Rolling in the emergency room
By Barbara A. Crowley.
Barbara A. Crowley writes about everyday life as a wheeler.
"Can you stand and pivot, Barbara?" the emergency room nurse asked.
The question stunned me. I had just explained to her that I was a T-12 paraplegic. Surely she knew why I was using a wheelchair, a chair that did not remotely resemble the hospital clunkers.
I was sitting at my computer that Saturday morning when quick jabbing pains attacked my lower back. Great, I thought to myself, another urinary tract infection. I popped a pain pill and lay down. But no matter which way I turned, the pain increased. Sweat broke out on my forehead. A look in the mirror revealed red blotches on my face. I vomited.
This was no urinary tract infection.
My primary personal care assistant, Ron, called my doctor. He was out of town; when he returned the call, he suggested we go to the emergency room. He would call ahead, he said, with a brief history of my condition.
A hospital volunteer greeted us and led us to the triage nurse for further evaluation. The nurse took my temperature, pulse and blood pressure, and asked numerous questions. She then asked if I could stand.
It was the first of many odd questions that night. A triage nurse should have knowledge of a patient's basic conditions. If I had called myself a cripple, would she have understood?
After signing hospital permission and insurance forms, I was pushed over to the waiting room. Since it was the height of the tourist season in Florida, there were few empty seats. Babies wailing, patients holding ice packs on various parts of their bodies and too many people coughing told me it would be a long wait. I was right. Two hours later, my name was called and I was led to a bed in the ER.
"Do you need help getting into bed?" the orderly asked.
"Unless the bed can be lowered to wheelchair height, then yes, I will need help," I answered. Of course, there was no such accessible bed in the emergency room, so with the help of Ron, the orderly lifted me onto the bed.
A nurse came in, once again took my temperature, pulse, blood pressure. What medications was I taking? What was I taking them for? she asked. These were questions that I had already answered on admission; they were written down on my chart. Why did I have to answer them again?
"If I put a bedpan under you, can you give me a urine sample?" she asked. Had the nurse bothered to read my admission chart, she would have known that catheterization would have to be done to accomplish this.
I explained. The nurse knew exactly what I was talking about, she said; she had worked in a rehab hospital. This was great news. I felt I had someone who'd know what to do.
The doctor made his first appearance after the urine analysis results came in. I did not have a urinary tract infection. He asked if anything unusual was going on, emotionally or physically that might be playing a part in this back pain. Did he assume I had emotional problems just because I was in a wheelchair, I wondered, or would he have raised that question with any patient? The doctor's next best guess was a kidney stone. He ordered x-rays.
Next stop, X-Ray Department. Again I was asked if I needed help getting on the table. I gave them my usual answer: "If the table cannot be lowered, yes, I'll need help." Off went the technician in search of able-bodied personnel to lift me on the table. She came back with two great-looking hunks to get the job done (I have to admit that getting their assistance didn't bug me as much!).
The technician then informed me that my bladder would have to be empty for the x-ray. Seeing that she was about to dash off for a bedpan, I quickly halted her. "A bedpan won't be all you have to get. I'll need a catheterization kit."
"What's that?" she asked.
As explained the situation to her, her eyes were getting wider and wider. I almost felt sorry for her.
She went off to find out what I was talking about, and came back with the emergency room nurse who'd seen me earlier (the only nurse on duty, it seemed, that knew what a cath kit was) and watched in amazement as I emptied my bladder.
X-rays taken, the hunks came back to lift me off the table.
I was back in the emergency room waiting for the results when the doctor made his final appearance.
"We're stumped," he admitted. "No kidney stone was detected, and we can't find anything that would cause you pain. There might have been a stone which may have dissolved when the dye was pushed through your bladder," the doctor said.
With that said, he gave me a prescription for pain, and an antibiotic for an infection I did not have. The usual instructions were given: go home, get plenty of rest, drink a lot of fluids and call your regular doctor on Monday.
The seven-hour visit produced no answers.
A few days later, the pain disappeared.
When my gynecologist examined me later that week, it was her opinion that I had a sizable ovarian cyst, which would cause severe pain and disappear when it burst. She believed that if an ultra-sound of my pelvic area had been performed, it might have revealed a cyst. Why wasn't she called by the hospital, she asked. I did not have an answer.
If I ever need to visit the emergency room again, I will be much more prepared. I will not let them send me home with the "I'm stumped" routine. I will insist they call in a doctor who has knowledge of my condition. I will not leave the hospital until I am satisfied with their answers.
More questions came to my mind after this experience.
I thought about the time I tried to make an appointment for a mammogram. The hospital could not accommodate someone in a wheelchair, so I ended up calling three facilities before I found one that could. Why?
The optometrist's chair has to be pushed out of the way every time I go for an eye exam, as the chair is not adjustable. Why not? Even in my own chair, I have trouble looking through the lenses, as they cannot be lowered to my exact eye level.
My doctor's office does not have an adjustable exam table, so I have to be lifted by the doctor and his nurses, praying they don't drop me. Even getting into the exam room takes some innovative maneuvering, as these rooms are closet size. Why?
Ever visit a patient in the hospital? If you have, you know how hard it is to get close enough to visit with the person without shouting from the foot of the bed, all the while getting bumped into by nurses and other visitors.
Yet the dentist's office is the only place I can go without any assistance as the chair lowers and raises with a push of a button. So I have no excuse to avoid a checkup.
Why aren't hospitals accessible? And why do we wheelers let them get away with it? I have learned that since my visit to the emergency room, an adjustable x-ray table has been installed. If a hospital or a doctor uses able-bodied personnel to lift a wheeler onto a table, does this mean they are complying with the Americans with Disabilities Act? Someday, I suspect, this issue will be decided in court -- after an employee drops a patient on the floor, injuring them further.
We as wheelers spend time and energy citing restaurants, theaters, airlines and stores for inaccessibility. Yet it seems we don't question why the medical community seems to think it's exempt from making structural and equipment changes to accommodate all patients.
Maybe it's time to start.
"Removing Barriers to Health Care" shows how to make dressing rooms, exam rooms, lobbies and parking areas accessible to people who have vision, hearing or mobility disabilities. The booklet is available from the Center For Universal Design (800/647-6777; e-mail to Cindy_Crouse_Martin@ncsu.edu ).
Hausmann Industries, Inc. (888/428-7626; www.hausmann.com) manufactures a patented wheelchair-accessible PowermaticŪ examination table with a motorized lift, pneumatic backrest, pop-up elevating leg rest and more.
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