Life and Death in the Emergency Room

Life and Death in the Emergency Room
Emergency rooms and their disturbing world are much better places to leave than at which to arrive—and so much better to leave alive. ...
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The emergency room is such a microcosm of drama, emotion and sharp twist in fortune. Feelings are stripped raw, whether the trials are your own or you are witness to the sufferings of others. Both experiences were mine when my father had an accident, and the emergency room became our harried home for a day.



My dad is now 90, and his Alzheimer's is settled in: he still recognizes his immediate family, though even that anchor is slipping. When he fell in the bathroom and severely cut the top of his hand and sharply twisted his knee, he couldn't clearly explain what had happened. Though his injuries weren't dire, we had to call an ambulance to get him to the emergency room, since we couldn't get him in and out of a car.



The emergency room had a long L-shaped central counter, narrow center and side aisles, and a series of patient and supply rooms along the periphery. I was immediately struck by the noise, the amplitude of which moved up and down like it was pushed through a bellows. It's a challenge to immediately orient in such a place: the activity levels, some of them involving quick and complicated decision-making, are intense—a phalanx of nurses and attendants moving in darting, un-syncopated spurts, from hallway patient to the admitting desk to aisle rooms, a dance to the untrained eye without evident direction. That arrhythmia has a counterpoint in the steady flow of arriving EMTs, mostly in pairs, with their gurney-bound patients, my father among them.



There was already a pile-up of gurneys butted up to the aisle walls when we came in, holding mostly elderly people in various states of misery. We waited for a half-hour or so to check in, my father patient and essentially alert, his EMTs flanking him like bodyguards. He was finally moved into a corner room adjacent to the bathroom and the door to the public waiting room, a position that afforded over the next few hours many scary sights and sounds.



One sobering tableau quickly unfolded: I stepped to the doorway of my father's room, which gave me a view of the main emergency room doings. I looked up just as a priest was leaving a curtained-off area of the room. He passed me to enter the public waiting room, and moments after, a line of people of mixed ages and sexes moved from the public room toward the curtained area, their faces grave. Over the next hour, people streamed in and out of the curtained area, often weeping, some clutching each other for support, some faces taut but emotionless.



Then, it was over: having not looked over there for five minutes, and then looking again, I saw the curtain was pulled away, the bed stripped, the despondent parade departed. For that family, lives were undoubtedly altered forever, a loved one gone, the magic animation that is life, stilled.



Meanwhile, in my father's room, the initial flutter of activity also stilled, in favor of cases needing more immediate attention. One of the EMTs that had come with our ambulance hovered outside of the room, needing a nurse to complete his delivery paperwork so that he and his partner could leave. I asked him how he dealt with the daily savagery of accident and circumstance. He told me he'd been haunted by the horrific when he first started, but he'd learned to remove himself; he looked at his work objectively, as science, or as problem-solving. As he spoke, more problems were arriving, seeking solution.



The noise level escalated, a weird goulash of sounds: beeping monitors, clacking keyboards, the wheezing of strange medical equipment, some quiet moans from the gurneys. The nearby bathroom had an astonishingly loud toilet, like a freight train leaving its tracks. It's a wonder that the noise of that aggressive waste disposal didn't kill some of the stricken souls that visited.



And waste itself--it was remarkable how much is generated in an emergency room. It took almost three hours before my father was visited by a doctor, and in that time, he was seen by a nurse, a trainee, and the emergency room's own EMT, all of whom came in and cleaned his wound, gave him shots or adjusted or changed his bandages. The bandage and needle sets came in little plastic trays, with various sterilizers and fluids, and because my father continued to bleed pretty freely, the trash can in the place was soon overflowing with bloody hell from the bandages and the various packagings. It was fascinating to see the medical people whip open packaging and fling all the wrappers and leftovers toward the can; the floor soon looked like a battleground. In the almost six hours we were there, the large can had to be emptied twice, and I saw the maintenance person who did the emptying always circulating through the various rooms with a wheeled, giant-size trash can, always overflowing.



By this time, most of the initial patients had been processed, either moved to rooms in the ER, or discharged, or admitted to the hospital. But more than could be handled kept arriving. One of the scariest for me was a tiny, elderly, barefoot Asian woman, who seemed to have dementia. She had no family members with her, and I didn't see the usual EMTs in charge of her gurney. She had a waist restraint on, and I soon understood why. She kept attempting to clamber over the raised side-slats of the gurney, on a mission unknown, resulting in her getting tangled up and essentially dangling over the side.



Wraith-like, she was somewhat like a small animal, moaning, clawing and reaching out. For some reason, no nurses or attendants paid much attention to her, occasionally stopping by and righting her on the gurney, but not securing her properly, so she would immediately try to clamber over its sides once again. This went on for an hour, and then the next time I looked up, she was gone.



Finally, the doctor was able to pull away from his paperwork—he seemed to be on the computer at least as much as he saw patients—and he stitched up my father with quick dispatch. He examined his wildly swollen knee and its X-rays, and pronounced my father alive, and with the potential to be well. All the while the doctor was talking to my father and me, a man was so violently vomiting in the adjacent bathroom that the doctor had to raise his voice. Combine the ill man's explosive expulsions with the concussion from the cannon toilet, and you have a cascade of menacing sound.



At this point, my father looked like a gunshot victim: his shirt and undershirt were soaked with blood, though the stitches had finally stanched the bleeding. But that didn't seem to faze him; he had other concerns. Like many Alzheimer's patients, my father gets into patterns of asking the same question over and over. Through our hours there, my father selected three areas of interest: our departure time, the location of his wallet, and if I had an income-producing profession. The first one was essentially unanswerable—the atmosphere of the place seem to warp time's lines anyway, and for my father, whose question of two minute’s past is born anew when asked again, time is a fluid thing. We still had to wait for an official discharge, and another ambulance pick-up, since he still needed assistance into the house.



As for his wallet, I had it securely in my pocket, but displaying it to him only soothed him for mere moments; the flickering signals in his brain illuminate a memory only for a minute or so; then it is swallowed back into darkness. I couldn't give him the wallet back, in his bloodied, bed-ridden state, and confirming its safe existence only provided a rapidly evaporating security. If I was employed was easy enough to answer—yes—but even with a variant explanation, not all that interesting.



However, one aspect of my father's condition—and one for which my family is deeply grateful—is that he still has a sense of humor. So, after explaining to him a few times how I made my living these days, I began to tell him other things: that I was an acrobat, a dancer, a lumberjack. All of them made him laugh, and say, "Really, an acrobat?" But he was in on the joke, and enjoyed the thought, however fleeting its impact.



He was discharged, and the ambulance arrived for the ride home. My father was taken out on another gurney, past the pinched, drawn faces of the new gurney arrivals, past a dazed-looking woman wandering in a flopping robe, past the area where short hours ago a life left a grieving family behind. Emergency rooms and their disturbing world are much better places to leave than at which to arrive—and so much better to leave alive.

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