THE HOSPITAL

THE HOSPITAL

EMERGENCY: AM I OLD?

The question has to be asked, at what age are we considered old? It is a universal question that fields no concrete answers. Is it after sixty years of age? Seventy, eighty, ninety? Is it connected with being infirm? Perhaps age and infirmity are the answer. We all have a view of what is old. The person, grey hair, wrinkled skin, and bent over in a wheelchair? Perhaps the person using a walker stooped and sauntering? Or maybe the grey-haired woman who wears her wrinkles with pride and holds on to a food cart for support?

When I was just sixty-three, I was sent to the hospital emergency department by my family doctor. I had a condition she didn’t understand. My legs were very inflamed with a condition called pitting edema. Pressing a finger into the skin would leave a noticeable indent. My legs not only felt like tree trunks, but they also looked like them as well. Both legs were extremely painful. It was as if someone had systematically removed the skin from my legs.

At home, a walking stick helped somewhat. It allowed me to get from my chair to the bathroom and back. But that was the extent of my travel. Even that short walk of fifteen feet drained every ounce of energy from me. My wife, being extremely ill herself, could offer little support apart from encouragement.

Meals were difficult. My wife tried her best to feed the both of us. It was bare-bones food. Besides, I had little appetite. However, the need for me to eat was critical, for I had diabetes. I was insulin-dependent, and as a result, I needed to eat a balanced meal of protein and carbohydrates to stabilize blood sugar. Carbohydrates (simple sugar) are pure energy used by all cells of the body to function correctly. If there are insufficient carbohydrates in the brain, unconsciousness can result, which, if not corrected, will eventually lead to death.

My doctor had done her research about the condition of my legs and discovered it was not related to blood-thinning medication. I had been taking the treatment for years. She contacted a colleague, an expert on such conditions I was experiencing. As luck would have it, he was working for a colleague in the hospital emergency department. He would see me as soon as I arrived. At four in the afternoon, and following my doctor’s instructions, I walked into a sixty-seat emergency waiting room that was empty.

I went directly to the triage nurse and registered. I explained who I was and why I was there. I told her of the physician waiting for me and the email sent to him by my doctor. The Nurse acknowledged that the email had indeed arrived. She had already informed the physician of my impending arrival. As I was the only patient in the department, I felt sure I would see the doctor relatively quickly. As standard practice dictated, I was triaged. My blood pressure, pulse, breathing, skin condition, etc., were dutifully recorded. I informed the Nurse I was diabetic and would soon need food.

“Take a seat and wait until called,” the Nurse said abruptly, followed by, “don’t eat or drink until you have seen the doctor.” Her response supported my opinion the I would be seeing the doctor sooner than later.

At six in the evening, the waiting room was full. Those in need of a physician had taken every seat. There was standing room only. I was getting hungry, and I knew my blood sugar level was dropping. I went back to the Nurse and explained my situation. To my chagrin, she once again told me that I would have to go without food or water if I wanted to see the doctor.

I was becoming concerned not only with my health but with the safety of those in the waiting room. The triage Nurse has a specific role to play. She is required to triage patients into categories. Her role is to group patients into those who are very seriously injured or ill to those less serious. The role of a triage Nurse is to ensure her patients (those in the waiting room) are continuously monitored to ensure their injury or illness doesn’t worsen

In my case, my blood sugar was deteriorating. I informed the triage nurse of that fact, yet she did nothing. Like I, others in the waiting room sat for many hours without being monitored. It was a complete breakdown of the Nurse's responsibility. In my case, she had utterly failed. She allowed my blood sugar to drop to dangerous levels. And when confronted with that, not only did she not take my blood sugar reading, but she put me in worse danger by telling me to sit back down.

At eight in the evening, my blood sugar had dropped to the point food was essential. Therefore I went home to eat (the hospital restaurant was closed). At nine o'clock, my family doctor phoned. As I answered, she worried that I was home and not in the hospital. I explained all that had happened. With that, she told me to return to the emergency department immediately and that she would email the triage nurse. My doctor was annoyed. The physician I expected to see had waited for me but eventually left for the night.

I was angry. It was just over a week before Christmas. With Christmas music playing softly in the background, I was back in the emergency waiting room with a triage nurse who didn’t obey the complex rules of her station. The soft Christmas music did little to distract me from the hell in which I was sinking. Had I not been an Emergency Medical Technician with training in triage, I would never have bothered with the complex workload expected of a registered nurse.

The Nurse offered no apology. At that point, none would be accepted. I could not voluntarily give in to someone who, purposefully or not, tried to do me harm. I had reluctantly accepted my fate and waited peacefully for my call to enter the emergency department. I received that call at ten-thirty.

A further two hours went by while I remained in a smaller waiting room that sat ten people. At two in the morning, I was given a bed. The beds on either side of me were empty. I wondered just how long it would take to fill them.

My bed was opposite the Nurse’s station. I thought myself fortunate, for there were two nurses there for their patients, and I was one of them. With the pain in my legs increasing exponentially, I saw before me two angels who could assist me to the bathroom, or if nothing else, bring a urinal to me. My angels slowly turned into ogres, interested not in their patients but their conversation. I would have to wait till the end of their shift before I would see either of them.

I began to wonder if my age impeded my treatment.

Very slowly, three in the morning slipped by. While in excruciating pain, I had crawled to the bathroom. My grandmother’s walking stick was my trusted support. On the way back to my bed, one of the two nurses scolded me for not being in bed when the doctor arrived. She told me he was upset I wasn’t there. My strength sapped I could offer no resistance. I crawled into bed, not caring. The previous twelve hours had drained the very life from me. I lay in my bed in the Emergency department, almost in tears. At that moment, I hated life.

It was almost three-thirty when the doctor arrived. He introduced himself as an intern. As proper etiquette dictates, he examined me from head to toe. He listened to my medical history, trying to put in the context of what I was suffering. He was keen to learn, asking what seemed to be a thousand questions. Being vocal in his thoughts, he quickly told me his training had never prepared him for what was happening to me.

He could not explain why both legs were inflamed. He speculated that it could be a blood clot in the femoral artery at the point where it separates into two separate arteries, each supplying fresh oxygenated blood to the legs.

It was guesswork. The doctor didn’t know, and he was honest enough to say so. The equipment needed to find the truth was in hibernation until seven in the morning. His escape? He asked me my opinion of the treatment he proposed, to whit I responded with, “you’re the doctor; it’s your job to know this stuff.” With that, I received four doses of heparin. That I was on warfarin, a blood thinner didn't seem to bother him. For the next forty-eight hours, I watched where I went, for I didn’t need to damage my skin. With the amount of blood thinners in me, I would bleed like an uncontrollable river if I nicked myself.

After all the upheaval and struggling to get to the bathroom and back, I became very thirsty. I realized I hadn’t had any fluids since nine that evening. Politely I asked a Nurse if I could get a jug of water. She told me she would bring me some “in a moment.” That moment never arrived. I had to wait until eight in the morning when care aides came on shift before I could quench my extreme thirst.

It couldn’t be my age that determined my care, could it? It was pure speculation, silly really, utter nonsense. But at that time, I could find no plausible answer.

The day opened with a flurry of activity, all designed to discover what was wrong with me. Although I endured ultrasounds and CAT scans, along with several blood tests, nothing pointed anywhere near the elusive answer we all sought. Even a name to my malady would have been helpful.

My wife, daughter, and her husband arrived early that evening. They had stopped at a Kentucky Fried Chicken store. Supper, although late, was going to be delicious. I often wonder if anyone else in the emergency department grew hunger pains from the smell as it permeated the stale air. I was just about to tuck into my first chicken leg when a nurse came along with a wheelchair.

“You are going to be admitted,” the Nurse snapped as she pushed a wheelchair past my family to my bed. She was in a rush. Hastily, she placed all my belongings on my lap. Within moments I was out of the madness of the emergency department and into the hospital proper. A sense of relief flooded over me. I left the den of iniquity and headed somewhere where doctors would hopefully find out what disease or illness I had and find a cure.

ADMITTED

I woke after a short sleep in my new bed, a hospital bed. There were two others in my room, a woman who constantly vomited and an elderly gentleman who, I was to learn, had an Acquired Brain Injury.

Staff had given the woman a washing bowl to catch her vomit. The amount of vomit made a kidney bowl obsolete, at least for this patient. I learned from staff it was easier for them. They would not have to rush back and forth emptying a small kidney bowl. Their workload was significantly reduced.

However, by taking shortcuts with patient care, there are always consequences. Having a washbasin as an emesis catch bowl intentionally left the patient alone for an extended period. As she was within ten feet of me, I could neither escape the smell or sound of her in distress. I had empathy for her, but due to my health, I was unable to help her.

The other patient had the intellect of a three-year-old inside the body of an eighty-year-old man. He had an indwelling catheter that collected his urine as his body manufactured it. His urine drained into a two-liter bag. When the bag was sufficiently full, staff would drain his urine with a urinal, then pour the contents down the toilet.

Often he would soil his brief (adult diaper), resulting in the nursing station care team using a full-body lift to raise him from his chair to his bed to change him. Often the smell was enough to make my nose flare and eyes water. Air conditioner spray is considered an irritant; therefore, I had to suffer until sufficient natural airflow pulled the stench away.

I didn’t know his name, but the male patient with the brain injury was a prisoner in his body. He was dependent on others for all his daily care. The only meaningful gratification I saw him accomplish was eating by himself. And yet, it was ground food. But for someone with his limited cognitive ability, it must have felt a considerable achievement.

Staff were far too busy to bother with his emotional support. Instead, they provided the bare minimum care. He was being held captive in the hospital and had been for two years. Although he was on a transfer list to a Long Term Care facility, he had been refused acceptance countless times due to his dementia and attitude. Management of those facilities preferred a resident that was able to be controlled and with ease.

At seven in the morning, a Nurse suddenly appeared at the foot of my bed. In her hands were those all too familiar sheets of paper, the admitting paperwork. For the next hour, I was subjected to a string of questions, most of which I could not answer.

“When were you diagnosed with diabetes?”

“Years ago,” I said honestly.

“Do you know the year?”

“Haven’t a clue, sorry, but I would say probably twenty-five years ago.” And so it went until we hit a roadblock. We were like two vehicles head to head on a one-lane country road. One had to give in and reverse, and It wasn’t going to be me. I’m too thick-headed for that. The problem? Insulin. I have to take, by injection, two types of insulin. Short-acting, taken just before or after meals. The other, long-acting or background insulin given twice a day and as close to twelve hours intervals as possible.

I used to work eight-hour night shifts. I administered my long-acting insulin ten at night and ten in the morning. I found the balance was easy to maintain. My doctor was pleased with the blood test results I was obtaining. My diabetes was well under control, and it had to stay that way. But then I ran into a problem, a hostile nurse who failed to understand the significance of insulin administration and health.

“I can’t give you your long-acting insulin at ten in the morning,” She said authoritatively. “I won't have time for that.”

“But that is when I take my insulin,” I said, a little annoyed. “ Have done so for years. Ten is the time for my insulin.” I remained calm, yet I could feel the storm of anger rising in me.

“My staff and I will not have adequate time to give you your insulin. It’s that simple. There is no argument. You will get your insulin at breakfast, and that is at eight o clock.”

It was beginning to turn into a fight. I looked at the Nurse square in the eye and said, “not good enough. I must and shall receive my insulin and at ten o clock.” I then added, “ If you can’t take a precious thirty seconds from your day to give me my medication, then perhaps I will give it myself.”

“We can do that,” she answered, “but you take full responsibility for delivering the correct dose to yourself and for storing your medication safely?”

The argument, such as it was, lasted ten minutes. I was disgusted with the Nurse, for she gave no latitude to her contention no one on her staff had time. Until my release from the hospital, the tension between the nursing staff and me was exceptionally high.

Admitting complete, I had time to study my surroundings and to get my bearings. At the foot of my bed were three lockers. Grey in colour, they looked dirty. The small lever to gain access had grime on and around it. There was dust on the top edge of the door and the three fresh air louvers. Dust had also accumulated on the top of each locker. I guessed it had been there a long time.

The apex of the wall to the ceiling was a twenty-four-inch wallpaper border. It wrapped the entire room. It had been there many years. It was now peeling away in large tendrils that clung perilously to the wall. Slowly I looked around the ceiling edge to find many other strips of wallpaper letting go. As the large strips fell away, they formed curls. Dust was very noticeable, collected over time, no doubt, at the bottom of each loop. I sighed. I commiserated with fellow patients who, over time, lived through this inadequacy in proper housekeeping care.

Adjacent to me was the bathroom, a mere ten feet to the toilet. A sink completed the furnishing. The room was canavorous. I thought there was enough room for several people. My mind, cloudy until the morning, suddenly began to put two and two together. Purposely built for those individuals needing a lift, the room was large enough to allow patient, lift and care team.

THE WARD

I couldn’t understand why I was on this floor and in this room. I was not going to a long-term care facility, at least as far as I was aware. And I wasn’t old! Or was I? I began to rationalize my inner fear of moving into a nursing home. The fear of losing my legs and being cared for by continuing care aides filled me with angst. Was this my future? Was my family aware of the possibility of my being an invalid? Fear gripped my throat, twisted my stomach, and drew a heavy cold sweat over my grey skin.

I had always assumed I would lose my legs. I could see no other outcome; they were getting worse exponentially. And yet, I was receiving massive doses of antibiotics IV push three times a day. Perhaps my family had looked into their crystal ball and saw an ugly future. I shuddered, turning on my iPad to get lost in a movie or youtube, I discovered the free hospital wifi signal was too weak to carry streaming, and my data had run dry, and worst of all, I was broke.

I was miserable. Unable to watch a movie in the evening dragged me further along that dark path of depression. There I was, my sick wife at home, and me, unwell and in hospital. We had been married at the hip for well over forty years. We had been apart for just a day, and I missed her terribly.

After lunch, I began to look farther than the wallpaper. I didn’t have to look far. The room was old. It was apparent wear, and tear had played a significant role in its demise. Four feet from the floor, the walls had been wrapped in compressed, thick vinyl that resembled porcelain tile. Originally the tile must have worked very well, the ability to keep it clean obvious. But then the Grey nuns had rebuilt the hospital waving goodbye to the old and welcoming the new. However, fifty-one years ago, the room I occupied was being built, and I presume it was state of the art then.

In the hospital's early days, Nurses' medicine carts were heavy and bulky and perhaps challenging to maneuver. That may explain the several holes in the wall near the entrance to the room. These were not just holes but deep scars that ended in fissures. While those scars had an explanation, similar types of damage on the floor did not.

The marks on the floor were deep, cutting down through the lino and into the concrete. I couldn’t think what would have caused them. I was, however, more concerned with them being the perfect host for bacteria. After all, my room was part of a hospital. I assumed it would be as clean as possible. I had always believed that hospitals were sanitary institutions. Sadly I was proven to be wrong. As a child hospitalized, I vividly recall the wonderful smell of disinfectant that permeated through the building. It gave the sense that cleanliness was at work.

I have always held Nurses in high regard. My wife is a Canadian Registered Nurse and a State Registered Nurse in the United Kingdom. My great aunt was qualified as a hospital Matron (Director of Nursing). Yet, she stayed as a village Nurse her working life. I held a license as an Emergency Medical Technician.

Consequently, healthcare in my family runs deep. As a result, I look upon Registered Nurses and support staff to perform their best at all times. My first day then was a jolt to the system. And it was such a jolt that six years post-hospital visit, the time spent there still permeates the mind with horrors that should never have been.

Day two started much the same as the first. The nursing staff had established a routine, and I had to follow it and without complaints. I understood the need for routines. Like everywhere in healthcare, there was a chronic shortage of workers, whether nurses, care aides, or support staff. The only department that appeared fully staffed was management.

THE BATHROOM

I needed to visit the bathroom. Like a wounded duck, I waddled to the large restroom taking an inordinate amount of time for each step wracked me with searing pain. But I was determined to conquer the short distance between my bed and the toilet. I would not be treated as an invalid. I was fiercely independent and obstinate to the core. Using a urinal was, at that point, out of the question.

When I eventually arrived at the lavatory, someone on staff had left a full smelly urinal sitting in front of it. I had to remove the smelly container before I could use the toilet. I pressed the call button. It didn’t work. Stretching to put my head out of the door, I could see no staff member in sight. The urinal was so full the only alternative to spilling the contents was to pour it down the toilet.

Murphy’s law dictates that it will not be there when you are in desperate need of something. There were no gloves or goggles to be found. Therefore I had to handle the putrid-smelling urinal with bare hands. That went against all conventions of cleanliness and sanitation. I was annoyed.

Gingerly I picked up the full urinal and poured the contents down the toilet, a simple procedure that staff should have done. I cursed as I washed my hands. It was against protocol for a patient to handle some other patient's bodily fluids.

Considering her poor health, my wife had visited as often as she could. I worried for her because of the decay in my room. I didn’t want to see any bacteria wandering its way into her already compromised immune system. I felt sure if that happened then, she would be no more. Therefore we met outside my room.

At the end of the hallway were several comfortable chairs for both patients and visitors. It was two hundred feet of agony. But I was comforted knowing my wife was safer there.

We parted company at four-thirty. My wife took the elevator to access the ground floor parking area while I slowly inched my way back to my room. In extreme pain and walking like a disabled person, I crawled past many staff members. Not one offered help in any way. I was discouraged, and my depression was growing more profound.

I was aware hospitals were understaffed, especially in the nursing department. I include RN’s, LPN’s, care aides, housekeeping, maintenance, and dietary in that understaffing classification. The only department that didn’t seem short of staff was management. Unfortunately, I didn’t see any on the floor while I was there. Had I done so, they would have had a verbal bite of my tongue.

The following day saw no improvement with my legs. The antibiotic IV push was giving me a terrible metal-like taste. I could do nothing to rid myself of the awful sensation, for I had a massive amount of infusion three times a day. With no noticeable response from the medication, I had visions of myself as a double amputee stuck in a wheelchair for the rest of my life and beholding to my wife for encouragement and support.

After a frustrating night trying to break through the interminably slow hospital wifi so I could at least watch youtube, if not a movie, but alas, all attempts failed. However, the pain in my legs began to subside. The need to get out of bed, stand, and take a short walk flooded through my invigorated mind.

I felt ready to challenge Dr. Roger Banister's four-minute mile. An impossible dream, maybe, but that was how I felt. However, walking once again into the toilet, I found a full washbasin of vomit on the floor. And once again, I had to move it so I could use the facility. And, of course, there was no personal protective equipment available. And so, like an idiot, I decided to empty the foul slop so I could enjoy using the toilet. Once again, I told no one of my situations.

I still felt a bond between the nursing staff and me. Although being mistreated, there was still a measure of familiarity to their plight of being short-staffed. Although I received inhumanity and mistreatment during my stay, I did have a modest empathy for the staff. Working short on shift was never easy and was wonton for short tempers and flareups. But then that is the nature of the beast. As far as I can tell, nursing has always been short-staffed. My wife often told me stories of her first nursing position and being short-staffed, and that was forty years ago. It’s a chronic systemic problem that is not going to go away any time soon.

After finishing in the bathroom, I felt somewhat dirty. Across the hallway was a shower. I felt strong enough to use it. I hadn’t had either a shower or bath since arriving. Furthermore, I was never offered the chance to choose either.

I asked the nurse if I could book the shower.

“It hasn’t worked forever,” she said, a wry smile searing her face.

“Maintenance doesn’t work on this floor?” I said, sarcasm drooling from my mouth.

She smiled.

“Mind if I have a go at fixing it?”

“Go for it,” she said, smiling at my spirit and possibly my idiocy.

I did go for it, and for thirty minutes, I tinkered with the antiquated system. Every joint in that old pipework oozed white hard-water fur. Many chromed pipes seemed to lead nowhere except into the stratosphere of useless and redundant pipework. It took an excessive amount of time to discover the hot and cold sides of the system. Then it was just a matter of what valves to turn on.

It took over thirty minutes to get the shower to work. But the wait was worth every minute. The water was hot and delicious, making my skin come alive once again as I soaked up the heat. I felt invigorated. My legs had stopped hurting, and the inflammation was receding at a rapid rate. And now the shower was working. I felt like a brand new man. Slowly I walked out of the shower room and into the hallway.

The same Nurse happened to be in the vicinity as I stepped out.

“You are all wet,” she said, a little surprised.

“Something that always happens when you stand under rushing water,” I said, countering her humour with my wit. It drew a smile from her as she continued to walk away. I had no reason to chat.

Early that evening, I crawled into bed and propped myself up with a couple of pillows. Resting my iPad on the over-the-bed tray, I settled in to watch the news. I was feeling much better. The swelling on my legs had visibly decreased. The pain was gone, and I felt re-energized. A short while later, the hospital doctor stopped by. She asked, “How are things?”

With complete honesty, I answered, “couldn’t be better, doc.” My smile was genuine and warm. “My legs are getting better by the minute. Not sure what you did, doc. But you sure worked a miracle.”

“It was no miracle,” she said with a smile. “You have erythema nordosom. We don’t know what causes it, and it’s more prevalent in women and pregnancy.”

“I’m neither,” I said, a guttural laugh filling the room.

For the next two days, I stayed in the hospital but was allowed to wander the unit. What I found and heard bothered me. To a person, every patient was over seventy and in poor health. Most were bedridden, with others in wheelchairs and a few walking. I wondered if they had were classified as old. And if they were, what hope did I have of escaping that derogatory title.

It was then I question myself. Was this what I was looking for, my answer to am I old? Had I gone through hell because of my age and infirmity? I found it ridiculous to believe I, as a sixty-three-year-old, would face the prospects of being old. I had always considered an age a state of mind. A ninety-year-old in excellent health may think themselves to be forty or fifty. On the other hand, a fifty-year-old quadriplegic who needs constant support with all the aids of living might make him feel as if he were ninety. Two different people, two different outlooks on life, and both living as best they can under their circumstances.

Is the fifty-year-old quadriplegic old because of health and loss of independence? Or is the ninety-year-old fit person old simply because of age? At sixty-three, I had the mental capacity of a thirty-year-old. My body may not have agreed with my brain. However, my brain took command and made me live up to my promise of semi-youth.

Two days after my self debate on age, it was time to go. It was Christmas eve when I walked out of that hospital. Snow, crisp and frozen, lay at my feet. As my wife and I strolled to our car, the freshly falling snow crunched beneath our feet. Like a billion twinkling stars, the sun cast its rays onto fresh crystals of snow. I felt elevated, alive, free. My harrowing journey from the emergency department to the unit and my week there made me feel old. And yet;

Am I old?

Not on your life.

Peter Bowden

By the same author:

Scammers Inc chapters 1-4 (vocal.media)

Abuse of the Elderly and the political connection (kindle, (Amazon) books))