Being a Compliant Patient

The daughter of one of my dearest friends is an emergency department doctor. She chose to work in New York, right in the thick of the urban action at its most challenging. This young woman was tops in her med school class and blew the lids off her medical exams. She could have chosen any specialty but bee-lined it to Emergency Medicine.

Thoughts of this brilliant young doc kept popping up on my mental screen a few weeks ago, when I became feverish and landed in the emergency department. The ED. The previous day’s infusion might have triggered the fever spike, or maybe it was brought on by the 2-bag transfusion I was given as a chaser to the chemo. I hadn’t experienced spiking fevers before, so I started tracking my temperature every 20 minutes as I lay splayed out on our bed.

The fever was hovering around 102°. New to this business, I obediently followed the instructions — and warnings — I was given on Infusion Day One.

Compliant Action #1

I called the infusion center at the world-class, suburban medical center where I am being impeccably well treated. The charge nurse transferred me to the “heme onc” on call. (medical specialty-ese for a hematologic oncology doctor). After I read him the record of my temperature tracking, the doctor was very clear and firm: you must go to Emergency right away. You are on chemo. You could have an infection.

At the time, I was a chemo-newbie who had been told I might have an infection that could blow up to something significant and/or terminal. I was complying with an almost-anonymous doctor’s orders. He had taken the call, and like any good on-call doc, was opting for the safest path for all of us: the hospital, his career and me.

It was about 6:00 p.m. when we arrived at the ED. The arrival time is significant. There were very few people there so we felt optimistic. But slowly and steadily, the seats filled up. I have since learned that you don’t want to go to Emergency unless you can hear the angels’ harps or see the “heavenly” white light in the psychedelic tunnel that supposedly connects you to from This World to Whatever’s Next.

Extended families arrived. I was seated too far from the triage desk to see who the patient was in these family groups, each assemblage featuring a full-spectrum of ages, shapes and genders. There were lots of anxious people, not speaking English. Then came the screaming toddlers, and people in wheelchairs looking way, way worse than me.

Compliant Action #2

I was acutely and uncomfortably aware that I was there because I had a persistent fever of about 101.5 — and during the long wait, I was sure that my fever had gone away. My rational instincts told me to just leave, but my Good-Girl inner voice urged me to stay because the doctor had sent me there. My husband was worried and urged us to stay, amplifying the Good-Girl voice in my head.

It wouldn’t be an exciting ED scene without the mentally ill guy who persisted in wandering around the waiting room, yelling at people, complaining about the hospital, strafing the air with F-bombs and brazenly mocking the security team. Truth be told, I’ve seen school crossing guards who looked more intimidating than the duo patrolling the emergency department. They didn’t get in the guy’s face, for sure.

My thoughts wandered back to my friend’s daughter, dealing with this day and night, and in a far more diverse, charged-up and potentially dangerous place than where we live. My respect for her career decision and for calmly focused ED team in front us deepened with every hour that we waited in the increasingly-surreal waiting room.

About five hours later, we were ushered into a small room in the medical action area of the ED. At that point, exhaustion was my main symptom. Let me go home! The fever’s gone. I wanna sleep!

Not so fast….

I sat upright and unhappy on the gurney, while Rob settled into an uncomfortable plastic chair. Maybe they’d let us leave, now that we were, at last, in a treatment room! Then a man entered the room. He was neither nurse nor doctor. His work clothes told a different story.

Our first thought was that he looked like a funeral home director, not-very-smartly attired in an ill-fitting black blazer with a telltale synthetic sheen. The hospital’s logo was sewn onto the blazer pocket, imitating the style of a yacht club officer or country club manager. But his behavior brought to mind a security guard whose costume is the sole source of his authority.

The zero-affect guy in our room turned out to be a corporate cog who materialized as soon as we’d dropped ourselves onto the gurney and chair. He wasted no time on pleasantries, telling us right off the bat that he was from Financial Services. He wanted to know how we were paying for the evening’s entertainment and medical care. We eagerly told him we were paying, had insurance and that the medical center didn’t need to worry collecting payment from us. We handed over our Visa card. Clutching it, he exited for a few minutes to swipe and verify the card. We somehow hoped this would speed up my release.

Not quite. After Financial Services Man was satisfied that we weren’t deadbeats, a bright, very friendly and straightforward nurse appeared. At some point during the previous five hours, I’d had a chest xray and some blood tests. Nurse assured us that as soon as a doctor could check them out, we could check out, too.

Another hour passed before the nurse re-appeared, promising that we’d be discharged shortly. Just short of the 6 – hour endurance mark, I crunched up and stuffed the freedom papers into my bag and we stumbled out, through the now-vacant ED waiting room.

This was the price of compliance.

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