They say that the ER is a place where you come to have your life dramatically altered forever. This thought was spinning through my head as I was getting wheeled into an exam room. I must have been so lucky, I got in Right Away. The lighting is muted and they peel my clothes off to my underwear. I won’t be in clothes again for days. Every movement is excruciatingly painful.
ER Nurse: “What happened?”. Me: “I fell 9 feet off of a ladder”. “Did you hit your head”? “No, I don’t think so”. “Did you lose consciousness?” “I don’t think so”. What month and year is it? What’s your name? Where are you? What is your birth date? Wiggle your toes. Push your feet against my hand. Pull your foot against my hand. Grab my two fingers and squeeze as hard as you can. How much pain are you in?
I think they call this a neural assessment. A few minutes later, they ask me what time I came in? 6:08 p.m. I think they were a little surprised that I was so coherent. Actually, a lot surprised. The ER nurse just looked at the other person and said, “I’m sure he’s right”. It’s starting to dawn on everyone How Damn Lucky I Am. I don’t know when I figure this out but I am on an automatic order for “nothing by mouth”. That’s because they aren’t sure about whether I have internal organ damage and I might need surgery stat. This is why I wanted to go to a trauma center, they are prepared for this and can immediately wheel me into surgery if I need it.
After the neural assessment, they needed a CT scan. I’m wheeled over there almost immediately. In the ER bed so I didn’t have to transfer onto a gurney (thank god). But they did have to transfer me onto the CT scanner bed and they did so with the minimal possible pain (it still hurt like hell of course). It’s kind of interesting to be taken care of so competently by people who are younger than your kids. There’s hope yet, I encountered a lot of really competent, caring, and professional young people in my stay.
A CT scan requires “contrast die”. This turns out to be iodine. Wait, iodine? They must have put an IV into my arm in the ER room because they just put the contrast die into my IV and warned me, “this is going to feel warm all the way from your arm to your groin”. When this happens and it hits my groin it feels like I peed my pants. But it was just the warmth of the contrast die. The CT scan doesn’t take as long as an MRI and I’m wheeled back in to the ER exam room after a few minutes.
Then the wait begins. There’s nothing more they can do until the ER doc assesses the CT scan. I can’t remember how long this takes, but it could have been as long as an hour. And at this point they have given me nothing except a saline drip. As in no painkillers at all. My left lower back has a nasty hematoma (subcutaneous bruise) and I have lots of soft tissue damage and muscle trauma. Plus who knows what internal damage. I get asked the pain on the scale of 1-10 question many, many times. I never know how to answer this except when I have no pain, which eventually occurs when I’m not moving at all. But when I’m experiencing pain, I don’t know how to judge it on that scale. I get jabs of pain that make me yell. Is that a 5? Is that an 8? Right after I hit that floor, maybe that’s a 9 or 10. And maybe it’s muted by the adrenalin. But later, I don’t know how to assess this because I can imagine much more severe pain and so the pain I’m having must be a 5 or a 6, right? I’ll talk more about this later, because I want to talk about my experience with opioids in this newsletter.
Finally the doctor comes in and says, “I don’t know if I should tell you that you are lucky unlucky or unlucky lucky. What happened to you is bad, but the good news is that you don’t have any internal organ damage and your spine is stable. You have three broken ribs (me: really?) and several transverse process fractures. No internal organ damage, everything looks fine”. He goes on about lots of bruising, etc.
Then we have the conversation about pain management. This is the talk about the opioids they are going to give you. I tell them that opioids scare me and I don’t want them. I had Tylenol with codeine when I was a kid and had my wisdom teeth extracted. I remember it making me feel incredibly woozy. I only took it for a day. I didn’t want to take opioids unless the alternative was dire. Pain I can deal with. I think. We go back and forth. How much pain do you have? Zero, it feels fine if I don’t move. If you move, how much does it hurt? They’re so nice and so concerned and doing what they know is best. But I Don’t Want To Take Opioids. I have heard so many first hand horror stories.
The counter-argument is interesting, however. If you have broken ribs, you are quite likely to aggravate them while breathing. So you breathe shallowly, which can result in pneumonia. So pain management is normally considered to be crucial in rib fractures because of this risk. I knew this before I walked in because a friend of my broke ribs in a mountain biking crash. He took the opiates for a few days because of this risk. I finally allow them to give me one half of the minimum possible dose of dilaudid (.25mg). They put it into my IV and I Feel Absolutely Nothing. The episodic pain doesn’t get any less and I didn’t feel high or loopy or anything. So that was interesting and not what I expected.
By this time it’s a couple of hours after I got wheeled in. They’re waiting for the dilaudid to take effect and see how I am after it takes effect. My wife is concerned I am hungry. I’m not hungry but I also haven’t eaten in a long time. We’re near Whole Foods in Bellevue so she goes out for something to take out. At this point I don’t need surgery so I can eat or drink anything I want.
The door to my room is open and I see a guy with a crazy look on his face and a hairdo to match walking past my room demanding “Librium!”. He also wanted to know where the bathroom was. Well, he didn’t wait, he just peed all over the floor as he walked by. This caused quite an uproar as you can imagine. The ER is a crazy place. I admire the people who choose this as their calling. It takes a special kind of person to take what comes and deal with it professionally. Overlake ER is amazing. Every horror story you’ve ever heard about the ER wasn’t true for me that night. They were fast, efficient, kind, caring, and they got their job done amazingly fast.
It felt kind of bizarre getting fed smoked mozzarella pasta and sushi while sitting in the ER. This is the kind of thing that middle America must consider a West Coast stereotype extraordinaire. I’m near tears. I think I should have died a few hours earlier, or been paralyzed. I don’t know if this is stress or relief or gratitude or what? I actually still don’t a few days later as I write this.
After eating they come in and see if I want to admit to the hospital or go home. I, of course, want to go home. So they want to see if I can walk. They stand me up and I take a few hesitant steps. I can walk but I’m stiff and it’s painful as hell. I have no coordination, no balance, no strength, and although I can actually (barely) do it, I feel in no condition to go home and deal with the Activities of Daily Living. The doctor and ER nurse look visibly relieved when I say that it would be better if I got admitted.
I don’t know why they didn’t just look me in the eye and say, “you need to be in the hospital for pain management.” Perhaps they really can’t force you to be admitted. Maybe you want to go to a different hospital (um, no) or something. So it felt a little bizarre that this was so much up to me. I think they would have let me walk out of there even in the bad shape I was in. But that felt like the Really Stupid Choice. And I had already done enough stupid things that day.
It was 9:30, six hours post accident. They needed my room in the ER so they whisked me out of there in a wheelchair and took me to 4th floor West Wing. The attendant who wheeled me was probably sorry she got assigned me to transport. She hit two bumps on the way over and I just screamed. It was so painful. But we got there with only those two bouts of stabbing pain and I ended up in a bed in a private room at the end of a hallway.
Four hours, start to finish. I cannot say enough good things about the ER / trauma center at Overlake. I can’t answer the pain scale number but on a 1-10 scale, I give that experience a 10. They were amazing.