October 5, 2007

Nightmare on 58th Street: Trust lacking at the ER

Do you lie about how much pain you’re in? Do you take trips to the ER in ambulances “just for fun”? Are you overly dramatic, just for the attention that it will get you from the nice doctors?

You should be answering with an indignant “no” to all of these questions, just like I am. Despite this, on Monday, September 24, I spent the night in the University of Chicago Hospital emergency room, and was treated like a college student looking for an ambulance joy ride.

I understand that snap judgments are easy to make, and that in the short term, they make life much easier. I also understand that college students are easy to disrespect—it’s unlikely that they are going to complain much, or that their complaints will have much clout behind them. However, in the long term, rushes to judgments make everyone’s life much worse.

When I woke up that morning, I was having difficulty breathing and in the worst pain of my life, so I did what any sensible person would do: I went to the emergency room. I assumed, of course, that I would be taken seriously and given good care. I had been to the ER for this pain before and seen Johns Hopkins University doctors, but the cause remained a mystery.

There is a special kind of trust that a patient puts in the nurses and doctors in the ER. When you call an ambulance and place yourself in the hands of the paramedics, you put yourself completely at the mercy of the medical system. When you present yourself to triage, you are asking the nurse to see if you have a life-threatening condition. When you are dismissed as hysterical, told you are acting against medical advice, or informed that your pain is just “because of stress,” your nurses and doctors are violating this trust.

When I arrived at triage, the first thing the nurse said to me was, “Are you under a lot of stress? I think you’re having panic attacks.” I have spent enough time in emergency rooms to know better than to antagonize the nurses, so I tried to tell her politely that it wasn’t a panic attack.

From the moment the triage nurse made her ad hoc diagnosis, I was dismissed as an unimportant patient; my inability to breathe and monumental abdominal pain became simply symptoms of a panic attack. I waited as calmly as I could, convinced that when I was given a bed, this diagnosis of “panic attack” would go away, and my trust would be repaid.

I was told not to put on a gown as “I wouldn’t need it,” and was left in a corner room. I was seen by a resident, who declined to listen to my history or my complaints about current pain. One hour and a couple of tests later, I was in just as much pain as I when I came in.

Naively thinking that the ER was a place where I would be treated for pain and problems with breathing, I pointed this out to my resident. She kindly told me that there was nothing wrong with me and that they were going to send me home. I politely disagreed and asked to speak with the attending doctor.

This didn’t help. My attending physician informed me that if the doctors from JHU hadn’t been able to figure out what was wrong with me, then the doctors here certainly wouldn’t be able to either. He managed to be condescending in all possible ways, but what he didn’t manage to do was solve my problem.

He had already made up his mind before he walked into my corner room that I was not a patient to be taken seriously. Had he waited to hear what I, the lowly college student, had to say, he might have received some actual insight into my care—he might even have managed to take a step toward the proper diagnosis.

I now know that I had gallstones that night, which were the reason for my excruciating abdominal pain. My gallstones were possibly life-threatening, but because I was dismissed immediately as a hysteric, the U of C emergency room never even had a hope of making that diagnosis. It’s difficult to imagine: How many times can diagnoses be missed because of preconceived notions? How many times until someone dies because of that?

My medical trials aside, do students deserve to be treated like this? Yes, we sometimes come in excessively drunk, and yes, we push ourselves to the point of exhaustion, but we don’t come to the ER for sport. We don’t enjoy having the paramedics haul us out of our dorms, and we don’t think it’s fun to take up hours and hours of doctors’ valuable time, or of our time. U of C students have a lot of sense, and we are only at the ER if we have no other choice—trust me, we would rather be studying.