Caregiver for a day

“ We need to go to the ER”, said my wife suddenly one afternoon last week.

“Why?” I ask a little befuddled.

“Because this pain in my leg is now excruciating and they say that it could be a blood clot which could lead to a stroke”.

Now you need to know my wife. At four feet something, she is tiny but, as my friends often say, she is “a force of nature” and not to be trifled with. She had always wanted to be a medical doctor but due to her family circumstances, she could not follow her dream, but became an English major instead, and then a very successful editor. However, throughout our married life of about four decades, she has retained her interest in medicine. After my heart attack some five years ago, this almost became an obsession as she read copiously from medical journals, devoured any medical breakthrough reports and subscribed to any number of journals promoting good eating and health. Many a time she would interrupt a conversation with a completely random (at least to us) remark about “ they say you need to cut your carbs” or “ they say that diabetes is a silent killer” or something similar drawn from the latest news from the world of medicine. So much so growing up, our two kids invariably rolled their eyes when she started quoting some medical factoid.” Oh no,” they would cry, “ Not Dr Day again”. You see I had converted her admonitions into a fictitious Dr Day who was always right on medical issues and an Inspector Should, whose commands could not be brooked! It added a lot to her directives that she had rarely been sick or unwell during our four decades together.

So when she announced that we needed to go to the Emergency room (ER) at the nearest hospital, my ears pricked up, as she is normally not an alarmist, at least about her own medical problems. She is rather a procrastinator. I immediately called our family doctor for his advice. My wife described her symptoms in great detail over the phone and was advised that it was unlikely to be anything serious. She, on the other hand, was insistent that it could be a precursor to a blood clot leading to a stroke. Dr Summer then told me that if she needed reassurance she should go to ER and get an ultra sonar test done there. So there we were at the ER at our neighboring hospital, which boasted that it was the best trauma center in the country.

Now the ER, popularized by various TV shows, is a place frantic with activity with doctors and nurses running around in a panic with “code red” or some such thing, working to save a persons life with only seconds to spare. So the calm and silent ER that we found ourselves in was a bit of a shock. There were a dozen or so patients sitting in the room waiting and there was nary a doctor to be seen. There seemed to no sense of urgency there, and I wondered why. Instead, I found that there was a well-developed ritual.

When you first arrive at the ER, (and despite the name to the contrary, the average wait time for emergency room treatment by a doctor is two hours), you will likely undergo some form of triage; a process of determining the order in which, patients are seen. Generally speaking, the highest priority is given to those with the most urgent or life-threatening needs. Emergency rooms do not operate on a first-come, first-served basis. Instead the simple rule is “if it bleeds, it leads.” The triage nurse prioritizes each patient's condition into three general categories: immediately life threatening, urgent, but not immediately life threatening, and less urgent She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category.

After triage, the next stop is registration - not very exciting and rarely seen on TV. Here they obtain your vital statistics. You have to provide them with your insurance information, Medicare, Medicaid or HMO card. (Although a notice says that the hospital will treat all patients even those without any insurance under the law.) This step is necessary to develop a medical record so that your medical history, lab tests, blood work etc., will all be located on one chart that can be referenced at any time. The bill will also be generated from this information.

The next step is finally the exam room. Here you are seen by an emergency-department nurse who obtains even more detailed information about you. She then gets you settled into a patient gown so that you can be examined. Once she has finished her tasks, the next visitor is an emergency-medicine physician. He gets a more detailed medical history about your present illness, past medical problems, family history, social history, and a complete review of all your body systems. When he has all the information he can obtain, he makes a determination of the most likely diagnosis. Alternately, he may decide that he does not have enough information to make a decision and may require more tests. Or he may decide he needs more advice and so he speaks to a general surgeon. The surgeon comes to see you and performs a thorough review of your history, and your lab data. Depending on a patient's specific medical condition, they will either admit the patient to the hospital, discharge the patient, or transfer the patient to a more appropriate medical facility.

The first ER or specialized trauma care center in the world was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky, and was developed by surgeon Arnold Griswold during the 1930s. Griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today the modern ER performs an important role in the US medical system with over 100 million visitors and an average cost of $1200 per visitor. It really is a marvelous invention that has saved countless lives.

In our case, it took two hours to finish the paperwork and before we were led to the examination room to see a doctor. And it was another two hours before all the tests were completed and she was discharged from the ER. She had an ultra sound test, which was pronounced clear with no signs of any blood clots or possible stroke symptoms. So we came home with a prescription for a painkiller and an admonition to rest her legs. It seemed strange pushing her around in a wheelchair – for the last five years, it was I who was being pushed around by her. Thus began my brief tenure as a caregiver.

Now that I was the caregiver, I had to watch over her. Her concern that the doctors did not know her problem, however, remained. So I kept awake at night to ensure that she did not go into any strange contortions, presaging a possible stroke. Next morning, we decided to consult another doctor- an orthopedist. But he too was sure that it was merely an old injury of the knee and all she needed was rest. The painkillers were now another problem – while they dulled the pain they in turn caused constipation.

I was now in charge of running the household in addition to looking after the lady of the house. I must confess that it was a tiring experience as I shuffled from her bedside to the kitchen and then to the shopping mall. The shopping lists I had, always missed a few essential elements that I found out about only on my return when my wife pointed out that bread without butter would not work. Even as I was moving from the washer to the drier to the microwave, my better half looked on with alternate looks of glee and compassion. I relearned to operate the microwave, the oven, the drier and all these pesky modern machines that clutter up our lives on the pretext of simplifying them. I knew it was time to call it a day when I started dreaming about how to streamline the cleaning and washing and cooking, and started neglecting writing my blogs!

They say you need to walk in another shoes to really develop empathy. Boy, did I develop empathy- loads of it. Of course, she had been doing it for five years. I was ready to give up after five days. But it taught me a lot and I would urge all patients to spend at least a day exchanging places with their caregivers.