To coin one of my oft-used phrases — ‘we’re going to have a sharing moment!’
I live with spastic diplegic cerebral palsy and several years ago an episode of chest pain required that I go to the ER at the city hospital, 40 minutes away. I’m not a ‘frequent flyer’ in the ER so for me to make the decision to go is not without a lot of thought. Do I really, really need to?
Earlier that day while at the mall, I was having difficulty wheeling up a ramp which normally was not a problem given my powerful upper body. I was worried because my heart was hurting. My family doctor at the time made house calls and while attending me at my home, after the mall outing, put me on his portable heart monitor. He was concerned enough after the exam to insist that I go to the hospital immediately though there was no need for ambulance transport.
I went to the hospital ER, outlining symptoms in detail, noting that my family doctor felt that I experienced a mild ‘cardiac event’ based on his exam. I didn’t have a long wait, thankfully. Given my status as an ‘at risk’ patient, I also have a need to be really proactive when it comes to avoiding too much contact with germs - colds and flu. For me, a simple cold could develop into pneumonia.
The ER doctor arrived and I took note of the fact that I wasn’t invited to get out of my chair to lie on the exam table. As was my habit, I wheeled around the space, mentally photographing the environment - part of my modus operandi in the event that I did have to stand up and make my way to the exam table. I prefer to move under my own power as being ‘manhandled’ had potential to cause me to totter/balance shift; then I have to ’re-balance’. A fall at my advanced age poses even greater risk, given I am a senior citizen with a since-birth brain insult but still uprightly mobile - quite an accomplishment. I wasn’t about to jeopardize my health and wellness any further by landing on my bum and possibly breaking or dislocating a limb. It’s important for clinical staff, whether nurse or doctor, to ASK if a patient with obvious mobility disorder who IS able to walk, would like or requires assistance. To not ask and simply latch onto a patient without regard for their personal safety is inappropriate as their personal boundaries were not respected.
I also noted another ‘problem’ with the ER doctor’s protocols. She did not wash her hands. I had observed her munching on a slice of pizza just moments before she came to see me but said nothing. I was asked about the reason for my visit while the doctor, rarely making eye contact, looked at the chart. She then asked why I was in the wheelchair and was informed about the spastic diplegic cerebral palsy status. Much to my shock, she asked what CP is. Confidence in this physician went right out the window, barrelling down the highway.
The doctor put the chart down, bent over and leaned into me and with her thumb pushed on my stomach. There was no blood pressure taken, no temperature taken, no questions about chest/heart pain asked, no questions about what I ate that day. Red flag! Red flag! Red flag! Red Flag! In just seconds, the diagnosis - indigestion. She wrote a script for Propulsid, and with that, the examination had concluded.
For the record, I’ve never had indigestion in my life. I would be remiss, however, if I didn’t point out that in many patients, heartburn and indigestion can and do mimic the symptoms of a heart attack and all avenues must be explored.
I accepted the script and bid the doctor good day, wheeling away without a backward glance. There was NO WAY I’d be getting that script filled. Once at home, I researched the drug and was stunned to learn that it had potential to cause fatal arrhythmia. It was finally taken off the US market in 2000. I had a conversation with my father, a old-school country doctor, and within days was examined by a cardiac internist in Fredericton. More tests followed, and I was subsequently diagnosed with aortic insufficiency. It was possible that I had I taken the drug as prescribed by that ER doc, I’d have gotten into serious difficulty, compromising the ‘golden hour’ of care lost because of my proximity to the hospital would have most assuredly worked against me.
My point in sharing this story is to make people aware that when they really, really know something is not right with their body, they need to assert themselves when they decide to go to the ER to seek treatment and appropriate care. And to the doctors - you REALLY need to pay attention not to just what YOU see and hear from the body you examine, but what the patient is telling you. Hearing and listening are vital to outcomes. Let those two critical skills be your gifts to your patients this holiday season and all year round.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her aging Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca
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