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Cheryl Hughes: Let's Prioritize

Last Monday, Garey and I were at the Medical Center Emergency Room in Bowling Green for twelve hours.  I know that sounds like an exaggeration—God knows I wish it were—but it isn’t.  We arrived at 10:15 a.m. and left at 10:15 p.m.  

I want to pause here to say that there are many fine medical professionals who work at the Medical Center, a few of whom are personal friends.  This is in no way to disparage any of those people.  The problem lies within the system of prioritizing patients.  Let me explain.

Garey is a pretty active guy.  He’s always outside doing something in his shop or out on the farm.  He has a heart condition, but to watch him, you would never know that.  Last Monday morning, he began to feel light-headed and a bit dizzy, so he came to the house to take his blood pressure.  Garey has a pace maker, and he is on BP meds, as well as heart meds.  His BP was higher than it should be, so he called his cardiologist.  Garey sees a doctor at Vanderbilt.  She was unavailable, but the person on duty asked Garey a series of questions.  After hearing his answers, she advised him to head straight to the ER in Bowling Green and to make sure someone else drove him there.  She would call ahead.

I drove Garey to the ER.  I was afraid for him.  When we arrived, Garey registered and mentioned that Vanderbilt had called ahead, so they would be expecting him.  The front desk receptionist told him to take a seat, and they would be with him shortly.  After 30 minutes, they took him back for an EKG.  He came back to the waiting area, and 45 minutes later, they took his blood.  He came back to the waiting area for another two hours, then they did a second EKG.  We were pushing 4 hours at this point.

The waiting area was starting to overflow.  There were people with various conditions.  A few people were coughing, a young guy had a sprained ankle, and there were several women there with small children—those young mothers were the ones I really felt sorry for.  A woman with heart problems arrived shortly after we did.  She sat in our area and talked to us while we waited.

 Another hour passed, and they wheeled a woman in from the ER.  She was in her pajamas and looked to be in her late seventies.  She had a large knot on her forehead, and she was a pistol.  She talked to everyone around her and across the room, and before long, we all knew her life history.  She moved to Kentucky from Arizona, and before moving, she had been in a diabetic coma for two months.  She had fallen that morning (the ER morning) and hit her head.  A neighbor had called the ambulance for her.  

“Wait a minute,” a lady next to her said, “you came here in an ambulance, and they put you in the waiting room?”

“Sure enough,” the lady with the knot on her head, said.  “And I thought Arizona health care was bad.”

“Did they at least do a CAT Scan before they wheeled you out here?” the first lady asked.

“No, they did not,” the lady with the knot on her head said, “and if this goose egg bursts, they’re gonna owe me some bacon.”

I looked at Garey and said, “This isn’t looking good.”  Garey agreed.  It was then that I remembered the card they gave Garey when he had his second EKG.  The card had an explanation of the “Rapid Assessment Side” of the ER, the side to which Garey had evidently been relegated.  The card explained that his condition had been evaluated by a “qualified emergency medical provider,” and he would be “brought back to an appropriate treatment area as soon as possible.”

We ate both lunch and dinner from the waiting area vending machine.  Garey and the other heart patient were still waiting.  The woman with the knot on her head looked around and said, “I guess if I was gonna die, I would have died already.  I’m outta here.”  She called her neighbor—the one who had called the ambulance—to come pick her up.  

It was 8:15 p.m. when Garey turned to me and said, “It’s past time for my BP meds.  I have them with me, and I’m going to go ahead and take the usual dose and an extra half pill.  I will get them to check my BP in 45 minutes, and if it’s okay, we’re leaving.  At 8:30, they took him back to a room, and hooked him up to a machine which took his blood pressure.  It was 225/125.  It was another hour before the doctor saw him.  By that time, the BP meds he took at 8:15 had kicked in, and his BP was 140/88.  The doctor looked at Garey’s BP reading and said, “Well, I can’t do much better than that.”  He told Garey to follow up with his cardiologist and to take extra meds if his BP was elevated the next morning.

At 10:15 p.m., they sent him on his way with 18 typed pages of information on the importance of a low-salt diet, how to take your blood pressure at home, and the number for the Suicide Prevention Hotline—information that would have been helpful three hours earlier.  My favorite bit was the page that instructed patients to call 911 if their BP was 180/120 or higher, because it could lead to organ damage.

When we got to the car, Garey looked at me and said, “Evidently, the word “emergency” does not mean “urgency” to these people.  The take away from all this for me is this: If you sprain your ankle or have pneumonia or a bad cough, head for the ER in Bowling Green.  If you have heart problems, go ahead and drive to Nashville.  You’ll be home in time to watch NCIS.



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