Pack a Pound of Patience Before Heading to an ER

Pack a Pound of Patience Before Heading to an ER

My 16-plus-hour wait to diagnose a clot was a frustrating experience

Photo by mohamad azaam on Unsplash

On Monday evening, I had the unfortunate need to visit an Emergency Room (ER) because I suspected I had developed a deep vein thrombosis (DVT) after my 7+ hour-long flight home from Paris.

The discomfort started Sunday evening, 24 hours after my flight. I was well aware of the risks of developing a clot in-flight, and usually take an aspirin two or three days before flying to mitigate them. It’s not a recommended practice, but it is something many people do, knowing the blood-thinning properties of this readily available medication.

This trip, it didn’t even enter my head to pop the aspirin — until I felt the first niggle of discomfort once home. I was cross with myself! The return trip was uncomfortable because the seats on this particular flight were tightly configured. Airlines are more about profit than comfort, and jamming as many souls into that aluminum tube is their motto.

There was little wiggle room to change position or stretch out my legs despite having an aisle seat. I usually get up and move at least a couple of times to go to the bathroom and stretch my legs, and although I complain about having to move for my neighbours to do the same, I was sitting beside my son and his friend, who didn’t move the whole flight. Oh, to have the bladder of a racehorse!

I went to work Monday morning, hoping to get some advice from my nursing colleagues. My leg had no other symptoms typical of a DVT. No redness, no swelling or heat. Just a discomfort deep within the flesh and particularly when I dorsiflexed my foot. Maybe I was overthinking my symptoms or being paranoid.

They all said I should go to the ER.

Before I knew it, 3 pm had rolled around. I came home and took a brief power nap to take the edge off a mild dose of jet lag and then decided to call our regional health line, hoping they could refer me to a clinic the next morning with a Doppler machine, the primary diagnostic means to confirm a clot.

I asked for a callback as the wait time was 75 minutes. I received the callback over two hours later, only to be told I had no choice but to go to the ER. Ugh.

30 minutes later, I was in the triage room. It was 730 pm. The nurse asked me all the same questions the 811 nurse had:

• Where is the pain? Is it localized? (It wasn’t in my calf, but more behind my knee)
• On a scale of 1–10, how would you rate it? (It was more a discomfort than pain, so it was 2/10. I’ve given birth to three children, and this was no comparison to that!)
• Do you have any chest pain, dizziness or difficulty breathing? (No. She was asking this as it would indicate the clot had moved and dislodged in my lungs; a pulmonary embolism)
• Have you travelled recently? (Yes, I was sitting like a stuffed dummy on a plane for 7.5 hours on Saturday)

The nurse took my blood pressure. Me — being nosy — asked what it was: 162/105. Whoa, that’s high for me! She seemed unfazed.

I was sent back to the waiting room. I sat there until 10 pm, when I was summoned to a different room for blood to be taken. Being a nurse myself, I knew what the vials the nurse used were assessing: yellow is for chemistry, things like potassium and magnesium levels; purple is for hematology tests, which check the hemoglobin and platelet levels, and whether the white blood cell count is elevated, indicative of an infection. The blue tube is for coagulation studies, which measure how quickly your blood clots and how effectively the various clotting factors are working in the body.

Since I was complaining of symptoms that were likely due to a clot, I was sure they would also be doing the D-dimer test. When elevated levels of the protein D-dimer are detected, it is suggestive of clot breakdown. Ultrasound technology should then be performed to confirm the presence, location and size of the clots.

At 0130, a nurse circulated the ER waiting room to determine who was waiting to be seen. The room wasn’t full, and no one appeared to be in any major distress.

One young fellow sitting beside me was intriguing: he was quietly talking to himself, and often gesticulating and laughing. I watched him as he carefully extracted the handles from a paper bag, broke them into smaller pieces and arranged them in perfect lines on the seat. He had a pair of women’s sandals that he placed on a piece of cloth, then wrapped them up before returning them to his knapsack. At times, he would walk over to the water fountain and press the button, watching the water flow in a trance.

Another older gentleman lay across four seats and listened to video clips on his phone. I loathe having to hear other people’s conversations, let alone music or social media experiences, but there was nowhere to escape to.

Periodically, names were called out, summoning fellow prisoners to a room for further examinations or treatment. It was another two hours of trying to stay awake, get comfortable or keep myself from losing it before my name was called.

I have a student graduate to thank for getting me into a private room, all-be-it briefly. It was ironic that she had messaged me a mere two weeks ago, updating me on her nursing journey. She was a star student, and I was thrilled to hear that she was now working in the ER — at the hospital I was at.

On arrival, I had reached out to her to see if she was on duty. She was, and she did her best to move me up the line, but apparently, having a blood clot isn’t a priority these days! The MD came to see me soon after being moved into the room, and I was stunned when I asked if the D-dimer was positive and he said they hadn’t done that test. Apparently, the nurses have standard orders to initiate with patients, but that wasn’t one of them — despite the fact I was presenting with clear symptoms of a blood clot.

I was furious, since I’d already been waiting for 8 hours at this point.

I didn’t need another blood test; he just added it to the screening. But what a waste of time not ordering it in the first place.

I was also amazed that no one had bothered to recheck my blood pressure. My graduate did — at my request — and it was better (132/84). Phew! She then brought me a nice warm blanket and dimmed the lights for me to get some sleep.

I woke up to her voice gently telling me they needed the room. I was grateful to have a couple of hours of horizontal time in a private room. It was another three hours before I had the Doppler, an ultrasound to examine the veins and arteries. That service is only available from 0800–1600!

It’s one thing to read and teach about these investigations, but to experience them is next level. Aside from the cold, sticky lubricant spread from my femur to ankle, it hurt when the technician dug the probe into my upper leg veins (nowhere near the problem) and even more so at the site in question.

Now and then, I heard a ‘whooshing’ sound, which was reassuring. I ain’t no vascular technician, but I’m aware of the noises blood flow makes.

After getting lost in the maze of the ER, I settled back into the waiting room for another three hours. By this time, my patience was starting to wear thin with fatigue. Being on the other side of the fence of patient care is never easy.

While I am very much aware that patients entering an ER are triaged based on their degree of illness, I was surprised I had to wait so long. Clots are dangerous beasts; if they suddenly dislodge, they can travel through the circulation and often first get stuck in the lungs, causing a pulmonary embolism.

It’s not a pleasant feeling to be sitting waiting and wondering if I did indeed have a clot or that it could decide to migrate at any time. Equally frustrating was that I knew what needed to be done to diagnose what I suspected. The collective time spent with healthcare professionals amounted to an hour, and yet I spent 16 hours waiting before I received a definitive diagnosis and was sent home with a prescription for oral anticoagulants.

Throw in sleep deprivation — and I was already severely lacking in zzz’s, having crossed several time zones — and the fear of the unknown, I can understand why people lose their cool when waiting in an ER.

I stayed calm by coming prepared. I grabbed my cellphone charger, a book, a blank journal and some snacks before calling an Uber to the hospital. I patiently sat, knowing that there was more going on the other side that was not visible to us all in the waiting room.

Several patients arrived on ambulance stretchers, some of whom also ended up sitting in the waiting room. Just because you came to the hospital via that means doesn’t make your needs a top priority.

There’s a reason they play on loop on a large TV screen about how triage works. The practice dates back to Napoleon Bonaparte and the French military when physicians ‘divided sick or wounded soldiers into three categories according to the severity of their illnesses or wounds.’ Source

The presentation fell on deaf ears for some patients who were pacing, swearing and outwardly irritated about a lenghty wait. One gentleman beside me asked his wife how long they had been waiting. It had only been 30 minutes! I dare not mention I’d been there for 15 hours at that point.

The presentation also suggested four rules to adhere to while in the ER:

• Wash your hands frequently and wear a mask if you are coughing or have a fever.
• Respect the privacy of others around you by not taking photographs — including selfies.
• Have only one support person at your side.
• There is zero tolerance for verbal or physical abuse.

I couldn’t agree more — and would even add to avoid speaker-phone conversations or playing music or videos without earphones. Those two things were what almost drove me to lose it.

17 hours from my arrival in the ER, I saw another MD, who confirmed I had several small clots that were more superficial than deep, but could combine to create a problem. I was sent home with a prescription for three months of anticoagulant medication and a follow-up appointment with the hematology clinic. Yup, 17 hours later, I had confirmed clots in my vessels and yet never received an initial dose of treatment before leaving the hospital. I was shocked.

I took a cab home and then had to jump in my car and drive to my local pharmacy to fill the script. I live alone and don’t have anyone to do that for me. I was tired, hungry and not thinking clearly. Honestly, this irked me the most. No one bothered to ask me about my personal situation or consider that I’d just missed out on a night’s sleep and was a potential menace on the road!

That’s just wrong on so many levels, but it is what happens when a system is stretched beyond its means.

The moral of this story?

A trip to the ER will never be a pleasurable experience, but it need not be a painful, prolonged or impersonal one. The D-dimer test could’ve been done with my initial blood draw had protocols been put in place to allow it in certain situations. If a technician had been available on call to do my Doppler, I wouldn’t have had to wait for hours to have it done.

Healthcare systems are broken in many places around the world, and cost-cutting is one predominant reason why they’re suffering. If you need to go to an ER, you will have to wait. You will get frustrated. You will feel neglected and deprived. You will feel like you’re more important than the others waiting around you.

But sometimes, it is the only way to get healthcare services when the system is failing.

Prevention is always better than a cure. If you are taking a long-haul flight, they do pose risks, regardless of your age. Get up and move every couple of hours. Drink plenty of fluids to stay hydrated. Don’t wear constricting clothing or shoes and if you have heart issues, speak to your physician about taking aspirin or wearing compression stockings during the flight.

But, most of all, if you ever have to visit an ER, pack a pound of patience before heading there. It will make the difference between accepting the delays for what they are and losing your cool.

Doing that will get you nowhere.