For those of you not in the healthcare field this might not be the most appealing post, but for the fellow HCP’s in the crowd, some observations from up close and personal.
Last Thursday night I was hit by a GI bug of some description, the likes I have never had before. It’s now Wednesday and I would say this is the first day I have felt anywhere even near normal since, and still down a quart or so in energy. Having a fever, violent Vomiting and Diarrhea is never fun, but even less fun when you aren’t at home. By Monday when it was apparent I wasn’t getting better, we trekked off to a nearby ER to seek medical attention. I want to share some observations, but first I want to say that the care I got was good, the problem seems to have been identified and treated and I’m regaining my will to live. But oh my little flock, it is so interesting to receive health care in an unfamiliar land. So, in absolutely no order….
- Not every hospital that has an ER is in fact an ER. The first hospital we went to was only for Eye emergencies. Into another Uber and off to hospital 2
- Registration was much what you would expect except for having to show my passport, them getting my name in the wrong order (I was called “Lynn” through my entire visit), I live in Esmonton. Oh yes, and cash on the barrel head. Ingoing fee, about $130 euros. Didn’t think that this was unreasonable given what we charge non residents in Canada.
- Hearing your name in a long sentence of Portuguese with directions where to go is bewildering. The corridors of the hospital were twisty, windy and crowded, with people everywhere.
- The physician I saw followed me through my whole visit (over 8 hours) and spoke good English.
- There is ABSOLUTELY no privacy. Anywhere. The Doctor’s are seeing patients on what we would consider physio tables in an open cubby, with people walking by constantly.
- The ER seemed to be divided into sub specialty, I was in the Internal medicine pod.
- They use the Manchester triage system. Thank god my bracelet was yellow and not green. I might still be there.
- Visit started with a Blood gas, taken by the attending Physician. Must have been Point of Care because he was back to me within 10 minutes with a thumbs up. Because of the amount of puking and dehydration he was concerned. Next, a visit to the “Poking” room. This room is staffed by the most hard working, efficient team. An IV was plunked into my AC fossa, blood taken, a litre of fluid infused, anti nausea drug and something else I haven’t figure out given. NO IV pumps in evidence anywhere. They hang IV bags from hooks on the curtain rods, hooks on the wall, wherever they find a space. Hep locked and sent back to the waiting room.
- Another mysterious page. To have an x-ray of my abdomen. OK. The waiting room consists of people milling around the hallway in a crowd, waiting to be called. In the room, the techs spoke almost no English. I stood for the film. I had sweat pants on with a back key holder zip, this earned me a snort and the pants were unceremoniously pulled down. She then proceeded to pat down my chest, which earned me another snort. Underwire bra. She grabbed the bra, reefed it up over my boobs and pushed me up against the plate!
- Back to the waiting room. Another mysterious page. Back to the Dr. Oh, I forgot to tell you, I ordered a CT because of your abdominal pain, that was probably CT calling you. A kind orderly was taking another patient to CT so he herded me along with him, down a corridor, into an elevator, down a floor, down another corridor. Changed into a gown this time, however they were completely unconcerned about the zipper on my pants!! Asked for allergies, they didn’t understand Septra, I had no words in Portuguese. Finally mumbled antibiotic. Ahhhhh! this garnered big smiles. No problem. With which they hooked me to a contrast IV and stuffed me in the machine. (Now, disclaimer here. I will always own up to my own ignorance. I always thought you had to remove all metal jewellery before a scan so the magnet didn’t suck it out of your body. No one cared in the slightest and having this cross my mind as I went into the tunnel and hoping my nose stud wasn’t about to get ripped out through my ear was not reassuring. It did not, and exam finished, I managed to find my way back to the waiting room.
- Said waiting room probably held 50 people on wooden bench seats, crowded together like sardines. This did give me the chance to observe the steady flow of ambulance traffic coming in. And the fact that they were immediately offloaded. I have no idea where they stuffed all the patients, but they did. NO EMS crews hanging about, until later in the evening when there was a back up at Triage.
- Finally back to the Dr for the final report. Blah blah blah, CT grossly normal, some blood work out of whack, inflammatory markers elevated, probably something bacterial, need antibiotics, another attempt to describe my allergies, but knew this time to say antibiotic right away. Ahhhh! His eyes lit up. Ciprofloxacino? Can you take this. Yes, no problem. I will also give you something for the nausea. Before you go home, they will give you a dose of Cipro IV to get you started.
- Waited in another, smaller waiting room in the ER. Packed with chairs, recliners, wheelchairs, family. Half the people had IV’s running, on the hooks everywhere!
- Got my drugs, settled my bill (an additional $230 euros, which didn’t seem bad for all they did) and thank god, home to bed.
So that’s the factual part. The impressions part is harder to describe because I don’t want it to sound critical, but it certainly highlighted for me some strong differences.
- Electronic charting. Everything is electronic. NO paper. Anywhere. Physician have a card for session persistence. (Means they don’t have to log in every two minutes and can move from computer to computer.). they use bar code scanners. So far ahead of us.
- I left the hospital with a full transcript of my visit, including DI reports. Albeit in Portuguese, but still. The attending shrugged and said, “tell your Dr to use google translate”
- They had a vacuum tube System to transport things to the lab.
- No patient got to “own” a space, unless they were in the higher level room next door, and I assume waiting for a bed. I fell asleep on the stretcher and was awoken quite briskly to get moving on!
- The nursing and lab staff were all good at their jobs, moved a million miles an hour, seemed to have many balls in the air at the same time. The noise, chaos and congestion would be intolerable to Canadian nurses.
- I mentioned that everyone was kind. But also quite brisk and at times a bit rough. The IV in my arm was yanked, pulled and twisted when they changed lines etc. Didn’t seem to be an issue and every department did the same.
- A Canadian patient would lose their mind if an x-ray tech pulled down their pants and reefed up their bra! As hospital administrator I would have had an irate patient in my office to file a complaint!
- Infection control. Oh dear god. The wonderful ICP’s I have worked with would come unglued. Nothing was cleaned between patients (chairs had Kleenex from previous patients, paper was changed on beds, linens were shared at one point, injection sites are not swabbed but sprayed. Single use is not in the vocabulary for many things. The sheer press and congestion of humanity would make it almost impossible to keep up, let alone to the standards that we are used to in Canada.
- No pillows anywhere. No anti stick needles or IV catheters.
- Trust me, no NOD (name, occupation, duty). No 2 patient identifiers. If they asked if I was Lynn and I nodded, good enough.
- I can’t speak for any other area of the hospital, it’s an old building, obviously has seen many retrofits and some areas have lived harder than others.
- Take Immodium and Gravel with you on all trips. Gravol was easy to find at the local pharmacia. Immodium finally required Ron to take a 45 minute bus ride into the tourist central area where a pharmacy there had it. They do encourage the use of Probiotics, one was even prescribed by the Dr.
- Bring sweat pants on all trips. between the shivering and shaking with fever and needing something to wear to the ER, they were the best thing ever. I almost didn’t bring them.
- My husband is awesome. I already knew that, but just wanted to repeat it. I would probably be dead on the couch without him!
- Our landlord and his family are incredibly kind. They brought me “Melissa” tea when they heard I was sick, and his Mother sent Ron homemade soup and me stewed apples to sustain us. Antonio offered to drive Ron around Lisbon to find an all night pharmacy.
Thanks for sticking with me if you made it all the way through. It was the weirdest mash up of a First world hospital overlaid with an inner city/MASH unit place I have ever been. I’m grateful for the great care I got, and have nothing but admiration for the professionals who work in that environment!
Today I felt well enough to go out of the house to the grocery store. Thank god for antibiotics.
Lynn…. I mean Donna