An Emergency Room Experience
by Ute Carson
Floridian, February 27, 1977

I was neither calm nor collected when we rushed our 5 daughter to the hospital emergency room. Her arm was broken from a high fall and she was in a state of shock.

Sitting with her in our car on the way to the hospital, images of graver accidents flashed through my mind. I started to hear the sirens of ambulances zooming by with their red lights turning and I began to envision the place to which those racing, squealing vehicles would deliver their needy, ill or injured victims.

For those unfamiliar with a medical setting, the emergency room of a large hospital looms as a forbidding place in our fantasies. We imagine it to be that arm of a hospital geared to deal only with crisis situations. We think of highly trained personnel who, in cooperation with highly specialized machines, receive us "emergency cases."

Although it was some relief to realize ours was not an extreme emergency, my attitude was nevertheless one of guarded apprehension. A comment I a student who had worked two years in the emergency room was apropos: "This place brings out the worst in doctors." I arrived prepared to have to fight for every bit of personal treatment for our child while being processed through an impersonal structure.

Waiting starts upon arrival. Questions about medical history and insurance may be necessary but it can be quite frustrating when you must try simultaneously to calm your upset child and spell your maiden name. We spent five hours at the hospital that night.

Our daughter was placed on a cart in a small room. A nurse took her temperature and paged the resident in pediatrics. Seeing the disjointed and swollen arm, the resident ordered X-rays. Time seemed to drag. We paced deserted corridors while the X-ray films were read. Some had to be taken again because our little girl moved. Back from X-ray we waited from the "main man" who would set the broken bones. He was with another patient and it would be about 30 minutes.

From the time of our arrival until his appearance many things happened ‹ some anticipated, some unexpected. A student nurse insisted our daughter be placed in a wheel chair to go to the X station. That rule was later broken when the resident discovered how much calmer our child was when carried by her father. A member of an ambulance team bringing in an injured person returned our little girl¹s smile as he passed the open room. He later returned to talk with her about her fall and show her his squawk box. She asked him all about his work and he warned her not to play Tarzan again. They parted friends.

More human kindness was shown to our daughter by the nurse who had taken her temperature. It occurred after another nurse had mishandled an injection of thorazine. Preparing children for an unpleasant procedure with frankness should be done in a reassuring manner. Our daughter responded well to comments like "what a brave girl you are" or "you are doing real well" She flinched and started to cry when she was told: "This injection will hurt. You¹d better hold still." Hearing her cry, the first nurse returned with an inflated sterile glove on which she had drawn a smiling face. What a thoughtful distraction.

The orthopedic resident helped to make the waiting bearable by breaking long time sequences by keeping us informed. Comments like "the films are not back" or "the room is not ready" let us know we were being considered and not forgotten. The importance of that simple courtesy was brought home the next day when we had to return for more X-rays and were part of the large crowd which filled the empty spaces of the night before. Many more nurses, technicians, aides and volunteers were on duty, but no information was passed thus.

Now seems an appropriate time to portray the senior resident more fully He walked into the emergency room after having seen the films of the bro ken arm. At first, I was skeptical. He looked like Omar Sharif in "Dr. Zhivago." "I hope his good looks don¹t stand in the way of his doctoring," I thought silently. I soon found out they wouldn¹t. He introduced himself by his first and last name. Why did we, who dislike back-slapping and false informality, experience that as remarkable? In a tense situation, it bespoke self-assuredness ‹ a sense he could comfortably handle his forth-coming task and that he was at ease with the injured child and her parents. Again, we felt included.

A contrasting behavior may help to drive home the point. The next morning, we looked at the X-rays of the previous night. The senior staff physician was asked to review them and to check finger movements. He did manage a smile at our still groggy daughter, but we never heard his name nor were we included in the conversation among the staff physician, the resident and a student. He talked past us. The night before, the senior resident had explained every step of the procedure to the pediatric resident, the student and us. Being included bolstered our confidence and mitigated our feeling of being condescended to by someone skilled in an area unfamiliar to us.

The resident agreed to have us present at the setting of the arm. Parents can be both a help and a hindrance in such situations. They add their own anxieties to already tense circumstances, and they have a tendency to meddle since they are indeed best qualified to judge their child¹s reactions. A problem arises only when the child¹s reactions interfere with a necessary medical procedure. For example, when we returned to have the first cast replaced, my daughter cried harder and louder than she had when the accident occurred. I knew she cried not because she was in pain, but because of a painful memory. Al- though I understood her fear of the repetition of an unpleasant experience, she nevertheless had to be held tightly so the cast could come off.

Parents can serve several important functions. They can provide security for their child in strange and frightening surroundings serving as a buffer between the familiar and the unknown. They provide the most important outlet for the child¹s aggression which arises from fear.

Our daughter acted in a passive, accepting, brave manner with nearly all the strangers in the hospital. Her frustration at not being able to escape the unpleasantness was acted out in hostility toward me, first by pinching me ("I want to go home . . . get me away from here") and later by biting my hand.

Parents can be an added burden for the physician. However, if he is able to include them and is himself not put off by displays of affection be tween parents and child, he is apt to create a much less anxiety-laden atmosphere.

It was neither our humming nor our rocking but the thorazine that, after a long struggle, finally put our daughter to sleep so the arm could be set. But the fact the senior resident was willing to wait a long time rather than increase the sedative dosage, all the while letting us try to calm our daughter, had a salutary effect on the student who was assisting; He, too, relaxed and ceased his earlier efforts to command her with a stern voice to "settle down." He even felt free to stroke her head when all was over and done.

What it all adds up to seems to be the praiseworthy ability of the senior resident to consider the feelings of the people around him and to perform with skill his medical task. The senior resident did indeed show human kindness to his patient and her parents. What is more, he taught, by his example, those who worked with him and under him, and thereby set the tone for this complex set of inter- actions and for those that will follow.

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