A Tale from the ER

Posted on April 6, 2011

Iris Diaz
Research Unit, Fountain House

“Often there is a temptation for clinicians to attribute any physical symptom to the psychiatric diagnosis without necessarily assessing the person thoroughly.”
--Dr. Alex Mitchell, University of Leicester, in a 2009 study that reveals that people with mental health problems receive inferior medical care
I stopped smoking a week before New Year’s Eve 2010.  I quit cold turkey, and the first four days were the hardest. Sometime in mid-January, I developed a hacking cough and a low grade fever –usually the temperature was about 99.6 degrees F.  I called the clinic where I receive my medical care and made an appointment for a physical.  I had to wait about three weeks to see the primary doctor.  Already about three weeks into not feeling well, I decided to go to my local emergency room.
I was afraid I had cancer of the lungs and thought when I explained my history to the emergency room doctor, he/she would order an x-ray to check out my lungs.  When I arrived to the emergency room, there was no one in the waiting area.  The emergency room nurse took my vital signs.  My blood pressure was within normal range, I had a low-grade fever, and my oxygenation level was 97%.  (When you are an asthmatic like I am, they have to check that the oxygen level to the brain and extremities is good.) 
The nurse asked the routine questions, i.e. “What brings you to the ER today?” and “On a scale of one to ten, what is your pain level?”  In a matter of about 10 minutes, I was sent to the treatment area.  I was put in a private room and soon saw the ER doctor.  She was a white woman and she was in her late twenties or early thirties.  She didn’t smile and actually looked annoyed when she approached me.  I started to explain that I had stopped smoking about three weeks prior and had a hacking cough, which I was worried about. 
She asked me what specifically brought me to the ER that evening.  I tried explaining that I had a physical scheduled in about three weeks but didn’t want to go to my clinic as a walk-in, because that hadn’t gotten good results in the past.  She asked me again what the reason was for my coming to the ER this evening.  I started to get apprehensive.  What was she trying to get out of me?  She asked me the same questions about four times. 
Finally, I confessed that procrastination brought me to the ER that evening.  I felt like I was the child and she was the mother.  She promptly went away.  A few minutes later, the nurse came in with an albuterol treatment.  I asked the nurse why I needed albuterol if my oxygenation level was 97%.  She quickly left the room.  When she came back she told me that I probably had spasms and that this was normal protocol.  I felt powerless, physically exhausted and wanted to resist no more, so I complied.  The nurse only gave me one albuterol treatment. 
Soon afterwards, she came back with my discharge instructions and some medication.  She gave me three prednisone pills.  I knew I didn’t need them, but it was like I was five years old again; I was tired and scared so, again, I complied.  She also gave me a prescription for Tylenol with codeine, which I never filled.  I was told to follow-up with my primary care doctor.
Now you have to understand that my previous visits to the ER room have been plagued with fear - mostly due to the staff’s reaction when they read my history and ask me my infirmities and I mention I have bipolar disorder.  There is no specific thing the staff has said in the past to make me feel stigmatized, but there is an attitude that says it all.  It’s as if they hear me but are not listening.  They talk at me, not to me.
I’m just so disappointed with hospital staff that are supposed to be educated and trained to handle any type of medical and/or mental situation.  Maybe this is the point –not enough professionals in the field are trained regarding mental illness or the underlying stigma that is so prevalent in this supposed “first world country.”  

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