Observations from a long night spent in a Niagara hospital emergency room
“Code Grey” is one in a series of stories in The Lake Report about health care in Niagara Region. In hospital parlance, “Code Grey” means loss of essential service.
Ontario’s health care system is in dire shape. People can wait months for appointments or tests or surgery.
A visit to any of Ontario’s clogged emergency rooms is an adventure, not always in a good way.
But that’s not new. It’s been ever thus, it seems, despite billions spent and promises made by successive provincial governments.
The situation has been widely debated by politicos and incessantly documented. The fact is, ERs are a sort of black hole, sucking in resources while leaving patients fearful of joining the never-ending queues of people awaiting treatment.
We likely all have heard stories about people who gave up waiting for ER treatment or opted to not even go, deterred by the long waits.
The doctors, nurses, technicians and other staff are not to blame. Typically, they are run off their feet, doing what they can in an underfunded and increasingly overwhelmed system.
And more and more, The System appears to be broken and in need of resuscitation.
This essay is inspired by two unrelated visits to the emergency room at Niagara Health’s St. Catharines hospital in the past two months.
Our problems were unrelated to the computer system meltdown that has plagued the region’s hospitals earlier this month.
Despite some critical observations, this story is simply intended to document what happened — and maybe start a conversation about how Niagara’s system can be fixed.
Other people’s experiences may differ, but in our two ER visits, we spent roughly nine hours in the ER, from start to finish.
That is far above the statistics for the St. Catharines ER for August and September that have been posted on the Health Quality Ontario website.
For August, they show an average wait of 2.7 hours to see a doctor and total length of stay between 4.2 and 5.7 hours.
For September, when our first nine-hour visit occurred, the stats show an average wait of three hours and total length of stay of 4.4 to 5.7 hours.
That was not our experience and it makes one wonder how those statistics were arrived at.
It seems that enduring six, eight or 12 hours in the ER for medical treatment is now commonplace. Surely, we can do better.
*****
In the main ER waiting area, people stare at a few video screens silently playing CP24 news, commercials promoting various extended health services and one that updates the total number of patients in the ER, broken down into how many are being treated and how many are waiting.
It’s a tiresome waiting game in which the winners are those whose name is called so they can move to the next level.
Deep inside the ER, it’s a different world. Doctors, nurses and other staff walk briskly past, en route to someone who is lucky enough to have made it to the top of the queue for treatment.
Most make no eye contact with the denizens seated, waiting, hoping to hear their name called.
Humanity feels absent from the equation except for the brief few minutes of direct interaction with a nurse or doctor that occur along the way. There are just too many sick or hurting people for The System to cope.
To get to this point in the queue, patients have already been waiting four or five hours and been through check-in, triage and registration.
And at every stage, we wait.
*****
There has to be a better way.
I don’t know the answer to improving patient flow or reducing the bottlenecks that inevitably happen any time day or night, but there must be a way to ensure universal ER health care in Niagara can be delivered … universally.
Braving the ER experience is a waiting game, literally.
At St. Catharines, depending on the initial queue, once you arrive, you wait to check in at the window marked “Start here.”
Then you wait for the call to see what’s behind Door #1, 2 or 3 — the triage area where you’re initially assessed by a nurse.
He or she is inevitably empathetic and professional — and in some cases they tell you they’ll try to expedite your case.
But that just inspires a false sense of hope, because you’re stuck in The System.
Once you’ve been triaged, it’s back to the main waiting area. To wait. Maybe an hour. Maybe three hours. Your goal is to be called into the inner sanctum of the ER.
Of course, the sickest and most urgent cases are seen first, as they should be.
When your turn comes, you are directed to “follow the yellow line to B1, 2 or 4 and take a seat.”
And wait some more.
You wait until a nurse calls your name, not to treat you or assess your problem, but to check your blood pressure and other vitals, ask a few questions, update your chart as needed.
Then back to “B1, 2 or 4” to wait some more.
Each step along the way puts you closer to your goal of getting help. Having the occasional intercession by a staff member seems designed to ease the burden of waiting and make you feel like you’re making progress.
But don’t bother asking a nurse where you are in queue or how long it might be or … they don’t know because they’re just running to try to keep up and they’re focused on delivery care.
It’s a treadmill that never stops.
On this evening there is a steady stream of infants in arms, seniors like ourselves, people bent over in obvious pain, patients arriving by ambulance — and many others — all seeking help.
The video screen in the main ER lobby says the wait time to see a doctor or nurse practitioner is five hours-plus. There are between 55 and 60 people registered in the ER, the screen says. About two dozen or so are being treated and the rest are … waiting.
The hospital’s website has the same information just a click away. You can also see what the wait time is in Niagara Falls or Welland.
If you’re lucky, after your vitals are taken, within an hour you’ll be called to take a spot in one of the ER unit’s “rooms” — curtained areas with three walls and a wide opening, a stall reminiscent of a garage. But it’s your space until the doc, nurse practitioner or maybe just another nurse can stop by to check on you. Or treat you.
Until then, you wait.
*****
On this day, we make it to the “garage” around 11 p.m., just under five hours after arriving at the hospital.
We started this adventure just after 6 p.m. The doctor appears at our stall at 11:39 p.m.
He clearly has got a lot on the go and in six minutes he’ll be gone. No name or introduction, but based on his observations, apparently he has read the chart.
The patient has had a serious reaction to an antibiotic prescribed for a stubborn sinus infection.
On the face of it, pretty minor. But it results in a terrible, inflamed full-body rash, skin on fire. For more than 36 hours, nothing provides relief. Clothing on skin causes painful spasms.
It’s really bad, the doctor acknowledges. One of the worst she’s seen, a nurse said earlier.
In his seeming haste to diagnose, treat and move on, the physician offers a prescription of a powerful steroid (but it’s almost midnight so it can’t be filled till the next day). But he has no real suggestions for relief or treatment.
Even if given a pill now, “You’ll probably have another uncomfortable night” until you can fill the Rx, he says.
Our own research told us that an immediate intravenous infusion of a powerful steroid is the best initial course.
As the doctor hands over the orange paper with the Rx scrawled out and turns to move on, I ask, “What about an IV right now?”
“Sure, she can have an IV,” he says. “I’ll see you in a bit.” He leaves to make the arrangements.
But if we had not pushed and advocated for the patient, it wouldn’t have happened.
The lesson for patients: Speak up. Ask questions. Be prepared.
The lesson for doctors: Take the time to make sure your patient gets what they need immediately and don’t sentence them to “another uncomfortable night” when there are obvious alternatives.
Twenty minutes later, a highly professional, very empathetic nurse painlessly slips an IV into a vein, starting the patient on the road to a quicker recovery. She is attentive, unhurried and answers all our many questions.
About two hours later, just after 2 a.m., the doctor swings by again.
To make room for someone else, the patient has been moved from the stall to a blue recliner in a hallway. Zero privacy. We found a chair that still reclines. Many of the others seem broken.
This time the doc is neither rushed nor dismissive, thankfully. His bedside manner is improved, though he’s not overly attentive.
But with others waiting, he doesn’t ask if we have any questions and is gone before I can get more than one out.
However, we got the juice the patient needs to start on what turns out to be a more than two-week recovery.
*****
Looking back, there are a lot of practical takeaways based on our experience on this visit and an unrelated one two months ago.
For patients: Obviously, know you’re going to have to wait. Be patient. Some people are sicker than you. Check the Niagara Health website for wait times at its three ER sites.
Come prepared. Do some research about your condition, if it’s appropriate. And speak up, advocate for yourself or a loved one.
Maybe pack a lunch. If you’re there after-hours, other than some items in vending machines, you’re out of luck if you get hungry.
If you’re there really late, fast-food places are a short drive away, but it means you’ll have to pay your $8 parking fee and then get a new parking ticket when you return.
Perhaps even bring a pillow, again depending on your situation. It’s difficult to get comfortable in any of the chairs you’ll be waiting in.
For doctors and medical staff: Catch your breath, take some time. A patient who has waited hours to see you shouldn’t feel they’re getting short shrift.
For hospital management, administrators and political leaders: Is this the best we can do? Are five-hour or far longer waits really justifiable?
What have other jurisdictions done successfully to improve ER wait times and delivery of care? What alternatives are worth exploring? How can Niagara Health improve? Ontario?
Is there a better way? There must be.
- What has your experience been in the emergency departments of Niagara’s hospitals or in accessing care in the region. Let us know. Send your stories to editor@niagaranow.com.
