Tuesday, October 19, 2010


Bur first, an interview with the Ripstick Queen, two and a half years ago.

Note: the helmet and wrist guards, the mother running beside the daughter to check for cars.

It was common knowledge that you didn’t have breakfast at the Morning Edition near Patterson Park unless you had three hours to spend. It’s not that it was too crowded—it was, but it was a narrow first floor of a rowhouse and held fifty people or so in church pews and wobbly, cast-out chairs. But it was quirky, and the food was delicious, and sometimes you were willing to wait, even though service was so bad it was obscene: a server would bring you a cup of coffee, set it down at your table, and look at you surprised when you asked for cream and sugar. Then she'd walk back for the cream, set it down at your table, then look at you surprised when you asked again for sugar, then walk back for the sugar, then set it down at your table and look at you surprised when you asked for a spoon to stir it all, then walk back for the spoon and only sometimes return.

Now imagine that you’re not at the Morning Edition for some ridiculously decadent French Toast but at the ER for x-rays and stitches after a terrible accident. You’d expect a little more from nurse. You get nice. You don't get efficient. There has to be a better way.

I'll back up. I had just turned dinner on, poured a Resurrection into a fancy glass, and sat down with my guitar to learn Radiohead's "No Surprises," when Marty came back too early from the park. Serena had fallen from her ripstick. Yes, a ripstick is a horrible piece of shit wheeled toy that I like to call “a skateboard—only dangerouser,” and she went speeding down a hill, sans helmet, sans wrist guards (not that either would have helped, as only luck spared her from a broken wrist and a brain injury). She was going too fast and dismounted, her left arm—her fret-playing arm—breaking, literally, her fall, and then her face stopped it the rest of the way. When we arrived at a local hospital's ER at 5:45, the waiting room was full. I’d forgotten what it was like here—hundreds of patients using the hospital’s emergency facility as a primary care physician—mostly because this hospital saved my life when I was in anaphylaxis after taking a dose of penicillin, and because of the hand clinic. If something was wrong with her hand, she needed to be at this place.

Serena’s face is bloody, her nose bruised, her jaw and arm too sore to move. I sign in, noting on the form next to “reason for visit” that she suffered a terrible fall in an accident. She was triaged quickly because the pair of young nurses was caught up, and she was given an ice pack for her face and told that she’d get a room as soon as one was available. More than an hour later, at 7:15, I started listening more carefully; everyone was told the same thing. So much for keeping hope and patients’ spirits alive.

The woman at registrar had told us to sit at her desk; she’d taken pity on Serena and was making phone calls trying to get her Tylenol and a room. She tells us we are going to “flex care,” as if that were some special kind of white-table-cloth restaurant that takes a little longer but has much better food. But we are still at her desk at 7:30. Finally, she gets up and cleans three rooms herself—the first (and only) sign of real initiative at the hospital—and takes us back to the Flex Care waiting room, where we wait after another fifteen minutes until the nurse comes.

Serena is given a preliminary glance—asked what hurts—and sent to x-ray. We wait there for ten minutes or so, and then Serena’s arm is x-rayed, and we are delivered back to the tiny cubbyhole to wait another half hour or so for the pediatrician. He is a cheerful Dutch guy who is pleased to tell us he studied under Serena’s pediatrician twenty years ago. The tools in our cubby don’t work, so he stretches them from the room next door, where a girl who’d had strep for more than a week and has been waiting for a doctor just a little longer than we were is being seen. That girl has had asthma since birth, and the doctor is incredulous that the mother has no asthma medicine at all, not even an emergency inhaler. The teen is told that her throat looks like strep, but test results would take two days, so she’s getting a shot of antibiotics. Two days? The ER doesn’t have a 20-minute strep test like every pediatrician’s office and Patient First on the planet? Really?

Our doctor says that Serena’s x-rays indicate a fracture, but he is waiting for confirmation from an orthopedist. He tells us a nurse will come and clean Serena’s wounds, and goes to sit at his desk and eat. He sits there for a good thirty minutes, while the nurse, who sees me lurking in the hallway and apologizes each time, saying, “I’m coming,” finally does come with an armload of stuff to clean up the blood that’s dripping from her chin and head.

I had to remind myself that the nurse was not the waitress. Yet she came to us with the coffee but not the cream, sugar, or spoon. She came with her hands full of things she needed, then left in search of things she forgot, gone a good ten minutes between, apologizing along the way. She wondered whether the triple antibiotic ointment she brought contained penicillin, despite the fact that it said “active ingredient: bacitracin” on the packet, and left for another ten minutes to find out. She put on the ointment, and we reminded her that she’d not cleaned Serena’s scraped knees, so she went back for the peroxide and water. And then she left to get more ointment. I don't blame her; she was the only nurse! It's the hospital's fault.

Where’s my fucking French Toast?

Last week, at Alonso’s, a popular restaurant and bar where I’ve been a customer nearly once a week for two years and have been treated kindly by most of the wait staff, we sat, on a busy Friday night, at a sticky, filthy spot at the bar for twenty minutes, unable to get the bartender’s attention—after taking twenty minutes to get served a beer—so I went behind the bar, grabbed a wet rag, bused the dirty dishes, and wiped the bar. It took seconds. The bartender hollered at me. Why? Because customers are not allowed behind the bar.

So how could this whole scenario been improved? I could've cleaned her myself. Marty’d already cleaned her before we arrived. This was three hours of bleeding. What about one of those triage nurses? Couldn’t they have cleaned her wounds after they took her blood pressure, in the room where they had all the equipment to do it, in a room that wasn’t being used by anyone but us because they were all caught up? What about the pediatrician in ER? Couldn’t he have done it quickly, before sitting down to dinner and waiting for the next underage patient, who didn’t show up until 9:30 p.m.?

There’s a bleeding, broken kid in the ER, and it’s just like a bad restaurant. Where’s my fucking coffee?

At 9:00, three hours and fifteen minutes after we had arrived, we are still waiting for a phone call or a visit from the orthopedist, and Serena is finally glowing with sticky ointment. I am blotting the blood drips from her chin with a tissue brought to us by the guy cleaning the rooms. At 9:30, we are sent for more x-rays, this time of the elbow, and the receptionist is talking on the phone for the first ten minutes, until I mention to Marty that no one would even know we were here if she didn’t finish her call. She hangs up and takes us back. She is the tech. She obviously doesn’t know that ER patients have been sitting for hours and hours before they reach her care.

We are back in our cubby at almost ten, and I’m threatening to leave. My back is killing me, my husband is asleep on the stretcher, and my daughter is crying again and saying fuck a lot. The doctor tells us, again, that the ortho “is coming,” but she’s been coming for the past hour, and the hospital’s not that big. It takes the nurse to tell us that “she’s in surgery, and we have no way of knowing when she’ll be finished.” But! But! You all keep saying she’s coming! As if she’s actually walking toward us! She’s not coming! She’s in surgery! Aware is different from coming! I understand aware! I want to leave, but the nurse reminds us of all the time we have invested. Do we invest ten minutes more or two hours more? Probably somewhere in between, the nurse tells us.

Is all this done to give the patient hope or shield them from the verbal hostility of frustrated patients? Is this the waitress soothing the ire of her hungry customers by telling us again and again that the food will be out shortly, that it’s next up, that she saw it back there, that it’s on the way out to us, even though the kitchen is short-staffed and has its attention on the six omelets that were easier to make than your fancy French Toast?

At last, the ortho arrives, and she spends nearly every moment of the next two hours working on Serena, stopping only to locate a cast saw because the one she had was overheating too quickly and burning Serena and to send us for a third and final, we hoped, x-ray. Fortunately, her break was set properly, and we are discharged. At midnight. Six hours and fifteen minutes after walking through the door.

Serena is just one patient. Some of the people who had arrived before or during our stay were parked on stretchers in the hallways with black eyes and bloody noses or zombiefied or comatose or just slumped over in alcoholic or drug-induced stupors. Or maybe they were just exhausted.

Let me say right now that everyone has been nice, kind, gentle, and generous. I know they were doing their best. And let me add that I haven't a clue about how to run a small business, much less an ER. I'm just a frustrated parent who saw countless missed opportunities to keep someone from waiting an hour for a glass of water. A woman got locked in the bathroom, and an alarm sounded and lights flashed, and the clean-up guy had nothing with which to open the bathroom door! He finally, and not in any real hurry (I guess he knew it wasn't a true emergency), located a screwdriver and opened the door. So I know they're understaffed and overworked (that same guy complained to us he was going on his twelfth hour of work, to which I replied that he was getting paid, and we were paying—not the same thing). I know they have a system. But things don't work this poorly at other hospitals, many of whom have hired independent consultants to fix things. I'm just suggesting that this is a hospital that needs fixing.

So what if the nurse helped one patient from start to finish, handing that patient over to the x-ray tech after cleaning the dripping blood from her chin, x-ray tech then handing the patient to the doctor while the nurse attends to the next patient, on and on until everyone is out of there or in the care of the appropriate specialist within an hour or two? Instead, there’s a waitress walking in and out of twenty cubbyhole rooms taking all the drink orders before putting a single one in, not returning to take the dinner orders until the drinks are up and delivered to each table. Where’s the manager? The food here is not worth suffering through the service.

The Morning Edition eventually closed, but we can make our own breakfast. We can’t stitch our own cuts, take x-rays, dispense pain relievers, set breaks, make casts. Still, it seems like the people who can would want to do it for grateful people, rather than tearful, weary, angry, powerless ones who feel so defeated by the system that they’re ready to walk out with serious injuries to become a drain on somebody else’s emergency room or worse—sit in the halls taking up space and being treated like they’re used to being treated—as though their lives don’t matter, which they believe. They are mostly alone and have no one to fight for them.

When we go in an ER broken, we do not expect to be broken even more. We don’t deserve it. So we either fix the ER (I am looking for a job!), or we wrap our children in foam peanuts and bubble wrap.

Tuesday, October 5, 2010

queen of denial

I’m about to lose another pet—my fifth as an adult. Their pictures, two cats and two dogs, sit together on the fireplace mantel; the shot of Cleopatra sits at the other end, waiting to join the group. Cleo is snoring on the dog bed next to my desk. Her eyes are open, but she’s asleep. She is deaf but feels my footsteps on the floor beside her and looks at me with one eye, the other still rolled back. She’s fifteen. Her hair mats in painful lumps behind her ears and back legs, and she’s too fragile to brush, so we sometimes cut the pieces out. A pink skin tag peeks above the black fur between her eyes, which have a blotch of black in each. She’s stiff from arthritis, and a bad disc in her neck makes her walk on her toes. Sometimes her back legs slide out from under her, and sometimes she stands as if gathering strength to lie back down.

I didn’t think she’d make it through the summer. Last week, she didn’t go to the park two days in a row, but on the third, she had a bounce in her step. She hasn’t moved all day today until Marty’s voice boomed, “Cleo, want to go for a walk?” and she bolted upright. She took baby steps to the back door and followed him and Chance outside, went to the park, and walked up a hill.

Cleo wandered into our yard in March of 1996, fell instantly in love with Beowulf, and had five of his babies in August of 1997, while I was pregnant with Serena. (Buddha, the first born, stayed with us. He was hit by a car when Serena was five; before that, hardly a photo of her exists without all or part of Buddha in it.) Wulf, a.k.a. Dogfaceboy, died, shortly after the puppies were born, in Marty’s lap while Serena was a new-born infant.

We all like to think our pets are the smartest, most soulful beasts, but Cleo has always been spectacular, in that border-collie-meets-black-lab way. She chortled and purred and engaged us in incessant rounds of fetch; she caught flying discs and balls high in the air and from a long distance. She played tug of war with sticks, tricking other dogs into letting go of their toys and stealing them. If she wasn’t finished with your affections, she would paw you for continued rubbing or push the ball toward you with her nose, barking until you caved in and threw it. She was always our protector, too. When we went for walks, she wouldn’t follow until the last person had caught up. She liked to bring up the rear, to herd us. This is the last trait to go, though I can’t tell if she’s waiting or just too tired to go on.

Every night, Cleo has to be carried up the stairs, and every morning, she must be carried down. She has twice fallen down the stairs at four a.m. in an attempt to relieve herself on the beautiful rug. Now we have a makeshift gate made of a cork bulletin board, so she pees on the bathroom tile or the hall carpet. Sometimes she poops on my bedroom floor—several hard lumps scattered here and there, and I can’t avoid the late-night landmines as I drag my groggy self to the bathroom.

Cleo pants, but she doesn’t whine. She snores when she sleeps, but she grunts when you rub her right. It’s been ages since she’s wagged her tail or barked, even at the mailman. But she eats. She eats like a crazy old lady with Alzheimers, like Marty’s grandma Ginny, who would sit at the table and finish a large breakfast at 8:30, then come back and yell, “Well, golly, it’s almost 9:00! Isn’t anybody going to feed me?!” Every time I open the refrigerator, she stands in the way, looking and smelling.

Our vet, the one who put Beowulf to sleep when he was moaning and unable to move because of kidney failure, took the last and second best of Cleo’s puppies, named him Timber. I’m sure he would come to us to spare his doggy mommy the frightening drive. But how will I know when she is ready? Every time I think she’s done with the world, she walks up a hill; every time I think she’s improving, she falls down it.

Beowulf’s health declined during my pregnancy, and I sat with him every day, begging him to hang in there until the baby was born. He did it for me, but he didn’t last long after Serena was born. Wulf had never been too sick to snarl at the mailman until one cold February day. His body was limp, and he moaned in pain, so Marty took him outside to the picnic table and stroked his fur and comforted him until Dr. Andrew arrived—on the heels of close friends who loved our dog. The dog lay in Marty’s lap. Andrew took out the needle, and Wulf let out a howl—a long, piercing, pitiful lament. I don't know if that howl said I love you or goodbye or thank you. I don't know if it said take care of the little one. I just pray, whenever I think about it, that it didn't say no, please don't, I'm not ready to go.

I can’t make this decision for Cleopatra, Queen of Denial, no matter how sad she seems to me. Each night, I lie with her on the floor and tell her that we will all miss her so very much, but that it’s OK to stay asleep if she is ready to be done with this world. We will understand.

I whisper into her deaf, matted ear that she doesn’t have to wait for us to catch up anymore.