So I couldn’t sleep and was thinking about the article that Jan sent me to read this morning about Dr. Powell’s personal story of becoming a patient himself. My next thought after that was a friend that I worked with (also a nurse) telling me her experience at FMC ER a couple of weeks ago. And then after that came the flashbacks of my own experiences in the ER last summer after my surgery. I can’t recall if I started writing about it but stopped or if I mentioned it in other posts but didn’t go into details. In any case, since I am having trouble sleeping again, I decided to get up and write.
About 8 hours after being discharged home, I was in crisis. Adrenal insufficiency is a medical emergency but I was not treated as such. This is an excerpt of the letter I sent to the director and manager of FMC ER :
On July 3rd, 2019 – I was discharged from unit 112 (my post op was complicated with transient DI otherwise it was uneventful and I felt comfortable with discharge plan). I presented to FMC ER 12 hours later with symptoms of hyponatremia secondary to adrenal insufficiency resulting from my surgery (which I found out much later from internal med). I did not receive treatment for a potentially fatal medical condition until 12 hours later. I was only offered and given hydromorph with maxeran right away to manage my headache and mask my symptoms of what is going on. I arrived at ER with my husband at around 2 am and I was triaged quite quickly. I was seen by the nurse around 3 am where bloodwork was drawn and assessment completed rather quickly. At around 4 am, the attending ER physician came to do his assessment. Behind the pulled curtains, my bat ears overheard the physician say to the nurse that “She just had major brain surgery, of course she would have a headache” Because I had heard this, when he assessed me, I assured him that I never had headache like this post-op not manageable by regular Tylenol. Again, in my experience, I know that not every doctor read through the whole chart/history of the patient – so I also mentioned I was diagnosed with Cushing’s disease prior to surgery. He brushed me off and assured me that he read my medical history.
Nobody (aside from the neurosurg resident that was consulted and saw me once told me that my sodium was “a little bit low”) In that 12 hours, I tried advocating for myself (while heavily sedated) and asked the nurse multiple times about the results of my CT scan that the resident had ordered and reported worsening symptoms of higher urine output. I also asked her about repeated bloodwork which was not drawn again until 12 pm. From the time that I was assessed by Dr. Michalchuk in the ER at 4 am, I was not seen by the new ER physician Dr. Su again until 2:30 pm when I again pressed my nurse to get off her lazy ass to do something because she only had two patients her entire day shift and was observed to be on her cell phone. At 3pm, I was finally being treated with hypertonic saline and IV hydrocortisone. Because I was left untreated for so long, my sodium dropped to 124 when it was drawn at midnight on July 4th.
When I came around and realized what had happened (I could have seized, left permanently disabled, I already have tachycardia…the list goes on). I can only conclude that it was gross negligence under the care of the providers the 12 hours I was in Area A at ER.
…I am seeking justice for my mistreatment, but most importantly, I am concern with others’ lives being put at risk because of negligence due to an attitude of simply being complacent. I am proud to be a patient advocate in my own nursing career and I will continue to do so even though I am not working right now and recovering at home. I want your respond to immediate actions taken to safe guard those patients that come through your ER. If I do not get a respond from you within a reasonable time frame, I will proceed with reporting the story with CBC so that my voice is heard (even though I do not entirely believe that this is a good thing for the morale of your ER team) I had overheard one of my nurses sarcastically asked the patient next to me about finding a way home after discharge (referring to the Pincher Creek lady’s story) – She was so disingenuous, I could not believe it.
Less than an hour after that email was sent, I got a reply from the director and manager via email and then my phone rang. At first, the manager seems to have a rebuttal for every concern that I had – she was well prepared, she had gone through the paper chart and SCM (which I already had obtained from health records) It would appear that procedures were followed properly and i’s were dotted and T’s were crossed.
Further into our conversation (which was almost an hour long) I asked her, what if that was your daughter, or your mother, sister lying on that stretcher for 8 hours already suffering with no plan, no communication from anybody about what is going on to someone that just had brain surgery. I told her that when my husband and mom left briefly to go home to rest and look after the dog, I was alone and started crying. There was not even a box of Kleenex near by and my nurse could not even bother to bring me one – she half-heartedly said “What’s the matter? Oh I know it has been a long day” In which I replied, “Um, no I have been in the hospital for over a week – I basically just went home to shower and change and now I am back”. She was the least bit interested in providing any genuine comfort or reassurance. Sharleen (the manager whom I was talking to) I can hear her tone of voice changed after that. I asked her if she would like her family be treated that way if one day they end up in her ER. There was a deep sigh and I felt a slight resignation from her after that.
In my letter I had threatened legal actions and selling the story to CBC if actions weren’t taken immediately to address my concerns. So I left that in her capable hands to do what she said she would do. Patient’s Relation would be involved just so that there is a paper trail and a third party to witness a meeting that would take place between the manager, the director and the head physician of ER.
After feeling somewhat victorious in getting that off my chest – 5 days after that phone call, never in my wildest imagination could I picture myself back in that ER again. I woke up at 4 am choking on my own blood. Apparently delayed massive epistaxis post transsphenoidal surgery happen in less than 3% of patients treated. We called EMS and when EMS asked me which hospital I want to be taken to…I seriously thought I was going to die, like this is it, my brain will swell by the time some doctor actually sees me. They kept asking me which hospital I want them take me to. It was one of the toughest decision that I ever had to make. In my head I thought I had just complained last week, everyone there will have known by now and this time I might just die there. I had no other choice, it was the only hospital with neurosurgery and ENT, being rational during such a frightening state is extremely challenging…
When we got there, the ER was swamped with the aftermath of “Last weekend of the Stampede” – I was placed in a wheelchair near the loading bay non visible from triage desk (there were already 2 -3 people waiting in stretchers with EMS which I knew was not a sit around and twiddle your thumb night at the ER) – my nose still bleeding…only at a higher rate and that useless nose clip they want me to keep on does absolutely nothing because within 15 minutes I was throwing up blood clots. The paramedic coming on shift was trying to reassure me that there are oodles amount of blood in my body that I won’t bleed out to death (I couldn’t tell her because I was coughing up blood clots that my concern is not losing blood volume, my concern is I just had brain surgery and a week ago I was in adrenal crisis and I have no idea if my half chopped off pituitary is actually producing any ACTH to alert my adrenals that I need more cortisol to deal with this trauma – and then I could almost die again). Yeah, she didn’t know that I am a nurse.
Blood was starting to pool into my ears, my hearing was getting muffled – finally what seemed like eternity, a doctor said he would see me in trauma bay (Trauma bay is a reserved area for people coming in with bullets or pieces of doors stuck to their side from MVAs) Guess what? It was my lucky day! It was the same ER physician that actually treated me and got me admitted after waiting for 12 hours circling the drain at my last visit. The nurse that came on after change over…even with her gown and mask on, I recognized her voice. It was the same nurse that I gave the name to the manager – one whom I complained about. Josh said she looked like she was about to cry when she saw me half dead covered with blood.
….[continued from my letter] I believe that health care providers need to be accountable for their own actions and stop using excuses like the system shortfalls for their conduct and care (in my case, the ER that night and part of that day shift was not busy at all) Their actions were consistent with the “pass the puck” mentality where do as little as possible and leave it for the next shift or someone else should have put those orders and consults in, I shouldn’t have to follow up and harass them until the patient harasses me to do something. These people need to be held accountable for their behaviours and actually have real disciplinary actions taken against them – real consequences with stakes as high as losing their livelihoods (licenses to practise) Nobody deserve to get paid 50 dollars an hour to sit and watch someone circle the drain and then go home.
If you are no longer passionate about working in the ER or just become so complacent with being a nurse. Find a new career. I believe that the majority of the people that chose Nursing as a career are genuinely kind hearted and altruistic beings. I get it, life wears you down. Many don’t feel appreciated, and the system is far from maximum efficiency. But going to work is a choice. Choosing to be the best nurse that you can be that day despite what is going on in your personal life is also a choice. It is a choice to call in sick and take a mental health day. If you can’t be compassionate with yourself you can’t be compassionate toward others.
I can’t help but think that the Universe needed me to go back to the ER for a second experience to see if my complaint had worked. There was absolutely no explanation to why I had massive epistaxis 19 days post op. It was such an anomaly that I sit that trophy next to the rare Cushing’s disease one.