How to get through the ER- even at Vandy

Something that has almost worked against me through this adventure is being "young and healthy." While I do feel that I have benefited from being "young and healthy," what that doesn't mean is that I am disease free and should not be treated with some amount of caution. What "young and healthy" means in the healthcare world is that I can tolerate more complications than the average person before I get really sick.

I was released from the hospital about 4 days after my splenectomy. I was doing well.  Walking, eating, taking care of myself, pooping….. well not so much.  Passing gas- YES! I got that.  (I am going to take a moment to speak to those who know me personally. I want to give you the best insight into this crazy predicament that I have found myself in, and for some of you it may just be TMI. This will not be the last time we visit bodily functions. If this makes you squeamish- move onto the next post. If you can't look me in the face after reading this- grow up. We all do this. You, your momma, your favorite movie star- everybody. Now that doesn't mean I need to hear about your bowel habits the next time I see you. But I will not be embarrassed to share this part of my story and don't harass me about it either- so let's get on with it.) You've seen my scar, this was a major abdominal surgery. Intestines really do not like surgery, nor do they like to be manipulated, and they stop moving when you do these things to them. This is normal. I woke up with a nasogastric tube (a tube that went in my nose and into my stomach- glad they put that in while I was asleep). Also, pain medications will slow down bowel function. I had all of those things done to me. I must admit, I wanted to go home, and to be constipated wasn't an unusual thing for me- so home I went. I was "young and healthy!"

I was home about 24 hours when  I began shaking uncontrollably, like chills from a fever,  but hallelujah, I did not have a fever. And I hurt everywhere. I became disoriented and I was extremely weak. Pretty much a clear checklist of what to "call your doctor if your have these symptoms" list. I live in a two story house, and those stairs- I didn't know if I could make it down them. And the nausea! Something was not right. We live about 1 hour from the Vanderbilt campus, so my husband packed me in the car and called the surgeon to let him know when were on the way in. Upon arrival to the ED (emergency department) I was wheeled to the triage area where I was promptly evaluated by a triage nurse. Triage is a vital key to the flow of the ED- I know because I was one early in my career.  I could barely walk at this time, the generalized pain was severe, I was extremely nauseated, just 5 days post- op of major abdominal surgery, with no BM for at least that many days and probably a couple of more. But, my vital signs were fine. So out to the waiting room I went.

There are a lot of articles right now about ED (emergency department) wait times and overcrowding of emergency rooms. All true. Triage nurses need to be sharp, tough and sometimes seem a little uncaring. They aren't really. They are just trying to save the ED beds for the sickest patients, because truthfully, that is what the ED is there for.  My preceptor (supervisory nurse when I was a new nurse) in the ED told me don't send anyone straight to the back unless they are red, white or blue. Red from all the blood they were losing, white from all the blood that they lost (or pain) or blue because they were hypoxic (not breathing). And truthfully, that is not a bad way to triage. I'm sorry to all the mom' s of kids with earaches who go to the ED. You don't belong there and yes- you are going to wait and yes-you are at the end of the list.   Because your kid is healthy and not dying. This is a good thing. Be happy if you are waiting for hours in the ED. You are not the sickest one there.

I looked at my darling husband. And truthfully I knew that the waiting room was probably not where she really meant to send me. For those students reading this…anything this close to post-op with these types of complaints, who is "young and healthy",  Get. Them. To . The. Back.  I told him I could not sit, please take me back to triage. Where I promptly started vomiting on the triage nurse and her area. I was taken to the back.

Constipation. Severe. Incapacitating constipation. Partial bowel obstruction. With severe pain and vomiting.  (Basically I was so blocked up, it was going out the other way, hence the vomiting). Oh lucky me. And this means only one thing. An enema. I am 40 years old. I am a nurse. I am young and healthy. I am not even sure that the nurse in the ED knew how to give an enema she was so young. But anyways here we are, and it's what needed to be done. They were extremely professional and compassionate, but nothing prepares you really to start to give up this independence. But let me tell you, pain and nausea are mighty tough negotiators. Kudos to my hubby again as he stood by me as I went through the whole thing. And I note to all the young nurses out there, make sure that they path to the commode is well covered, because it will get on the floor (see, I told you the nurse was too young to know how to give one).

Not being more frank about my lack of bowel habits earned me a two day hospital stay and 2 more enemas. And quiet a bit of misery. Lesson learned- I hope ( wait for later posts- sigh).

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