In my role as an emergency-room physician, I’m sensitive to my patients’ needs. As a mother, though, I have a whole new appreciation for just how devastating a child’s injury or illness can be. There is an unavoidable parental instinct that leaves us desperate to protect our children from suffering of any kind. And we know that children all handle things differently—some are brave and stoic, and some are like my youngest child, who recently howled hysterically for 45 minutes after a skinned knee, while demanding a “pedaticeen.” (An ER doctor was not acceptable for this crisis, apparently.)
We do try really hard to keep things moving as fast as possible in the ER. As you can imagine, the continual flood of mayhem and carnage makes this challenging. Patients are seen according to the severity of their complaints, not the order in which they arrived. That being said, there are things you can do to make the (possibly) excruciating wait and ordeal of treatment easier for you.
Avoid an Evening Visit if Possible
In general, evenings are heinous. Everyone from the teenager with a socially crippling zit to the unresponsive coding 70-year-old comes in at night. Meanwhile, you and your irate little guy with the ear infection are withering away from boredom and irritation. If it’s not emergent, talk to your pediatrician’s office before you come (they usually have someone to answer phone questions 24/7). You might be able to avoid a night-time ER visit with some guidance from your doctor or nurse.
That being said, most of you are in the Emergency Department because you have no other options. You may, however, have some choices regarding the actual treatment. Good examples: dermabond versus sutures, and observation versus a CT scan. If you are uncertain about something, it doesn’t hurt to ask, “What happens if we don’t do this?”
Come Well Prepared for A Wait
As the mother of little ones, I always keep an activity bag in the car. Coloring books, alluring toys, stickers, handheld computer games, whatever your little darlings are likely to find interesting. If you have time to grab a laptop loaded with movies, even better. Think of it like the 4-hour plane ride to Grandma’s house with ornery toddlers: Go for whatever allows you to get through it.
Even if you’re too rushed to get playthings and snacks together, you may not be out of luck. Once in the exam room, if there still might be a delay until you are seen, staffers sometimes can bring you warm blankets, drinks (if they are approved–see tip #1 below) and even toy. Part of our job is to make your unfortunate experience as pleasant as possible. Of course, it helps to realize that the doctors and nurses are often incredibly busy. There are shifts where I keep having to delay seeing a patient who has been there forever, as one ambulance after another arrives with something urgent. I hate to wait in doctor’s offices as much as the next person, so I really do sympathize.
Take Advantage of Time-Savers
The good news is that there are often plenty of things you can do to cut down on the amount of time you spend in the ER. These savvy strategies can all help:
1. Don’t feed the patient. There are some injuries and illnesses which require sedation. Doctors worry that during sedation the contents of the stomach could whoosh up from the esophagus into the lungs—an occurrence called aspiration—which can cause all kinds of badness. Sometimes sedating someone with a full stomach is unavoidable, and sometimes the risk is judged to be low, but check with the triage nurse for an okay before you give food or drinks to any child waiting to be seen in the ER.
2. On a somewhat related note, check with the same nurse before your child goes to the bathroom, in case a urine sample might be needed. This could save you hours later on.
3. Ask the triage nurse if numbing cream can be applied to a laceration in the waiting room—it can take a while to be effective, so applying it early could save some time later. Keep track of how long a cream has been on.
4. Ask if any part of the expected treatment can be started while you wait. If there’s going to be a delay, often the nurse and doctor will communicate to begin the assessment before the doctor can see your child. The physician might authorize drawing labs or placing IVs as soon as you’re moved to an exam room, or sometimes even from the waiting room.
5. Call someone to get a list of your child’s medications and dosages if you don’t already have this information. If someone else has been caring for your child, get specifics: time illness began, time of last urination, amount of fluids taken, time of last medication dosage, etc.
6. Don’t be hesitant to get help. If your child is in pain, or getting worse, speak up. The triage nurse can ask if the doctor can approve pain medicine, or reassess her place on the list.
Follow Through on Follow-Ups
Your goal for your ER visit is most likely to have your problem solved. Your doctor’s goal, on the other hand, is somewhat different: We’re all for solving the problem, but our main priority—always—is to evaluate for a life-threatening problem, and if possible to get you out of there in better shape than you went in. Sometimes that means making a decision about whether or not to do more tests. It also means the ER is structured for stabilization, not long-term diagnosis and management of chronic problems.
The ER doc might be able to send a message to whoever is on call for your pediatrician to arrange a follow-up visit for your child first thing the next morning if warranted. They can also pass along test results. I’m especially careful to make sure a child who is borderline for admission doesn’t slip through the cracks the next day. Pediatricians, who tend to be the nicest people on the planet, rarely complain about a late-night ER doctor’s communication about one of their little patients who needs timely follow-up. In less complicated situations, ask if your doctor will know what happened or if you will need to communicate it to them yourself, and make sure you understand when to follow up.
Try to Keep Calm
There is a good chance you will be able to remain in the room with your child in a bona fide emergency. Hospitals used to ask parents to wait outside during codes and procedures, but now we try to keep the parents present if possible. There are exceptions, of course, like severe traumas and other instances where the room will be very crowded with people and equipment. If you are in the room when your child undergoes a painful or frightening procedure, speak calmly and lovingly to him. Try to hide your own anguish if your child is awake, and focus on comforting him. If you are squeamish, sit down or wait outside; I have seen more than one parent hit the deck during a spinal tap on a newborn. If you can, write down any information the doctors and nurses give you, along with your questions, so you don’t forget it later. And finally, please know that we will care for your dear child as if she were our own—as kindly and compassionately as we can.
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