Wednesday, January 12, 2011

Deja Vu

Legendary female acapella group, Sweet Honey in the Rock, penned a song called "Emergency."  Six blended voices convey urgency and desperation singing out, "My soul is in a state of emergency!"  The group performs in classical Greek tragedy style where the chorus represents the background truth-tellers. Singing of doom and adversity, they sound the alarm to the current dark state of affairs.  During the chorus, one of the voices belts an ear-piercing siren-like pitch, and you feel like you're a bystander in a crowd watching an ambulance roar by.  It's that same gripping feeling you get in the middle of your chest when you watch the news.  Story and by-line after by-line of endless calamity and despair.  It's too much to take and you want to turn your eyes away, but you just can't because something about watching and sensing the fragility of the human condition is too captivating.  Furthermore, if you've ever been in the middle of a trauma as an unexpected victim, then you know that you do not have the privilege of having a remote control and just clicking the pain away.

Last week, I found myself on my knees screaming bloody murder in a curtained ER at Boston Medical Center.  There I was clutching the edges of the bed yelling, "Somebody please help me!  I'm in so much pain..."  I overheard soft sounds of doctors, nurses, orderlies, and patient reps calmly going about their business vaguely unaware of the banshee cries of a woman who could barely keep a johnny over her naked breast.  I found myself caught somewhere between "should I be laughing at this spectacle of myself?" and "is this really me? Here? Now?"  What made matters worse was knowing that I had been  here before.  Not this hospital, but this place of utter insanity and surrealism.  I stepped outside of my body, and my spirit hovered over me fixing her gaze upon me.  How did I actually get here?  To make a dramatic story short, I had a kidney stone.  A 2mm kidney stone lodged in my ureter that felt like a boulder trying to pass through a pixie straw.   One of the five ER docs who passed through my room chuckled to me that he heard that a kidney stone felt more painful than giving birth.   I always find it amusing how male doctors find it so convenient to joke around with their patients in a place designated for emergencies.   Desperately seeking pain relief,  I received the comic kind.  All I wanted was something stronger than ibuprofen to drip through the i.v. into my thirsty veins.  I reduced myself to begging for medication.  The nurse told me she would give me Toderol, (but not before my paperwork was completed), to take some of the edge off.  When ten minutes passed and the pain was still immensely strong, I was convinced that she lied (because my paperwork still hadn't been entirely completed) and  injected a placebo into my arm.  Years passed, and she returned with Morphine.  Ten minutes later, the pain amps up.  It took a third dose of something much stronger than Morphine before I stared to feel the high of being drugged-up and pain-free.  In my fit of madness, the attending nurse turned to me and asked if I was an intravenous drug user because " ...iv drug users tend to develop an immunity to drugs."  "No, Lady," I thought, "I just play one on The Wire." 

The ER is nothing like the frenetic, code Blue place you see on TV.  In a twisted way, I was kinda hoping that I would get that sort of attention when I was there.  It's the hospital red carpet treatment where everyone knows your name and there is a sanitized room awaiting your arrival, and a monogrammed johnny with your initials has been carefully draped over the side of the bed.  Whatever ails you, even if it is blood spurting out from your side, there is a fastidious and authentic diagnosis made by a highly trained and competent physician with the warmest of bedside manners.  TV has the main situational character (patient) somewhat in control of their  lines, how they are expressed and the timing of it all.  Ever notice how that even if the ending is dire for the patient, somehow the attending physician is absolved of his/her responsibility even if he or she did make the right, but painful decision to discontinue CPR?  The patient may retain some control over life altering decisions, but the doctor knows best.   Even though its characters are over-the-top, I think the show House is a near perfect example of how the frail egos of doctors overshadows the care of patients.

If anything, ERs are tiny microcosms of the larger ecosystem in which they dwell.  If barriers exists to providing all people equal access to adequate health care then the ER is the first place where the police tape that reads "Do Not Cross" is crisscrossed over the entrance to the hospital.  Ironically, the people who end up in the ER are those lacking health insurance. It's a break in the link in the chain of survival.  A job provides a health insurance plan.  Health insurance grants access to a primary care physician.   The physician is linked into a network of other providers, specialists and hospitals.  It seems simple and efficient, but we all know that our health care system remains stuck in a political holding pattern .  To further the disruption, consider a patient who exhibits these symptoms:
  • low income
  • oppressive environmental factors: living in an urban area with few safe areas to walk and play, limited or no access to fresh produce, etc.
  • English is not the primary language
  • elderly
  • person of color
  • co-morbidity (has more than one health condition, i.e.diabetes and asthma) exacerbated by all the preceding conditions
These aren't symptoms a physician checks for.   After all, in the event of an emergency they are trained to look for unusual sights, sounds, and smells.  On the wall of each  hospital room is a list of patient rights and a number to call if you are experiencing trouble; it may even be written in a few languages.  Does someone who is triaged, already in a vulnerable position, feel that they can invoke rights? I mean, the doctor knows best--right?

Rights are not being invoked, and it is not the patient's fault.  It's a system failure that has yet to be de-bugged and re-wired so that when it re-boots it defaults to the patient as the system administrator.  I served as a community trainer to a Harvard School of Public Health health disparities study investigating participation of ethnic minorities in cancer clinical trials.  In Boston alone, less than 1% of all cancer clinical trials enroll people of color, for whom mortality rates remain the lowest.  Besides a history of injustices regarding research (think Tuskegee), another huge barrier is health care providers not advocating for and educating their patients of color about the potential benefits of clinical trial participation.  Why don't they?  Because they don't think that their patients would be open to it, given the legacy of mistreatment.  They might be too scared, think it's too risky, or since their survival rates are statistically low, why even bother to let them know?

But, back to astral planing.  While I watched myself suffer, I remembered all those times I visited an ER, whether it was for me or with a family member.  To observe someone in pain is to be a bystander.   Innocent as you are, you can do nothing but hope that emergency personnel comes in time.  My spirit traveled in an out of that place to glimpse upon the distinct, worried faces of people waiting to be cared for, hoping not to be denied care.  Old folks on stretchers, some alone, some with loved ones planted nearby, infants crying.   And in the midst of all this chaos, I overheard soft sounds of doctors, nurses, orderlies, and patient reps calmly going about their business vaguely unaware that they, too have been here before.