly, white male. I mean, hell, when I've been arrested by the police I've been treated well. So my experiences are not necessarily representative of those less privileged than me.

1. On reflection, though, I recall that it was at least two hours before I got any real pain relief. The actual working of my case was pretty slow. But it usually is. Anyway, I think I should also admit that I'm rarely critical or impatient and I'm very forgiving. What other people complain about, I may not even notice.
posted by Ethereal Bligh at 12:08 AM on June 3, 2007


"It's unconscionable that anyone would ignore a patient in obvious distress."
{they seem to quote a lot of 'supervisors' and health authority types in that article - that's odd considering the legal shitstorm they are facing}

Mm. I can't quite believe that individuals working there would allow this situation to go on. Maybe the hospital has a bad rep. and is up for review but it's out of my comprehension ability to think that they only employ bad workers who would ignore the situation for so long. I've done enough emergency room work in the past to understand having a cynical attitude towards patients you don't believe, but unless there is a hurricane or building fire and patients are just stacked to the rafters, you would never ever, not in your wildest dreams, allow someone to just be writhing on the floor for that long, even if only because you wouldn't want them in full-view of people you regarded as more legitimate. (just meaning that, even if I thought she was totally lying for whatever reason, she'd have to be on a bed and if possible you'd want to put her in a sideroom --- and of course you'd need to do her B.P. etc regularly even if the doc was too busy to see her immediately)
posted by peacay at 12:10 AM on June 3, 2007


My experience in dealing with American ER's (always as a friend, boyfriend or husband of the patient) hasn't been very positive.

I had a broken kneecap a few months back, and it was about 20 minutes before they could find me a wheelchair, and about an hour and a half before anyone could find me a bag of ice to ease the pain. My brother had a concussion a couple weeks ago and it was difficult finding him in his hospital. I'm sure there are exceptions, but some ERs are definitely not run by compassionate people.
posted by Blazecock Pileon at 12:13 AM on June 3, 2007


How is dying of a perforated bowel less worse than getting HIV? Don't get me wrong, they are all horrible situations, but you can live with HIV.

I didn't mean that one is worse than the other for the patient, but as a complete medical layperson, it seems to me like the HIV infection is more scandalous because there are so many precautions involved that you really have to screw up in order for that to happen. A bowel perforation, on the other hand, while horrible, seems like something that a doctor could miss, or at least not treat in time, without necessarily being grossly incompetent.

Again, I'm not a doctor, just a hypochondriac who watches a lot of House and ER, so someone who actually has worked in a hospital is much more qualified to comment than me. I'm just giving me first impressions as I work my way through this humongous LA Times piece (and thank crap I don't live close enough to this hospital to end up there).
posted by infinitywaltz at 12:16 AM on June 3, 2007


I'm sure there are exceptions, but some ERs are definitely not run by compassionate people.

Not singling you out but I caution against people who make up their minds to judge a facility from one or two visits ---- you can never really know how busy these places are or what the staffing levels are like or what's really going on. If individuals are careless or horrible that's one thing but generally it's been my experience that the nature of the work attracts empathetic people who like to help other people: in this endeavour, dynamic circumstances beyond anyone's control often dictate how long a delay will be. A sore knee is low priority. Sorry.
posted by peacay at 12:27 AM on June 3, 2007


A sore knee is low priority. Sorry.

It was a broken knee, and the leg was pretty swollen. All I asked for was a little bag of ice while I wait. I'd apologize for being such a whiny whiner, but I wonder if apologizing for unempathetic, hostile care helps hospitals like these to continue to operate, and why healthcare continues to be such a miserable experience for so many.
posted by Blazecock Pileon at 12:44 AM on June 3, 2007 [2 favorites]


In St. Louis, there are definitely hospitals to go to and hospitals to avoid. The times I've had to go for my "thing," which tends to leave me in a lot of abdominal pain, I had an IV dripping Demerol and other painkillers fairly darn quickly. I think it's a combination of the hospital, the night you go, and the people on staff at the time. In some cases, the hospital is so bad the other factors just can't counteract it.
posted by adipocere at 12:48 AM on June 3, 2007


You know, it's not any secret that if you go to MLK E/R, you're not going to be getting the world's finest standard of medical care. That E/R is really dysfunctional, even by the "American E/R" standard.
posted by ikkyu2 at 12:50 AM on June 3, 2007


There may be other stories about American ERs not being up to snuff, but King/Drew, as infinitywaltz referenced above, is an especially terrible place. Whenever I read a story in the LA papers about that hospital, I wonder if they aren't a taste of what's to come for a lot of public urgent care facilities in urban areas. I hope other cities are watching and learning something from thier horrible example (and I also hope the rainbow unicorns shower me with golden Gund teddies, haha..ha.... *sob*)
posted by maryh at 12:57 AM on June 3, 2007


-broken knee-
Was it sore? Then it was a sore knee until you were xrayed. Again, of course I can't account for specifics but I know one place I worked at where getting ice was a not small deal. I'm just suggesting that your circumstances/description are entirely subjective (of course) and may have been completely different if they happened the next day.
posted by peacay at 1:00 AM on June 3, 2007


me: Due to completely idiotic stunt medicine by a triage nurse my wife was stripped of her diagnosis, untreated and then rediagnosed with the same condition (four months later by a specialist)

delmoi: How did that happen?

My wife has epilepsy. One night she had a seizure that was abnormal for her so we booked it to the ER. She started seizing (complex partial) in the waiting room. I inform the triage nurses. One of them grabs a packet of smelling salt and walks briskly over to my wife, who is slumped back in a chair, and waves the smelling salt around in front of her face. My wife wakes up in that way that people do when someone puts smelling salts in the vicinity of their noses. The triage nurse declares that my wife doesn't have epilepsy, that there's "something else wrong with her." Some while later we are escorted into an exam room. Long story short, the doctors there undiagnose her epilepsy and refer her to a neurologist who specializes in non-epileptic seizures. This being a busy lady, the first appointment my wife gets is 4 months later (which was actually earlier than we expected). After getting my wife's history (childhood seizures which reappeared in her late teens) and doing some basic tests she rediagnosed her with epilepsy. The specialist was not happy that my wife's epilepsy diagnosis had been stripped based only on the incident with the smelling salts. There are a lot of other explanations for why she woke up, the most likely (IIRC) being that while her seizure had ended, she wasn't fully with it yet. Now my wife is back on lamictal, has undergone a massive amount of tests and is going back to see the specialist in a couple of months for a follow-up. But there is no question, she has epilepsy.

The point of this story is that the triage people (and the ER was anything but slammed, I should add) operated on the assumption that my wife (and I) were either lying, crazy or both. And, furthermore, that they knew better than the neurologists who had made the epilepsy diagnosis. So they opted for this little stunt that did nothing but sow confusion. My wife went through four months of having to question her sanity. My previous experiences with American ERs have been similar, if, thank jebus, not nearly as extreme. Admittedly, one of those visits was kinda stupid. I escorted a friend who had gotten hypothermic because of an acute case of being from Florida (sledding in a tracksuit). I agree that there was no need for that to happen.

Every time I've been in an American ER waiting room, I and whoever I was with, have been made to feel like we're there only to cause the staff consternation and annoyance. I've never faced this attitude in emergency rooms in the three other countries where I or someone who's needed my assistance has had to seek immediate medical help. And some of the reasons have been pretty darn stupid. Such as my very drunken, shouty friend who had to have some gashes in his face sown up (from repeatedly falling into a grand piano).

peacay: If individuals are careless or horrible that's one thing but generally it's been my experience that the nature of the work attracts empathetic people who like to help other people

Yes. The nurses I know personally, whether they're family or otherwise, fit that description perfectly (doctors are more hit or miss :) ). Which is why I've been continually shocked when going to emergency rooms in the US. Let me stress that once out of the waiting room, into the ER itself, everything was of the highest quality (well, except the food, but as I've worked as a hospital cook, I'm actually endowed with the ability to tell good hospital food from bad*). The doctors and nurses in the ER have always been professional in every way. My problems have been restricted to the waiting room.


*Good hospital food only makes you wish you were dead... incidentally, the reason most hospital food tastes really bland and unpalatable is that there's very little salt in it (b/c it might kill someone) and you have to know what you're doing (or, as in my case, have someone tell you what to do who knows better) to make the food unbland and palatable.
posted by Kattullus at 1:09 AM on June 3, 2007 [3 favorites]


Was it sore? Then it was a sore knee until you were xrayed.

I think walking on a sore limb and dragging a broken limb are somewhat different. Perhaps you needed to be there?

I know one place I worked at where getting ice was a not small deal.

That's unfortunate. I feel bad for whoever had to go there to beg for pain relief.

Every time I've been in an American ER waiting room, I and whoever I was with, have been made to feel like we're there only to cause the staff consternation and annoyance.

Indeed.
posted by Blazecock Pileon at 1:11 AM on June 3, 2007 [1 favorite]


Not to take anything away from Blazecock Pileon's suffering, and indeed it does sound like a pretty bad experience, but there's a huge difference between crappy customer service and the kind of gross incompetence that occurred in so many of these cases at Martin Luther King Jr./Harbor Hospital.

Yeah, for all the money it costs to go to the hospital, you'd hope people would treat you a lot better, but I'd still take rude receptionists and a long wait for ice over death by perforated bowel, HIV by blood transfusion, or unnecessary chemotherapy by pharmacy error.
posted by infinitywaltz at 1:20 AM on June 3, 2007


blazecock, i don't care if you had a spike through your head, it was just a headache until you had an MRI.
posted by Hat Maui at 3:56 AM on June 3, 2007 [6 favorites]


I can only imagine how bad a broken knee must hurt. Apparently, some people can't even do that.
posted by Kirth Gerson at 4:13 AM on June 3, 2007


You know what I loved, the day I shattered my elbow? As I'm clutching it with my other hand (it didn't go through the skin, but you could clearly see the breaks), the admitting nurse tries to give me a stack of forms and a pen to sign them with -- umm, Queen of Common Sense? Kinda holding my elbow together right now, thanks. I know I was in shock, but I remember the whole thing being very surreal.
posted by bitter-girl.com at 4:35 AM on June 3, 2007 [1 favorite]


That reminds me of what a proffesor of mine told me one day: "If the devil comes and complains to you about pain he has, and you are sure that he is a healthy liar, you must be wrong and he must be right!"
posted by zouhair at 4:53 AM on June 3, 2007


And where in all this is the head of the hospitl who makes....tons of money, as most CEOs do at such places. No statement from him or her?

Note: in America, those with no health insurance usually do not have doctors. They go to emergency rooms for any and all medicl problems. Costs are then shuffled off onto those in the hospital with coverage. Then the insurance companies to cover their losses charge more for the coverage. And so it goes....
posted by Postroad at 4:57 AM on June 3, 2007


I don't care if you had a perforated bowel, it was just indigestion until... you died in our waiting room?!

oh and infinity, I think that difference in degree of seriousness is obvious enough, but even a relatively minor (if minor equals not causing one's death!) example of incompetence or carelessness in an ER can be enlightening about an attitude of carelessness in far more serious situations, don't you think?
posted by pleeker at 5:00 AM on June 3, 2007


This is really sad.
posted by hadjiboy at 5:06 AM on June 3, 2007


All I can say is thank goodness a few of the posters in this thread don't work in emergency rooms.

(Rereads link.)

Whoops. Actually, it seems they do.
posted by Astro Zombie at 5:25 AM on June 3, 2007


I was in an ICU for about a week, part of my time I shared a room with a screamer. The whole floor was littered with rooms that contained screamers. They'd wait until the lights went out and the TV was off, then they'd just start screaming and moaning. The nurses, accustomed to this, were rather taken aback when I asked to be transfered to a room that was either empty or had someone in a coma.

About a month ago, I had an appointment with a pulmonary specialist. In the pulmonary ward you get two types of people: people who have sleep disorders, and (the vast majority) people who have difficulty breathing due to advanced emphysema or various other reasons, but most are very old. Point is, there are people dying all the time on that floor. During my appointment, a casual voice came over the speaker announcing a Code Blue and my doctor, being the head of the department, excused himself. About ten minutes later he came back and continued our conversation like nothing had happened. What had happened? Just another patient dying. Yet his composure was more akin to someone who had just come back from using the restroom.

My point is just that doctors (and nurses) see pain, suffering and death all the time, and that there's a kind of machismo surrounding hospital staff to never let it get to you. This is for the patient's benefit as much to their own sanity, because running around like a crazy person is not going to help Get Things Done. Sadly, it appears that the gatekeeper in this story's scenario had fallen into the trap of substituting ruthless, stoic efficiency with abject apathy.

The fucking cops didn't help, either.
posted by Civil_Disobedient at 6:00 AM on June 3, 2007 [2 favorites]


Because without any other info this was: random woman dies in random emergency room oh and trust us, there's this video which if you saw, really, would cause you to be outraged, really trust us on this.

i say we dig her up and open up her coffin after the funeral ... she could just be faking it
posted by pyramid termite at 6:09 AM on June 3, 2007


I agree with what you just said, Civil_Disobedient. But I also think that they didn't help due to the bystander effect.

Maybe that's why they didn't help the poor lady.
posted by MissNefertiti at 6:31 AM on June 3, 2007


This is awful.

Also, the backstory infinitywaltz posted makes me want to scream. I'm only on Part 2, but my outrage-o-meter is already busted.

Every single member of the Board of Supervisors deserves a place in the Special Hell.
posted by Sticherbeast at 7:21 AM on June 3, 2007


Apart from having a reason to go there, my experience in American emergency rooms the ten or so times I've been in them has been just fine.
posted by Captaintripps at 7:34 AM on June 3, 2007


Brenda Nelson hurried though the doors of Martin Luther King Jr./Drew Medical Center in October, toting a container of gumbo soup for her son, Mario. She expected him home soon.
To her surprise, she was told that Mario, 28, was in intensive care. There, a security guard repeatedly refused to let her in. When she finally was allowed through an hour later, nobody told her what she would find.

Mario was dead, his eyes and mouth open.

"I screamed and hollered," she said recently, her hands trembling. "I tried to pull my baby out of the bed."

Then she closed his eyes.

A nurse told Nelson that Mario — the family's chief party planner and cook, and a onetime church choir director — had suffered from AIDS, something she hadn't known. The immediate cause of death was respiratory failure brought on by pneumonia.

What Nelson was not told, until The Times reported it five days later, was that the nurse assigned to keep constant watch over Mario had not. She had silenced the alarm on his vital-signs monitor, then failed to notice his heartbeat fading, according to the nurse's suspension letter filed in her Civil Service records.

Nor was Nelson told that the nurse had allegedly falsified her son's medical chart. According to Los Angeles County health officials, the nurse indicated that she found Mario stable at 6 p.m. — more than an hour after he had died.


Words fail me in describing the horrors in these articles.
posted by leftcoastbob at 8:12 AM on June 3, 2007 [1 favorite]


Words fail me in describing the horrors in these articles.

leftcoastbob -- "Too much of the story missing to muster outrage. Just seems like there was a backstory and I want to know more."
posted by ericb at 8:31 AM on June 3, 2007


Yeah, well, if I find out much more about the backstory, the only thing that I will be able to muster is my partially-digested breakfast.

This is L.A. local news in the same way that Katrina was N.O. local news.
posted by leftcoastbob at 8:51 AM on June 3, 2007


I know one place I worked at where getting ice was a not small deal.

You say this as if it were a justification rather than an indictment.

Christ, what an awful story. (And by the way, the linked news story discussed the history of problems with the hospital, so I had no problem mustering outrage.)

As for emergency/waiting rooms, fortunately I haven't had to sit in one waiting to be treated, but a good friend in NYC went to Kings County Hospital with what he thought might be appendicitis. After many hours of being ignored in hellish conditions, he went home, figuring if he was going to die he might as well do it there.
posted by languagehat at 8:57 AM on June 3, 2007


It's kind of weird to me that people keep dropping into this thread to mention that their experience in the emergency room wasn't as bad as this. I mean, one would generally presume this, right?
posted by washburn at 8:59 AM on June 3, 2007 [1 favorite]


I can second many of these experiences. I remember having to clean up my friend's vomit (she was in hospital for a serious skull fracture) in one because the nurses would do nothing.

That said, I always get fairly good service when I go in, partly because I always act super super obsequious and intelligent, also partly because the two times I've been in over 20 years have involved difficulty breathing (a moderate asthma attack).

I'd also second the discussion of the ridiculous methods such hospitals get paid -- and I've seen the "I'm going to be arrested? No, I have abdominal pains, take me to the hospital" trick pulled by the wife of some loser bozo who shot at me a decade ago (she was such a bad actor that both the cops and I laughed when she announced the pain... but they did call the ambulance... once she realized that the cops weren't going to do anything to her husband, her pain suddenly vanished, proving our deep skepticism).

Not that this justifies the execrable treatment this poor woman got!
posted by lupus_yonderboy at 9:08 AM on June 3, 2007


From inifintywaltz's link (part 4), it looks like it wasn't just this one nurse being callous. There's some kind of ongoing problem with it in the nursing staff. This whole mess that was a hospital looks like it's largely a problem coming from HR and the MSO - from their inaction in the face of nightmarish staff behavior.

I'm not sure how this place is still open, if they've lost CMS and JCAHO accreditation. How can they get enough money to stay afloat, public hospital or not?

As to emergency rooms in general, there's a huge difference here between the downtown ERs and the suburban ones. Huge. My SO walked out of one once when he'd been there for over 4 hours with blinding head pain, difficulty moving or speaking, nausea, vomiting, and cold and clammy skin in summer. It wasn't quite that they didn't seem to care, they just didn't really seem to notice, either. At a suburban ER for something that turned out to be nothing and that he would have taken to his regular doctor had it not been a Saturday night, when he wasn't actually in pain or obviously bleeding or anything, he was seen and out in 2 hours.
posted by dilettante at 9:26 AM on June 3, 2007


It's kind of weird to me that people keep dropping into this thread to mention that their experience in the emergency room wasn't as bad as this. I mean, one would generally presume this, right?

I don't think anyone has posted in this thread "my experience at the ER wasn't as bad as this". The people who've mentioned they've had good experiences in the ER have done so in response to the people who've dropped into the thread to mention their bad experiences in the ER.

As to emergency rooms in general, there's a huge difference here between the downtown ERs and the suburban ones. Huge.

Yeah, although it's not always so simple as downtown vs suburban. That's why I didn't make the distinction in my comment in those terms. Basically, some ERs are overworked, underfunded, and deal with more than their share of crazy people. Those are the ones you want to avoid.
posted by Ethereal Bligh at 9:37 AM on June 3, 2007


I have worked as a doc in a county hospital ER. Someone should get nailed to the wall over this, if for nothing else than a *clear* demonstration to the staff, the patients, and the community that this is *not* ok.

Here is my big but:
For every person complaining of abdominal pain who has a perforated intestine, appendicitis, aortic aneurysm, etc. there are literally 100 who are either faking to get drugs or have something benign like a flu. To minimize the chance of missing anything serious, you would need to get a CT scan and admit for observation the majority of these 100 people, but the safety net is already bankrupt. Waiting rooms are full of patients in real need, screaming louder and louder for that ever smaller piece of medical care that is doled out to them, while doctors and nurses are held accountable for the half-assed medicine they are trying to practice in a place like this. You can imagine empathy and morale at our country's public hospitals isn't the greatest.

This particular woman had already been seen and, judging by the note that said "return if you are worse," they hadn't been able to really diagnose her with anything with the tools they had, so they did what they do 100s of times a day, they discharged her and moved on to the next crisis. To me, this story says so much more about the health care system than just a disinterested, overworked triage nurse. My immediate reaction reading it was, "Yeah, I could see this happening..."
posted by Slarty Bartfast at 9:39 AM on June 3, 2007 [3 favorites]


I'm sorry, this is just a patently awful story. Maybe it's because my training is in peds, and thus I've only worked in pediatric ERs, but I can't ever imagine someone being treated this way in the placed I've worked. Whatever the backstory, whatever the excuses, this is plainly awful and negligent and abhorrent and wrong.
posted by delfuego at 9:43 AM on June 3, 2007 [1 favorite]


Don't forget criminal, delfuego. Some of the horrors that were mentioned are actual crimes.
posted by leftcoastbob at 9:47 AM on June 3, 2007 [1 favorite]


You say this as if it were a justification rather than an indictment.

Because it is in a way. Look, I get defensive. Doing this sort of work nearly killed me and I (like so many) burned out and left. People try very hard to do good work and then we have this obviously tragic story in the linked article and people are apt to come out of the woodwork with their own stories about alleged poor treatment.

In so many situations it would take ages just to explain to someone why you have pass them by to go do something more important. 99% of the time you just can't see that coming into an A&E unit as a patient or relative. I only mentioned the ice thing as an example of something that you wouldn't know about --- whether or not it actually related to blazecock pileon's situation is unlikely and of course I have no way to know whether or not he was treated badly in all the circumstances. But this is the thing: because it's all so emotional, because it's pain and our loved ones and all usually acute, there's very little in the way of rationality when people make up their minds as to how to judge a facility or a treatment provider or a waiting time and if you happen to arrive at the wrong time on the wrong day, well you have a bitch story to trot out when the topic of hospital or nursing or medical care comes up. (I mean 'you' in the general sense of course)

I'm not saying that people don't ever have justification to gripe and do in fact get treated badly sometimes, but I guess I was trying (perhaps badly) to intimate that in so many situations your 'sore knee' for instance just doesn't reach the radar when I/we/they are trying to .....I don't know: I could type forever about the myriad possibilities or memories I have in which there were acute, severe, serious consequences for other people if I wasn't just to, you know, put my head down and keep on walking.

{re: ice - That particular facility was being updated and there was no place to put the ice machine while building work got done. I mentioned it because running an extra 50 yards is just another factor you have to juggle into the decisions of time -v- help -v- priority. Most of the time it was not a problem but a few times making that short trip got delayed. I guess I just don't see it as an indictment of bad management - I couldn't see how they could do it better at the time and in any event it was for a matter of a couple of months and we had a much better unit for the work}
posted by peacay at 9:53 AM on June 3, 2007 [2 favorites]


I just finished reading that five-part article, and now I'm absolutely livid. This is DISGUSTING.
posted by Sticherbeast at 9:54 AM on June 3, 2007


I was in an accident at a concert where both my ACL tendons were severed, and my knees were crushed. I was taken to the downtown hospital in Dallas (Baylor, as the case may be...a private, relatively well respected hospital.) It took over 2 hours to get me extracated from the concert itself, and it was a weekend night, so it was after midnight when I arrived at the hospital. (For the record, I had been drinking, and had been at a concert, so I smelled of pot and booze.)

Despite the fact that both my legs had swollen to twice their size and my toes were turning purple, it took the ER over 2 hours to get me out of the waiting room into the triage area, and then all they did was shoot me full of painkillers and tell me to call an orthopedic surgeon in the morning.

Then...they told me to drive home. Yes. Drive. Drunk, full of morphine and incapable of standing up because BOTH MY LEGS WERE BROKEN, they told me to drive home and call someone the next day.

Thank gods there were cops there, and two cops going off duty made sure I made it home. They even carried me into the house. Bless their hearts. I'm still in contact with both of them. Good men.

The surgeon I called the next morning was the first medical person I've ever heard suggest that I should sue someone. He said that under no circumstances should I have been allowed to leave the hospital, and that because of their negligence, that my injuries had be significantly acerbated...leading to weeks of hospital stay.

And this experience at Baylor...a private and highly regarded hospital.... is not significantly different than ER experiences I've had/friends have had at other hospitals.
posted by dejah420 at 9:58 AM on June 3, 2007 [2 favorites]


I'm with peacay on this—I thought his last comment was excellent.
posted by Ethereal Bligh at 10:10 AM on June 3, 2007


ER personnel, particularly in downtrodden areas, can become near (or in this case, actually) criminally apathetic for the same reason it seems like cops are nothing but dicks: they spend way too much of their time fending off liars, scum, and people with mysterious and unpleasant agendas. I have also had someone close to me plunge into this sort of work idealistically and altruistically. It was hard to watch them morph, not all that slowly, into somebody who assumes that anyone not suffering from obvious severe exterior physical damage is a fraud and a liar and a distraction from the truly needy.

The problem --as in so many areas-- is that Sturgeon's Law applies to people, too. Police and ER people get a much clearer picture of that us MeFi perusers.

She had to quit the ER, though. It made her hate people. Just the opposite of why she had wanted to work there.
posted by umberto at 10:15 AM on June 3, 2007 [1 favorite]


...than we MeFi perusers, that should be. There is a preview, yes? Stupid me.
posted by umberto at 10:18 AM on June 3, 2007


retired lawyer here to remind you that california has a law known as "micra", the medical injury compensation reform act, which has capped "non-economic" damages (pain and suffering) at $250,000 for the last several decades, with no adjustments for inflation. in other words, when a corporate ceo is the victim of medical malpractice, he can still recover millions for loss of earning capacity, but perforated bowel-woman, who had very little earning capacity on her best day, can recover a theoretical max of 250 k, before attorney fees, and can usually be bought off at a discount, the old bird in the hand versus going years through various courts to even find the bush. a hospital like king/drew might take millions to shape up, but if they only have a couple of dodgy deaths per month, the financial consequences are akin to an item in their maintenance budget. remember to thank the insurance and medical communities for this enlightened state of affairs!
posted by bruce at 10:27 AM on June 3, 2007 [7 favorites]


if you can help it, don't walk into an ER without a friend and a video camera
posted by troybob at 10:44 AM on June 3, 2007


I'm with peacay on this—I thought his last comment was excellent.

I guess, then, you also think it's excellent when people's invariable response to other people complaining about anything (getting fired, the death of a mate, whatever) is to point out that some people (starving Africans, Gulag inmates, whatever) have it really bad. Yeah, the health system sucks, and yeah, I'm aware of the burnout rate and sympathize with anyone who's tried to work under those circumstances, and yeah, of course ER workers aren't going to sit around weeping over every suffering patient—how would they get any work done?—but none of that is justification for any of the horror stories. "That particular facility was being updated and there was no place to put the ice machine while building work got done" is a poor excuse for not having ice, and "the system sucks" is no excuse at all for leaving patients to die. (And no, I don't think peacay was trying to excuse that, but his defensiveness, while understandable, is misplaced.)
posted by languagehat at 11:04 AM on June 3, 2007


peacay - the fact that nearly everybody has a negative ER experience (on top of the medical crisis itself) suggests something more than just what individual emotional filters are at work here.

It is infuriating that so many in the medical community seem so dismissive about it.

I have had some good experiences in an ER. But the bad far out number them. Not necessarily in the medical care quality sense but the experiences have been universally negative in terms of dignity and respect. I think that is what is getting expressed here. Doctors would do well to heed these sentiments.
posted by tkchrist at 11:13 AM on June 3, 2007


On preview. I am with languagehat.
posted by tkchrist at 11:14 AM on June 3, 2007


peacay - the fact that nearly everybody has a negative ER experience (on top of the medical crisis itself) suggests something more than just what individual emotional filters are at work here.

How do you know that "nearly everybody" has a negative ER experience?

I guess, then, you also think it's excellent when people's invariable response to other people complaining about anything (getting fired, the death of a mate, whatever) is to point out that some people (starving Africans, Gulag inmates, whatever) have it really bad.

You guessed wrong. Not to mention that this isn't what peacay said.
posted by Ethereal Bligh at 11:38 AM on June 3, 2007


I'm not with peacay on this, his last comment really ignores how bad it was. This was without doubt the fault of the people working there. As leftcoastbob noted in another story from that hospital, the nurse decided to turn off the alarms for a patient's vital signs and ignore the heart monitor. I don't know why you would want to defend these people. There is no excuse at all for those actions.
posted by KingoftheWhales at 12:12 PM on June 3, 2007


this isn't what peacay said.

No, what peacay said was:

I'm not saying that people don't ever have justification to gripe and do in fact get treated badly sometimes, but I guess I was trying (perhaps badly) to intimate that in so many situations your 'sore knee' for instance just doesn't reach the radar

In other words, people are starving in Africa so suck it up.
posted by languagehat at 12:18 PM on June 3, 2007


here's a interesting comment from one of the members of another web community in response to the same article. from the sound of it the poster has worked/rotated in/clerkshipped at king:

"The employees at King aren't "cold and indifferent", but rather they were forced to be jaded. The triage at King is a chaotic no-man's land with homeless people, gang members, and psych patients. 2 inches of bulletproof glass separates the patients from the triage desk. It's not uncommon to have several patients screaming, while another one bangs on the window demanding immediate service. The situation is almost impossible to deal with. I never ventured into that waiting room when I was there. It was quite frightening.

The lady described in that article is just like fifteen other IVDA patients I knew there. They would smoke crack, or shoot up, then run out of money and come to the ED. They would go into fits of histrionics for chest pain, abdominal pain, or for any other complaint. The problem was, that a small percentage of the time these people were actually sick, but you couldn't tell the difference between when they were sick, and when they were trying to abuse the system. Every time any of these people were discharged it was like a roll of the dice. Apparently the physician who last discharged this lady lost that dice roll."

- GeneralVeers
posted by ruwan at 12:35 PM on June 3, 2007 [1 favorite]


I'm not with peacay on this, his last comment really ignores how bad it was.

Peacay was responding to another commenter's ER complaints, not to the subject of this post.

In other words, people are starving in Africa so suck it up.

That's tendentious. Peacay was diplomatic and sensitive in what he said. I would have put it more harshly: ice for the knee of a patient in the waiting room isn't a priority, nor should it be. Peacay wasn't saying that "other people are hurting worse than you therefore you shouldn't complain" he was saying "other people's lives are in danger while yours was not—the staff couldn't spare much time finding you ice because if they had, other people would have suffered more".
posted by Ethereal Bligh at 12:51 PM on June 3, 2007 [1 favorite]


Working in emergency services, I am well aware of the need for prioritizing and how quickly things can go to hell in a handbasket. However, it seems as though in the case of this particular hospital, the problem seems to be systemic rather than just a few bad apples.
posted by leftcoastbob at 1:12 PM on June 3, 2007


However, it seems as though in the case of this particular hospital, the problem seems to be systemic rather than just a few bad apples.

Definitely. But I don't think anyone has said otherwise.
posted by Ethereal Bligh at 1:25 PM on June 3, 2007


I suppose it's a reaction to the idea, real or not, that addicts will go to an ER and fake pain to get their fix.

Another benefit from drug prohibition!
posted by telstar at 1:49 PM on June 3, 2007


I had never suggested, as seems to be the insinuation, that my broken knee was more serious than this late woman's perforated bowel. I would expect that an ER in a triage situation, or with a patient who is critical, would prioritize needs.

Nonetheless, my experiences in my case, which was not a triage situation (front desk staff were sitting around most of the time), and in other situations I have had (a serious throat infection, my brother's concussion) and of other friends and family, and of those I had read in this thread, that something may be systemically wrong in some areas of care.

I would assume that requesting a bag of ice while waiting a few hours to get past the ER waiting room should not be asking much. If that is a problem, then it is a problem with the system of care being provided, not with the patient.

I do take serious issue with calling a broken limb a "sore" limb, as much as I am more outraged with Rodriguez being called a "complainer". If that is the kind of language used behind the front desk, the equivalent of "how dare this peasant ask for help", I would be even more upset about how much worse others will have been treated.

This kind of thinking highlights how broken the healthcare system can get, by not only how inured some of its staff have become to patients' suffering (necessary or not), but how indifferent and hostile those bad apples are to the notion of providing any assistance whatsoever.
posted by Blazecock Pileon at 1:54 PM on June 3, 2007 [1 favorite]


I would have put it more harshly: ice for the knee of a patient in the waiting room isn't a priority, nor should it be.

That's disingenuous of you; I said no such thing.
posted by Blazecock Pileon at 1:59 PM on June 3, 2007


Peacay was diplomatic and sensitive in what he said.

I never said he wasn't. I have no problem with peacay; I do have a problem with the attitude his comment, and far more so yours, represents.

I would have put it more harshly: ice for the knee of a patient in the waiting room isn't a priority, nor should it be.

If one day you find yourself screaming with pain with a nonfatal injury in an ER room, I'm sure you'll remember those callous words fondly. Remember, people are dying elsewhere in this badly run, ill-provided hospital, so your miserable pain is meaningless to us! That's the kind of attitude that's so endearing in bureaucrat-run health facilities the world over. Like the man said:

I would assume that requesting a bag of ice while waiting a few hours to get past the ER waiting room should not be asking much. If that is a problem, then it is a problem with the system of care being provided, not with the patient.


BP:

That's disingenuous of you; I said no such thing.

Don't worry, he wasn't saying you did. He's saying it himself.
posted by languagehat at 2:18 PM on June 3, 2007


I'm just going to go out on a limb and assume that anybody who isn't outraged by this story has never been seriously injured before, has never feared for their life, and is 10 feet tall and bulletproof.
posted by tehloki at 2:36 PM on June 3, 2007 [1 favorite]


Wow. These discussions get really emotional fast. You have, on the one side, people who have been injured or experienced the (perceived) wrongful harm to a loved one pitted against people (health care workers) who literally have given up their happiness and health to try and preserve the last functioning shreds of our health care system.

Presumably, none of us are close enough to this story to know what part negligence actually played in this particular woman's death but everyone wants to generalize the story and relate it to their own experience. I will say that well-meaning criticism from lay people often sounds, to people within the system, like "Doctors just need to try harder" or "The problem is that some nurses simply don't care enough about their patients." This implies a gross underestimation of the American health care crisis.
posted by Slarty Bartfast at 2:39 PM on June 3, 2007 [3 favorites]


Full disclosure: I went once to Killer King, as everyone calls it. They misdiagnosed me, and said they couldn't treat me based on that diagnosis. I went to a different clinic in a different neighborhood, which found King's error and treated me. (Thank you, God!)

Anyone inclined to blame the clientele for Killer King's absolutely shocking mismanagement is referred to County/USC -- which serves as many and as desperate people as KK, yet doesn't generally kill them or leave them to die.
posted by Methylviolet at 3:24 PM on June 3, 2007


I'm just going to go out on a limb and assume that anybody who isn't outraged by this story has never been seriously injured before, has never feared for their life, and is 10 feet tall and bulletproof.

Why do people keep knocking down this strawman? Who here has expressed that they aren't outraged?

If one day you find yourself screaming with pain with a nonfatal injury in an ER room, I'm sure you'll remember those callous words fondly.

I've been in the ER numerous times while in severe pain. In January, I was in the ER with something pretty much the same as this poor woman suffered. It took them several hours just to get me the narcotic IV. And a couple more for the CT scan. But while I was waiting, there was a very badly injured drunk man who kept trying to leave the hospital. That took several doctors, nurses, and orderlies occupied until they finally restrained him. My aunt's best friend—this would be my aunt who was sitting beside me—was, unbeknownst to us, a few doors down having suffered a cerebral hemorrhage (from which she died three weeks later). There were people who had heart attacks. People who were dying and who died. My condition was being monitored, I was stable. Palliative care for me wasn't a priority. I didn't complain that it took hours to get me substantial pain relief. So don't fucking tell me what I would or would not do or what "callous words" I'll remember.
posted by Ethereal Bligh at 4:23 PM on June 3, 2007 [2 favorites]


Hmm. Earlier, you said "I've not encountered the above mentioned attitude and in general my experiences have always been good... In all cases, the triage nurse/staff has taken my reports of severe pain very seriously." So it doesn't sound as if you experienced anything like this. But carry on with your macho "Hell, if I can take it, so can everyone" attitude. You do seem a bit touchy, though; there's no call for this "don't fucking tell me" nonsense.

well-meaning criticism from lay people often sounds, to people within the system, like "Doctors just need to try harder" or "The problem is that some nurses simply don't care enough about their patients."

Right, and understandable overreaction from professionals often sounds, to people outside the system, like "Suck it up, you whiners, there are people with serious problems."
posted by languagehat at 4:39 PM on June 3, 2007 [1 favorite]


I would assume that requesting a bag of ice while waiting a few hours to get past the ER waiting room should not be asking much. If that is a problem, then it is a problem with the system of care being provided, not with the patient.

Why do you assume this? That's treatment. It may not be treatment that the doctor would want you to have, it may not be good for you. People qualified to make a decision about such care for you are busy treating other patients. People not qualified to make such a decision may well have the time to do this for you, they may well be working at the desk. They could ask someone, you say? Well, they could ask someone about getting some other person in the waiting room a pain pill, too. There's a reason you're in the waiting room, you've been triaged. Your care can wait.

You aren't in a position to judge whether or not they should have been able to bring you ice right away. You think you are, but you're not.

I don't mean to rag on you—I certainly wasn't implying that you somehow had equated your experience with that of the woman in your story. I would have wanted ice or something were I in your place, too. As I wrote in my previous comment, I have been waiting in the ER in terrible pain. But though we can all judge that ignoring a screaming woman writhing in pain on the floor for ninety minutes is inexcusable, we can't all judge someone failing to bring you ice as inexcusable.
posted by Ethereal Bligh at 4:43 PM on June 3, 2007


So it doesn't sound as if you experienced anything like this.

Like what? If I had written that I was in the ER in an examination room in January and it took hours before they even gave me pain relief, would that have been "like this"? I don't doubt that some of the things I've experienced in the ER would be the stuff of other people's complaints. I haven't experienced anything like dejah420 experienced—but peacay's comment wasn't in response to her, nor was mine. I have experienced long waits and busy staff. I don't judge those as "bad" ER experiences in the sense that I thought someone was in the wrong.

But carry on with your macho ‘Hell, if I can take it, so can everyone’ attitude. You do seem a bit touchy, though; there's no call for this ‘don't fucking tell me’ nonsense.

I'm touchy because you wrote this:

If one day you find yourself screaming with pain with a nonfatal injury in an ER room, I'm sure you'll remember those callous words fondly. Remember, people are dying elsewhere in this badly run, ill-provided hospital, so your miserable pain is meaningless to us!

If I had written anything as insulting, patronizing, and tendentious to you, you'd be touchy, too. And while you keep trying to characterize this as being either sympathizing with someone's pain or not, the actual truth of the matter is that we're arguing about whether—for example, in Blazecock Pileon's case—someone is professionally at fault for not doing something about that pain. It sucks to be in terrible pain in the ER. I know, because I've experienced it many times. No one is saying "stop whining about how much pain you're feeling", they're saying "stop complaining that the ER personnel didn't do everything you wanted to, when you wanted them to, because the truth is that they didn't because they were probably doing something more important".

And it matters because people in the waiting room complaining about things like not having ice for their knee takes up time and attention that is better spent on dying people. I guess I'm just a strutting, macho guy because I'd rather dying people get attention before I—and others without life-threatening ailments—do.

In my mind, ERs are for, well, emergencies. That means very serious and life-threatening ailments. When I go into an ER with anything less, then I expect my needs to come after other peoples'. I avoid taking up the time of the staff. I was in the ER in October for what eventually sent me into the ER in January. It wasn't serious then, the doctor and I agreed it probably wasn't serious. I deliberately chose not to have further tests done because I didn't want to use any more of their time and resources when I knew it wasn't serious and I could follow-up with my family doctor instead. There is a collective responsibility involved here and there are a number of medical situations, the ER chief among them, when a selfish patient can make a big negative difference in the quality of care for other people.
posted by Ethereal Bligh at 5:13 PM on June 3, 2007


You aren't in a position to judge whether or not they should have been able to bring you ice right away.

I didn't ask for ice "right away", and I sure didn't get ice "right away". I'm no doctor, but I suspect it would have helped to ice "right away", because by the time I got past the waiting room my leg was so badly swollen my clothing had to be cut away. I grit my teeth and waited, despite suffering without relief, and the only reason I am commenting here is that, like her, my healthcare needs were not addressed in a professional, caring manner. It's my body, and I am in a position to make that judgement for myself. Thank you.
posted by Blazecock Pileon at 5:16 PM on June 3, 2007


Incidents such as these are arguments in favor of implanting all patients with their medical records. The ER triage nurses can scan a patient's chip and find that he or she has a record of severe gallstones (like Ms. Rodriguez), epilepsy, or Oxycontin abuse. No need to detect whether or assume that a patient is lying.

The supposed assault on privacy and the potential abuses of such a system are lesser evils than the fatal errors and assault on human dignity that routinely occur in ERs such as King/Drew's.
posted by bad grammar at 6:06 PM on June 3, 2007 [1 favorite]


It's my body, and I am in a position to make that judgement for myself. Thank you.

But you say you're not a doctor. Why do you think you're in a position to make that judgment for yourself? You say you're not a doctor, so how do you know that icing your knee would have made any difference whatsoever to the swelling? If it would have, then how do you know that reducing the swelling would have been better than not reducing it? You're not a doctor and you don't know what the doctors and nurses were doing, so how do you know that if it was best that your knee was iced as early as possible, then to have done so was more important than what they were doing when they weren't bringing ice for your knee?

There's a number of ways in which you're not in a position to make that judgment for yourself.
posted by Ethereal Bligh at 6:20 PM on June 3, 2007


Ethereal Bligh writes "You say you're not a doctor, so how do you know that icing your knee would have made any difference whatsoever to the swelling? If it would have, then how do you know that reducing the swelling would have been better than not reducing it?"

Oh, come on.

Medicine is not a black art, opaque to those on the outside.
posted by krinklyfig at 6:46 PM on June 3, 2007


You say you're not a doctor, so how do you know that icing your knee would have made any difference whatsoever to the swelling?

Because ice brings down swelling and eases pain. I don't need to be a doctor to know that, because it is common knowledge to anyone who has ever been hurt, or had to care for someone who has been hurt.

You're not a doctor and you don't know what the doctors and nurses were doing, so how do you know that if it was best that your knee was iced as early as possible, then to have done so was more important than what they were doing when they weren't bringing ice for your knee?

I asked the ER staff, who were not doing anything at the time but waiting around idly. Doctors and nurses do not populate the ER waiting room, in general, except to pass through.

There's a number of ways in which you're not in a position to make that judgment for yourself.

I guess this is a fundamental difference in opinion, but I feel I am responsible for my condition in life, at least those parts of it which I can control. I would be irresponsible to myself as a human being, to allow myself to suffer, or to apologize for someone allowing me to suffer without caring, out of some stoic, masochistic ideal of not wanting to be a "complainer" or a burden on those who I trust to help me out in a time of need.
posted by Blazecock Pileon at 6:48 PM on June 3, 2007 [1 favorite]


Oh, come on.

That's for knee pain in general. It's not necessarily what's best for a broken knee. Maybe it is. I don't know that.

Because ice brings down swelling and eases pain. I don't need to be a doctor to know that, because it is common knowledge to anyone who has ever been hurt, or had to care for someone who has been hurt.

Ah. So according to you, in all cases of swelling and pain, ice will ease the swelling and ease the pain and it's better for you than not. I didn't know that. On the other hand, I don't think you know that, either.

I would be irresponsible to myself as a human being, to allow myself to suffer, or to apologize for someone allowing me to suffer without caring, out of some stoic, masochistic ideal of not wanting to be a ‘complainer’ or a burden on those who I trust to help me out in a time of need.

Oh, please. Did they know you were in pain? Yes? Then you had done what was within your degree of competence by letting them know that. We're not talking about suffering quietly while not letting someone know there's something they can do to help you; we're talking about you not sitting quietly because you think that there's something more they could be doing to help you even though they're aware of your pain and what's wrong with you. What a load of self-serving rationalizing crap you just wrote.

You're not trusting them to help you out in a time of need, you're demanding that they do what you think is best. That's not being responsible to yourself or to others.
posted by Ethereal Bligh at 7:33 PM on June 3, 2007


You're not trusting them to help you out in a time of need, you're demanding that they do what you think is best

I suspect you're not going to bother reading this as well, but I didn't demand anything, I asked politely for small bag of ice while I wait, to help reduce swelling and pain, at a time when they were not busy. They were unwilling to do this, nor were they able to indicate how much time it would take to get looked at, but in the hours between, my damaged knee kept swelling up with fluid. It would have been irresponsible of me not to ask for ice.
posted by Blazecock Pileon at 8:13 PM on June 3, 2007


About this whole ice thing, Standard First Aid teaches RICE which is Rest, Ice, Compress, Elevate. As long as you don't give yourself frostbite or hypothermia, ice or some other cold compress is rarely a bad choice for that kind of swelling.

Until a doc or whatever looks at it all you have to go by is standard first aid so you may as well use it whether you're stuck in the woods or in ER.
posted by captaincrouton at 11:30 PM on June 3, 2007


I just want to say to peacay that I didn't take anything he said here personally — and I hope the feeling is likewise. I didn't mean any disrespect here.

I understand that he is coming to this discussion from the other side, having to deal with providing medical care to some people who can be very unsavory, ungrateful, unhygenic, and generally pains in the asses, people who are hurt but sometimes not in the best frame of mind to get assistance. These are people who peacay is not obligated to help, but he has helped them and others nonetheless.

It goes without saying that most folks in the healthcare profession, including peacay, deserve our respect and our gratitude for the thankless good they do. No bullshit.
posted by Blazecock Pileon at 11:55 PM on June 3, 2007


I suspect you're not going to bother reading this as well, but I didn't demand anything, I asked politely for small bag of ice while I wait, to help reduce swelling and pain, at a time when they were not busy. They were unwilling to do this, nor were they able to indicate how much time it would take to get looked at, but in the hours between, my damaged knee kept swelling up with fluid. It would have been irresponsible of me not to ask for ice.

I don't agree. But I will agree that if they were unwilling to give you ice, they should have told you why. I also understand you didn't demand anything, and I'm sure you were polite. But you are judging them badly for it after-the-fact.

About this whole ice thing, Standard First Aid teaches RICE which is Rest, Ice, Compress, Elevate. As long as you don't give yourself frostbite or hypothermia, ice or some other cold compress is rarely a bad choice for that kind of swelling.

Until a doc or whatever looks at it all you have to go by is standard first aid so you may as well use it whether you're stuck in the woods or in ER.


Sure. I'm not saying he shouldn't have brought ice himself, or that someone else shouldn't have brought him ice. I'm just saying that none of us is in a position to judge them wrong for not bringing him ice. I'm not convinced that a doctor would never prefer a wound like his not be iced—but more than that, I'm not convinced that bringing him ice should have been a sufficient priority for the staff that he is right to judge them badly for not doing so.
posted by Ethereal Bligh at 5:52 AM on June 4, 2007


EB, as much as I've appreciated what you've tried to get across here, I think you're on a loser beating this particular ice issue. They should have got him ice. Or they ought to have had a good explanation even if they didn't tell him until he was treated.

BP thanks. I didn't think anything you said was out of line. And it was a job. I was thanked, often.

LH, you weren't there. The ice machine placement was not a big deal, it was just something that very occasionally caused someone to wait a bit longer. But if you consider the alternatives - it might have meant spending $50K (yes, plucked from the air) on unnecessarily widening of the corridor to accommodate that machine for a short time, thereby reducing the eventual bed capacity by 2 as an offset perhaps, or moving an ECG machine or some other piece of necessary equipment out so the ice machine could fit in, or a whole raft of other possiblities - then perhaps you could turn it around and in the big picture, view it as actually quite a smart management decision. Because of course they don't have open slather on money and this was just one of those little things which I was using as an example of a situation where a delay might occur that was unbeknownst to onlookers but was part of the master plan of making a better thing for the community as a whole. We would have stopped to explain it all but, well, you know, the starving Africans were hungry.
posted by peacay at 7:52 AM on June 4, 2007


LH, you weren't there.

No argument there, and you may well be right about that particular situation. To the layman, though, it doesn't seem that hard a thing to have ice available—I mean, "we don't have any ice" sounds like something you'd hear in Iraq, not the U.S. But obviously I know little about it. And I'll take this opportunity to repeat that I'm not taking issue with you, just with the attitude that everybody should be expected to see the big picture and not complain so much. I mean, I'm all about the big picture, but when you or someone you love is in pain it's asking a lot to accept that the lack of attention is "part of the master plan of making a better thing for the community as a whole."

And I totally concur with BP's words:

It goes without saying that most folks in the healthcare profession, including peacay, deserve our respect and our gratitude for the thankless good they do.

posted by languagehat at 9:36 AM on June 4, 2007


I mean, I'm all about the big picture, but when you or someone you love is in pain it's asking a lot to accept that the lack of attention is ‘part of the master plan of making a better thing for the community as a whole.’

The litmus test for virtue isn't when doing the right thing is easy, it's when doing the right thing is hard. Especially when one has a powerful self-interest in not doing so.

Being in the hospital is among the few situations in daily life that strongly remind you that other people are suffering and in need—and this is even more true in the ER. When you are in the ER you are bombarded by images and sensations and reminders of other people's suffering. Busy staff and the waiting remind you that medical care is a limited resource. Being triaged reminds you that prioritizing care is critical and is necessary to save lives. You cannot be comfortably unaware of your responsibilities to other people while in a hospital.

I think how someone behaves in a hospital reveals much about their character. This applies to the caregivers, too.
posted by Ethereal Bligh at 2:10 PM on June 4, 2007


I urge everyone who's still following this thread to read the New York Review of Books article What's Wrong with Doctors? by Richard Horton, editor of The Lancet. It crystallized two issues that had been bothering me about this thread.

1) That one should trust the opinions of medical staff implicitly because they have the knowledge (e.g.).
2) That one should accept that medical staff assume that everyone is a liar or a basketcase because they see so many people with substance abuse and mental health problems (e.g.)

Let me address 1 first. Doctors aren't always right. In fact, 15% of the time, they misdiagnose. 15% is not an insignificant number. If you roll two dice, it's roughly the chance of rolling a 2, 3 or 4. Likelier than not the doctor's gonna be right, but it's better to be sure. The best way to be sure is to give as much information as you have and ask questions. To give you a f'rinstance:

Doctor: You pulled a muscle, that's why your left shoulder hurts.
Patient: But the right side of my abdomen hurts too.
Doctor: It's probably unrelated. No need to worry.
Patient: But could there be a link. Is there a part of the body that connects the two?

etc.

Yes, you'd be kind of a pain, but if you're in pain, it's better to make sure. The point, and one of the main points of Horton's article, is that being an active, assertive patient makes you a better patient, one who helps the doctor reach a diagnosis. Yes, you don't know everything that's going on in the hospital, but the doctor doesn't know everything that's going on in your body. Or, if you'd rather put other people ahead of yourself, imagine how badly the poor doctor would feel if you'd keel over from a burst appendix. Wouldn't want that on your deceased conscience?

As to the second attitude, which thankfully for my sanity hasn't been trotted out much in this thread, but I've heard bandied around before, that one should let oneself be treated like lint by ER staff because they see so many junkies and crazies... well, as the Horton says, that's an attribution error. The automatic assumption is that the patient is screaming because they're a complainer, not because they're in serious pain. Excuse me, but that's idiotic. If that's your attitude and you work in an ER, you should put in for a transfer or go see a psychologist because your thought process is churning out garbage (full disclosure: I've sought therapy and I don't think that it's a character failing, in fact, I think it's healthy and a sign of character strength to seek help for one's problems). If you assume that other people have serious moral failings or are insane without having fully investigated the matter then the moral flaw and error of mind are yours.

Now, I'm not saying that loons and druggies don't seek end up in ERs. Of course they do, and with more frequency than the median person, for reasons I don't think I need to elaborate. The danger, if you work in an ER, is that since in all likelihood the greater part of people with mental health issues and substance abuse problems are going to be your patients, you will start to associate your workplace with addicts and the mentally ill. It's not much of a leap to start thinking that your patients are most likely to fall into either of these categories. It's very human, I admit, but it's something that ER medical staff and supervisors should guard against (per Horton), because if they don't, disaster will strike.

I do not believe that the triage nurse from the linked story in the FPP is evil, but she fell into the trap of cynicism and it snapped shut, locking her in.

Okay, now that I've got this off my chest let me say that I have nothing but the utmost respect for health care professional. My grandfather is a doctor (though he mostly did cancer research), I have several relatives who are nurses or otherwise work in the health sector and I worked in a hospital as a cook for a spell. Doctors, nurses etc. save lives and ease pain. That is amazing. I have been in a doctor's waiting room while two drug addicts had an argument with the secretary about whether they could go see the doctor. It was a scary scene and I was thoroughly impressed how well the secretary handled the difficult situation the loud, overbearing drug addicts caused. I don't imagine for a second that it's an easy job being a triage nurse, in fact, I imagine that it's highly stressful and challenging. Anyone who decides to work in an ER should be commended. However, I think also they should be monitored, because it's so stressful and challenging. I wonder if cynicism is especially likely to take root among ER staff because they go in idealistic, because, as we all know, cynicism is merely the flip side of naiveté.

(and here I am assuming that people who work in ERs are more likely to be cynical, even though I don't really know)
posted by Kattullus at 5:36 PM on June 4, 2007 [2 favorites]


The point, and one of the main points of Horton's article, is that being an active, assertive patient makes you a better patient, one who helps the doctor reach a diagnosis. Yes, you don't know everything that's going on in the hospital, but the doctor doesn't know everything that's going on in your body.

I agree with this wholeheartedly and I've written this on MeFi emphatically and extensively. I have a genetic diseases and have been seeing doctors my entire life. The patient has an equal responsibility for their health care and no one knows as body as well as a patient knows their own.

I've also written on MetaFilter several times that doctors are fallible and that most of what they do is guesswork.

But neither of these things has anything to do with making claims of incompetency or negligence when you aren't qualified to do so. And just because doctors are often wrong doesn't mean that patients with no medical expertise are likely to be right when they ignore a medical professional's judgment.

It isn't a black or white choice. Many people worship doctors and never question anything and expect perfection. Other people, perhaps those who wrongly expected perfection but learned the hard way that doctors are fallible, see doctors as the enemy, in a sense, and they're always suspicious. But the truth is that doctors are highly-trained professionals who know far more than laypeople do about a subject no one knows as much about as we wish they did. They make mistakes, but they don't make as many health-care mistakes as people do with their own health-care decisions. Good care requires an active and interested patient, bad care happens with an uninterested and passive patient or with an antagonistic patient who disregards the doctor's advice.
posted by Ethereal Bligh at 7:20 PM on June 4, 2007 [1 favorite]


The situation is also probably getting worse, since the healthcare system (especially hospitals) is an increasingly unfriendly workplace. I know several ex-nurses who got out of it because of ridiculous working conditions... there are lots of reasons for this (although the HMO culture seems to be a big part) but the key part is that if we drive out a lot of the people who have options, you're left with 2 categories: the truly driven (and thank you to all those) and those who are there simply to fill a slot (and wouldn't have been hired/retained if better people were available).

Very similar to the situation in teaching or other low-pay/high-stress/high-value-to-society jobs. Either we make the working environment better (which isn't just about money), or we hope there are enough people willing to suffer through it for us. Unfortunately there generally are not.
posted by wildcrdj at 7:38 PM on June 4, 2007


-the attitude that everybody should be expected to see the big picture and not complain so much.-

Well I'm not sure that I suggested noone has a right to complain nor would I suggest that bad treatment, unconscionable waiting times or bad systems don't deserve to be highlighted and bemoaned.

But it is nonetheless ALWAYS a big picture thing. The ice machine is nothing, a pittance, a mere snip posited here because of proximity. On any given day there are hundreds of circumstances that go into this big picture. A multiwreck car accident, ICU staff shortage, psycho dude gone mad, xray dept. overbooking, surgeon caught in theatre because of tricky emergency procedure, path lab requiring more specimen, dying patient's relative needing grieving time and privacy, Police wanting info, relatives ringing left, right and centre, bed relocations, spills needing cleaning, staff needing meals..............you want me to go on??

Every day is the same in terms of having a massive profile of resource shanking circumstances that are always different. These are the realities of A&E services everywhere (and for the sideline readers, I'm not American but I have worked in about 6 A&E units on 2 continents) and I'm suggesting that yes, you have to factor IN A BIG WAY that the experience that you and your poor loved one encounter will have everything to do with what you don't know and you never will know.

It's wretched and perplexing and there is no way to predict it I'm sorry, but that IS the nature of the beast. It is always a roll of the dice as to what the lay of land will be once you walk or get wheeled in the front door.

None of this is meant in any way to suggest that poor care is acceptable (although sometimes delays are understandable) --- I only ever threw my hat into this thread so to speak because people are apt to come out of the woodwork with their subjective, highly emotional and always biased criticisms, and it's been my past experience that many (NO, NOT ALL) of them will be based on ignorance in one form or another for the true circumstances. But their often vicious attitudes are fuel for others reading or listening to these horror stories to bolster feelings of entitlement when they next walk through the Casualty dept. doors. And guess who gets to see/hear/wear it? If you wonder why your wife or mother or child is waiting so long next time you visit A&E, consider that the staff are spending 25% of their time explaining to other people why their wife or mother or child are waiting so long.

And it's (nearly) embarrassing to be thanked by people from another continent for things I did in a former incarnation which was something I loved and got paid for and thanked more than in just about any other job I could imagine. But thanks.
posted by peacay at 11:28 PM on June 4, 2007


I tend to think of myself as a diagnostician - as someone who really appreciates the value and the virtue of a good, timely, accurate diagnosis. Diagnosis is one of the most important things in my life.

Frankly I don't know how E/R docs do it. E/Rs used to be staffed by internists and surgeons - people whose expertise extended to situations outside the emergency room. They would often care for their patients as outpatients after they left the E/R. They cared for other patients too and they could watch the evolution of disease in that setting.

Nowadays with the "academic specialty" of emergency medicine E/R docs are encouraged not to know anything about this. The best ones know a vast amount of medicine and surgery, of course, same as any of the great diagnosticians that we all look up to; the average one memorizes a list of presenting complaints and common diagnoses and tries to get by.

It's ridiculous to assert that someone who's presenting to an E/R while critically ill should be an aggressive, assertive, informed patient advocate. E_B, do you really think that the experience of living with the diagnosis of a genetic disease makes a good analogy to having your abdominal aorta rupture one day?

When a person walks into the E/R, in shock and doubled over in severe pain, is that person really expected to give the E/R doc a bulleted list with "Abdominal Aortic Aneurysm Rupture - Diagnostic Tests to Consider" at the top in 18-point Helvetica bold before she passes out?

E/R docs, in my opinion, are called on to be master diagnosticians every day. The fact that US E/Rs are contaminated with patients who have no emergency and are using the E/R as a substitute for the primary care they can't get elsewhere complicates this immeasurably. And King/Drew is one of the worst-run, most dysfunctional public hospitals in the country. Because of this, many competent American-trained doctors steer a wide berth; it's mostly staffed by J-1s and other foreign medical grads, who bring the state of the art in Pakistani and Nigerian medical training to the Los Angeles urban environment. (Don't knock 'em, though - some of the sharpest clinicians I've ever met have fit that description. The sad thing is that they're so happy to be working in the US at all that they will put up with any kind of abuse on the part of the administration.)

The only surprising thing to me about this entire article and this entire thread is that Zev Yaroslavsky can still get by with issuing his shitty little platitude sound-bites, as if he hasn't watched his constituents deal with this daily for decades. I'm surprised they don't riot and burn him at the stake.
posted by ikkyu2 at 1:09 AM on June 5, 2007


One of the 3 ER's I worked at as a tech during nursing school had a 24 hr. non-emergent clinic next to it. That way the triage nurse was able to send the people who where there for cold/flu, pharmacological questions/refills, and other non-emergency issues next door. I've seen a few other ER's in the area work toward this direction.

I remember missing that clinic when I moved to another ER that didn't have one. In my ideal world I remember thinking there would be other needed facilities right next door too. A homeless shelter with clean showers for one. So many homeless came in with "chest pain" or textbook descriptions of emergent issues that got them in and all they really wanted was some warmth and maybe a shower.

A social services clinic and a mental health facility would also be in my ideal imaginary emergency center compound. And it wouldn't hurt to also have some place where the lonely could talk to someone who would just listen. And of course all these dream places would be fabulously staffed, supported, respected and clean. Some place for all the people who clog up the ER could get their needs met.

Working in an ER is a truly eye-opening experience, but not the one everyone seems to expect. I hope it doesn't sound elitist or exclusionary but there's something about it that it seems only other people that have worked in one can grasp (every job has that to some degree I think). You see people in a wide range of vulnerability, awareness, and ability to care for themselves.
posted by dog food sugar at 8:31 AM on June 5, 2007


E_B, do you really think that the experience of living with the diagnosis of a genetic disease makes a good analogy to having your abdominal aorta rupture one day?

Jeez, I'm getting it from all sides in this thread, aren't I?

No, of course I don't think that makes a good analogy. I wasn't making that analogy. I was responding to the comment previous to mine that made a general point about health care and being an active patient.

I mentioned my own disease because of my life-long experience as a patient. And not to mention doing it once-removed, too, with my father and my sister. Health care is a big topic of conversation in my family. And while there's lots of people in similar situations, we're the minority. A large number of people have as their experience only seeing their primary care doctor every once in a while, and maybe one or two more serious illnesses. In talking about this stuff with other people, I've noticed that most people are somewhat naive and passive. And for many people, perhaps most, there's a mystique about doctors that place barriers between doctor and patient as well as fueling unrealistic and weird expectations about health care. When you've been a patient all your life, you see things differently.
posted by Ethereal Bligh at 9:17 AM on June 5, 2007


One of the 3 ER's I worked at as a tech during nursing school had a 24 hr. non-emergent clinic next to it. That way the triage nurse was able to send the people who where there for cold/flu, pharmacological questions/refills, and other non-emergency issues next door. I've seen a few other ER's in the area work toward this direction.

That's a great idea and I hope it spreads.
posted by languagehat at 9:18 AM on June 5, 2007


Update: the feds are giving the place 23 days to clean up or lose federal funding. If they lose the funding, the Board of Supervisors says they'll have to shut down.
posted by dilettante at 11:34 AM on June 8, 2007


Yeah, L.A. County hospital lost federal funding in 1996 for similar reasons. The result was a last minute Presidential executive order by Bill Clinton authorizing $365 million in emergency funds.

No "shutdown" ever occurred, and some doubt that an L.A. County facility could ever be shut down.

I mean, look at it this way. The idea is that the hospital is supposed to help the sick people of the community. The regulators discover that the hospital sucks. Here's an idea: let's close it down completely, fully depriving all patients in its service area of hospital care. That'll be a great way to ensure these patients get the care they need, won't it?
posted by ikkyu2 at 12:52 PM on June 8, 2007


Why, no - then they'd just use the Lieberman Plan.
posted by Kirth Gerson at 1:31 PM on June 8, 2007


Right, exactly, Ikkyu2.

Killer King was built in response to the first LA riots, as a demonstration of the city's newfound awareness of and commitment to the problems of the poor here. They did it right, even partnering with Caltech and NASA to bring those new-fangled "computer" thingies to bear on how to best serve its users. They even listened, and largely did what the eggheads suggested. (My dad worked on that, and despite being a generally cynical guy, is still proud of the work they did there. It's a neat story. If I can find anything about it, I'll FPP it.)

In those days, paying out of pocket for health care was not impossible for the average worker. Now, as we all know, only the wealthy -- or those who feel they have nothing to lose from bankruptcy -- could possibly do that. In California, I hear, a third of children have no health insurance. The emergency room is the family doctor for many, many families, particularly at King/Drew -- where 28% of patients have no health insurance.

So the response is... King/Drew is not serving patients well -- let's not serve them at all? Here's one woman who died due to the shocking mismanagement there; let's have lots of people die -- due to the shocking evil stupidity of the county goverment.
posted by Methylviolet at 2:02 PM on June 8, 2007


So the response is... King/Drew is not serving patients well -- let's not serve them at all? Here's one woman who died due to the shocking mismanagement there; let's have lots of people die -- due to the shocking evil stupidity of the county goverment.

They've removed the specialty areas, severed the connection with Drew medical school, and instead joined it with Harbor-UCLA medical school. I agree that it would have been awful to simply get rid of it, but that is not what has happened - from what I've read, the solution sounds eminently reasonable, or at least as reasonable as we could expect.

It's obvious that the area needs medical care, but there's no sense in wasting money and lives on, say, a neurological division at that particular hospital if no one can run it well. The community which is served by that hospital should get the absolute best care they can - and the best solution at the moment probably comprises improving the quality at King-Harbor for general and emergency issues, while at the same time referring patients elsewhere for specialized treatment.

And if you disagree - well, if you had to have brain surgery, would you elect to have it at King-Drew?
posted by Sticherbeast at 12:56 AM on June 9, 2007


Here's the latest from the L.A. Times: How King Harbor has stayed alive.
posted by scody at 11:04 AM on June 12, 2007


The Associated Press has published an article today on the incident: Woman dies in ER lobby as 911 refuses to help
posted by ericb at 2:16 PM on June 13, 2007


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