Monthly Archives: September 2013

Waiting Impaitently

Sometimes it’s difficult to practice what I preach. But I try.

A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to go. So we went. And this particular ER encounter did not make me like the patient side of an emergency department any more than before.

We were there for an issue that is time-sensitive – it’s certainly on the list of things that need super-quick evaluation. It took longer than it should have to get through triage and into the actual ER (maybe 20 minutes or so), but to the hospital’s credit, once we were actually in the room, the ER resident saw us almost immediately, realized the potential urgency, and had the attending doctor come right away. They ordered the necessary test, called the department to make sure it would be done immediately, and let us know that my son was the next person on the list and would go up promptly.

We waited about fifteen minutes. I checked with the nurse, who informed me that “they’re on their way” to get my son for the test. We waited some more. After another fifteen minutes or so, I checked with the nurse again. The same reply: “They’re on their way.” Another ten minutes went by. I got the resident’s attention and asked him if he could call up and see what was happening. He told me that he didn’t have a way to call anyone else. Another ten minutes. Went to check with the nurse again, who at this point gave me a really annoyed look and repeated that “they’re on their way.”

Honestly, the only way that they could possibly have been “on their way” that whole time was if they had been coming from Ohio.

We waited far longer than we should have for the test that determined whether a surgical emergency existed. It should have been done immediately, but it took significantly longer than an hour to obtain. And my polite advocating for my son did not seem to be fruitful. One of my specialist friends called and texted several times to check up on us, and kept urging me to push harder to get that test done.

I pushed. And it was very frustrating. I kept my composure and stayed polite, but I was seething inside. The nurse made another phone call. And it worked.

When the woman came to transport my son, I don’t think it would have been possible for her to move any more slowly. She was perfectly pleasant but showed absolutely no sense of urgency. I smiled and helped her push the bed so that we could make better time.

Emergency departments are grossly overused. They are filled with people who have had sinus congestion for two weeks or lower back soreness for a month, symptoms which should be addressed in a physician’s office. I understand the frustration of ER personnel and the at-times jaded attitudes of the staff. But it is the job of the healthcare workers to get beyond the workplace frustrations and to look at each situation through the eyes of the patients and their families.

Yes, there are people who use emergency room resources when they’re not needed. But most of us go out of our way to avoid emergency rooms. When we’re there, it means we’re really concerned about something. Assuming people are being polite, medical personnel should not show annoyance. A person transporting a patient for a “STAT” test should look like she’s hurrying. Residents should know what phone numbers to call to expedite what needs to be expedited.

The test turned out normal. No need for surgery. A little rest would do the trick. The fact that it then took another hour-and-a-half to be discharged was merely an annoyance, not a worry.

But believe me, I get it. When I tell my clients and my readers to advocate for themselves and their loved ones, I know it’s hard. I know it’s a delicate balance between making sure you get what you need and not annoying people in the process. But it has to be done. And hospitals are working on seeing things from the patients’ side. The gentle reminders and the self-advocacy help them get there.

The bill for the ER visit arrived in our mail today. That’s a subject for another day…



Of Bicycles and Self-Determination

My almost-three-year-old niece is just learning how to ride a bicycle. The overall balance issue doesn’t come too much into play yet since there are training wheels on her bike, but there’s still a lot involved. The pedaling needs to be done in a forward direction in order to move; that can be hard to start from certain pedal positions. A backward pedaling motion stops the bike but you need to remember to do it when you want to slow down or stop. And you need to remember not to do it when you want to keep going forward. That whole steering thing is a lot to think about as well, especially when you’re focusing on pedaling and trying to catch up to your older brother.

As the family went around the block, my niece drove my sister a little nuts as she alternated rapidly between asking for help and pushing my sister’s hand away. The child wanted to do it herself but kept getting stuck. The parent was happy to give her daughter assistance and independence, but the rapid cycling between the two wasn’t the easiest thing to deal with. So the bicycle balance issue that was covered by the training wheels was replaced with a parenting balance issue.

But it wasn’t a balancing issue for my niece. She knew exactly when she wanted help and when she wanted to do it by herself. When she got stuck and couldn’t move with a try or two, she wanted a little push. Then she wanted to be left alone. She didn’t necessarily want the occasional steering help to keep her from going into the middle of the street or a hand on her bike on a big downhill stretch, but those weren’t up for negotiation.

It gets harder to ask for help when we’re adults. Maybe a lot of that difficulty comes from a fear of loss of independence: If I ask for a little help with my finances, will I lose my financial control? If I ask for help with my project, will people think I can’t do it and give it to someone else? If I ask for help with my health issue, will someone else make my medical decisions for me and will I end up having to do things that aren’t right for me?

And we’re much more aware of others’ feelings than we are when we’re three years old. My niece had no problem pushing my sister’s hand off of her bike. As adults, we worry a little about hurting someone’s feelings by not following their advice or by rejecting their help. Since it’s hard to stop accepting the help, we may think it’s easier not to ask for it in the first place.

We can learn a lot from a toddler on a bicycle.

Training wheels are ok while you learn to pedal and steer. If you’re new to cooking, start by following recipes closely. If you are having difficulty managing your weight, ask your doctor for a specific plan to follow as you learn how your body specifically responds to certain ways of eating.

Sometimes you need a little push – ask for one. If you haven’t been able to stop smoking by yourself, ask your doctor for something to help you. Ask an expert for advice when you don’t know what to do or aren’t sure you’re taking the right step.

If someone has their hand on your steering mechanism for too long, ask them to remove it. If you are feeling pushed towards having a medical procedure done that you don’t feel comfortable with, stop and ask for a second opinion. Discuss your goals and your fears with your helath care team. Find what works for you. Grab your steering wheel back.

It was delightful to watch my niece and my sister do the self-sufficiency/reliance-on-others dance. The pride beaming from both of their faces, the love, the frustration, the achievement, the annoyance, the accomplishment – it was a marvelous first ride around the block. May they have a million more.

Decisions and Advocacy in Someone Else’s Realm – In the Store, Studio, Doctor’s Office, or Hospital

Our eldest son had his senior pictures scheduled for this past Friday. It was the last day before school started that we could schedule them, and they have to be done at a specific place and before a specific time so that they’re put in the yearbook. On Thursday, I asked him to try on his suit with whatever shirt and tie he wanted to wear so we’d have everything together and ready to go the next afternoon. And of course the suit didn’t come anywhere near close to fitting him.

So we then had about an hour-and-a-half window to find him a suit. I brought Son #2 along with us since he fit neither into his nor his older brother’s suit and would need one within the next month. Thankfully, Son #3 fits perfectly into Son #1’s old suit.

The problem is, I know very little about mens’ suits and my husband was away on a business trip. I needed to go someplace where there would be someone to guide us. We went to a national chain suit store nearby. They had a decent selection, but their prices weren’t great. The salesman seemed to know the different brands and cuts well, and went right to the styles that would fit the boys. But he was pushy. About the colors. About the tailoring. About shoes. I resisted the shoe push. But overall I felt pressured into an overall expensive purchase (admittedly much of the pressure being my own fault for not having checked suit-fit weeks ago). I did not walk out of that store feeling comfortable and happy.

Eldest son’s suit was ready for pickup Friday morning. It actually looked quite good. We headed to the photography studio for his sitting.

The woman at the front desk took us to a waiting area where the photographer met us and ushered us into the back. The photographer did not seem like she wanted to be there. In front of us, she complained with a colleague about another customer before she had my son go through a number of poses with different backgrounds. She seemed like she just wanted to be finished. With one particular pose, I asked if we could do a “serious” (not smiling) shot, and she said, “No, we did another serious shot and I like the smiling one on this pose.” And then she sent my child to change out of his suit into his other outfit for some casual shots.

I was a bit more forceful (but politely so) with the next set, and rather than asking her to do a shot with a particular expression I stated firmly (and sweetly) that I would like one done. She didn’t argue. But I left the studio feeling that I hadn’t gotten what I wanted with the formal shots. And the formal pictures had been the whole reason for my prior day’s rush on the suits.

I bring up these events of this past week because my mother just finished proofreading my completed manuscript for “Your Hospital Guide.” One thing she mentioned to me is that it can be really difficult to insist on something (like keeping your Hospital Buddy with you at all times) in a medical environment.

I get it. I really do. It was hard enough to say “I’m sorry, we’re not purchasing shoes today” as the salesman put them on my sons’ feet and told them how they needed ones that looked like this. It was hard enough to say to the photographer, “I’d really like a standing-up shot with a serious look.” And these are situations that are relatively unthreatening. The salesman and photographer are the authorities in their environments, but I and my family are the customers and we can risk annoying these people or even walk out if we want to without worrying about physical danger.

In a medical situation, a patient may feel that arguing, advocating, or questioning anyone in the environment might cause their or their loved one’s care to suffer. “This woman has my/my family member’s life/health in her hands. I’m not going to say anything that might make her angry.” But when you’re a patient, your needs are extremely important. Much more so than your need for a blue rather than a gray suit or a specific pose in a photography sitting.

When you are going in for a medical test or procedure, the time you are left alone in dressing areas or waiting areas can be extremely stressful. It may be “policy” for family members to wait back in a different waiting room, but this type of policy is changing in many hospitals as people figure out how to run a medical enterprise with the patient’s point of view in mind. There are certainly some situations where people other than the patient and hospital personnel cannot be there (for example, in an operating room), but many times there is no medical contraindication to the presence of a Buddy.

And your Hospital Buddy is there specifically for you. Not to make the hospital run efficiently (although he may help with that when helping you document information or answers to your questions, thus facilitating understanding and ability to follow directions). Not to improve the rankings of the hospital (although she may do that by helping you stay calm and comfortable so that when you fill out a survey form after your visit you’re more inclined to rate your patient experience more highly). Not to improve the hospital’s bottom line (although he may do so by asking questions that help you stay safe after you leave the hospital and prevent you from needing to be re-admitted).

When you are feeling afraid of ruffling feathers in a medical environment, your Hospital Buddy (or Doctor’s Office Buddy or Medical Buddy) can step in politely for you. Neither one of you should ever be afraid of asking questions until you understand something or letting people know your needs, your goals, and your fears. Do it politely. Do it with respect. But do it. “I’d like my sister to sit with me until I go back for the biopsy. If you need to ask me anything in private, I’ll ask her to step out for a minute. Otherwise, I need her with me.” “I need a doctor to evaluate my father immediately. Something isn’t right.” “When should I take the first dose of each of these medications?” “What would happen if I didn’t undergo this procedure? What is the risk of the procedure itself?”

It can be hard to speak up. I left the suit store having spent more than I would have liked and having purchased a suit for Son #2 that was not really his top color choice. I don’t think my son wanted to offend the salesman (who was insisting that the gray suit was more versatile than the blue striped one). And I didn’t do a great job of stepping away from the salesman with my son to make sure he could decide without pressure.  And as I said earlier, I don’t really know much about mens’ suits. But this whole escapade was at worst a few hundred dollar less-than-perfect effort. With the photography sitting, at worst I won’t have a choice of all of the specific poses I would have liked. We can get another suit. We can get more pictures done.

The stakes are much higher with a medical issue. And I’ve been there, too. My worst decisions have been when I’ve felt pressured by time and been afraid of offending someone. The pressure and the fear can cause us to walk out of a doctor’s office or a hospital with that icky feeling that we’ve just done the wrong thing. Sometimes the time pressure is real, but don’t let the fear of offending someone prevent you from questioning or from getting another opinion. Do it respectfully but firmly. “This is a very big decision for me. While I’m thankful for and respect your opinion, I need a little extra input from another doctor so that I can feel comfortable that I’m making the right choice for me.”

Then know that whatever you decide, you’ve made the best choice possible with the information at hand.