Our emergency departments are a kind of purgatory

Do we have Stockholm syndrome that makes us accept appalling conditions?

The emergency department at St James’s Hospital in Dublin: “a different sort of purgatory, a grim one with security personnel and an air of healthcare professionals stretched to breaking point”. Photograph: Alan Betson

The emergency department at St James’s Hospital in Dublin: “a different sort of purgatory, a grim one with security personnel and an air of healthcare professionals stretched to breaking point”. Photograph: Alan Betson

 

Over the past few months, I have paid four visits to emergency departments, one as a patient and the others while accompanying someone suffering from severe pain.

How do we tolerate a system that seems designed to make sick people sicker? The first visit was to University Hospital Waterford, known locally as Ardkeen. It was by far the worst experience. Close to midnight on a Friday, we drove past the eerily empty Dunmore Wing. This five-storey building, designed to house a palliative care unit on the bottom two floors, has never been opened, apparently because there are no staff allocated to it. The emergency department was full of anxious, fearful people but what struck me most was the air of numbed resignation.

The young man I was accompanying was unable to stand up straight due to pain but it made not a jot of difference. He was told to take his place in the queue. Just ahead of him there was a man with a heavily bleeding hand. He was given a paper cup to catch the blood and told to queue, too.

My own recent visit to St Vincent’s was probably the best experience in that I got a trolley immediately, where I would stay for the next 24 hours

It may not have been hell, but it was certainly purgatorial.

In his epic poem The Divine Comedy, the 14th-century Italian writer Dante designed his purgatory as a mountain where, after sunset, you could ascend no further until sunrise. So it proved in Ardkeen. 

Poor communication

Later, my husband asked why communication with people was so poor about how long it would take to be seen. Looking baffled, a nurse told him everyone expected hours and hours of waiting because that was just the way it was.

Next to us was a young woman with a swelling face, with a cannula in her arm. She had arrived some five hours earlier and been told that blood tests were needed. We met her again 16 hours after she first came in and the blood tests had still not been performed. She still had the cannula.

For our young man, it took hours languishing on hard waiting-room chairs before he was given a trolley and pain relief, some 12 hours after he had first come in.

No one could find what was wrong with him. To cut a very long story short, he was just as ill the next day. His GP recommended that we drive him to St James’s Hospital in Dublin, which was a different sort of purgatory, a grim one with security personnel and an air of healthcare professionals stretched to breaking point. The queue was shorter but there was the same inability to get answers unless you stepped in the path of some already harried medic or nurse.

Some cases are far worse. Catherine Drea, a columnist with the Waterford News and Star, spent five days on a corridor in Ardkeen with a perforated intestine, unable to get an ultrasound to confirm the diagnosis. She had to use her mobile phone as a flashlight during the night for the nurse attempting to insert a drip.

My own recent visit to St Vincent’s was probably the best experience in that I got a trolley immediately, where I would stay for the next 24 hours. The staff were very kind but every test took hours longer than it should have. 

Has the level of dysfunction become so entrenched we no longer even expect accountability, much less change?

And it was still a trolley on a corridor. I was supposed to be taken to a specialist area within the emergency department but there were no beds there, so I got the privilege of a curtained cubicle for a few hours during the night. The rest of the time I was being examined out in public, giving my history to the other patients who could not help overhearing it, no more than I could help overhearing theirs, including that of a family of adult children whose father was dying. At least the dying man was given the decency of a room but the family had to meet specialist nurses in the midst of a corridor littered with trolleys. And the medical staff kept assuring me that I was lucky it was a quiet night. 

Exhaustion

Not to mention the fact that many of the medical staff were obviously exhausted. A Medical Council report published this summer found that more than a third of trainee doctors and interns reported working 60 hours or more in a typical week even though the European Working Time Directive limits the working week to 48 hours. This is in spite of the fact that we know sleep deprivation impairs judgment as much as being under the influence of alcohol.

More than half (56.6 per cent) of those working more than 59 hours a week had been directly or indirectly involved in an adverse event in the previous 12 months. The remarkable thing is that so many staff are extremely kind despite the pressure.

I know some people abuse the emergency department system but everyone I met was genuinely ill. 

Do we have a collective case of Stockholm Syndrome that we have come to expect no better than barely controlled chaos in our emergency departments? And has the level of dysfunction become so entrenched we no longer even expect accountability, much less change?

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