Column: Horse and Cart, Write and Attend

By Susan Parker
Tuesday August 22, 2006

I should have knocked on wood last week when I said I often use Kaiser’s Emergency Room as an office in which to get some writing done. As I e-mailed the essay to the Daily Planet, Ralph’s health took an unexpected and rapid slide downhill. I drove him to ER. I took a pen and notebook with me, but because his vital signs were alarmingly weak, he was rushed through triage and put in a room for patients who need immediate attention.  

Still in his wheelchair, and dehydrated from weeks of unusually hot weather, Ralph was quickly hooked to an IV and pumped full of fluids. He began to recover. A battery of tests was administered, x-rays were taken and blood samples collected. An exploratory camera attached to the end of a long tube was prescribed for insertion up Ralph’s nose and down his throat. But the machine the camera was to be attached to wasn’t available. The attending nurse wanted to insert the tube immediately. She said Ralph might be “a little uncomfortable, but he’d be ready once she could get at the machine.” 

I balked at her suggestion. “Why cause him discomfort while he waits?” I asked.  

“Priorities,” she explained. “I can do it now. Later, I may not have the time.” 

“No,” I said. “We’ll wait. Let’s not get the cart before we have the horse.” 

I could tell she was unhappy with my decision, but I’d observed this procedure during a previous visit to ER. It had been painful.  

Two hours went by. The IV bags drained and emptied. The staff changed, and a new nurse arrived, replacing the one who was angry with me. “I’ve been told you refused to allow the esophagus tube to be inserted,” she said. She held a clipboard in one hand and a pencil in the other.  

“Yes,” I answered. “We’re trying to get within reach of the machine. I don’t see the point in causing Ralph pain while he waits for it to become available.” 

“I understand,” said the new nurse.  

And then we waited some more.  

Eleven hours later and all the tests finally completed, a bed was found for Ralph on the eighth floor of the hospital. An around-the-clock staff of seemingly hundreds of people watched over him as he recuperated. A nutritionist stopped by to monitor his meals, doctors assessed his progress, nurses checked his vital signs, assistants turned his body to the left, and then to the right. 

Technicians collected blood samples, measured urine output, took bedside sonograms. Someone unhooked all the machines and pushed the bed, with Ralph in it, into the hallway and through the corridor to the service elevator. Ralph was wheeled inside and sent downstairs to get additional x-rays and sonograms. While he was gone, a janitor mopped the floor of Room 821.  

Finally, after five days, Ralph was returned home with additional medications, a special ointment for his bedsores, and a PIC line inserted within the vein of his right arm. I was taught how to administer antibiotics intravenously three times a day, at eight-hour intervals. A home health nurse was assigned to visit several times a week to monitor my work.  

I never had time to write while Ralph was hospitalized. I was too busy running back and forth to his room, and taking care of all the things that needed to be done before he could return home. And now I understand why the ER nurse wanted to insert that exploratory esophagus tube up Ralph’s nose while she had a spare moment even though the machine it had to be attached to wasn’t available. Forget the horse and cart thing, it’s all about time management.  

I wish Kaiser had sent Ralph home with more than just five new medications, miles of rubber tubing, and an IV pole. I wish they’d returned him with a team of doctors, nurses, assistants, technicians, someone to move his bed and manage the antibiotics, and a janitor to take out the trash.