A Medical Economics Web Exclusive

What could be worse than a night in my ER—as a patient?

Not much, the author concluded, as he signed himself out.

By Glenn G. Gray, MD
Radiologist/New York

Looking forward to a weekend off with my wife and daughters, I charged through the revolving door of my hospital, and clumsily tumbled down the stairs and onto the sidewalk. I grappled for the handrail, fruitlessly, and arched backward. The patellar tendon probably popped when I forcefully tried to right myself, resulting in a massive quadriceps contraction.

The pain was excruciating, a kind I had never felt before. I cradled my right knee with two hands while sitting on the concrete, the deformity immediately apparent. The patella sat about three inches higher than it was supposed to, leaving a gaping void where it once resided. The knee expanded by the second, as if someone were blowing air into it with a bicycle pump, each push of the handle raising the skin a millimeter higher.

A small crowd gathered.

"Oh dear," a woman said. "You okay?"

After a long moan, I said, "I don’t think so."

I felt faint, as if I would lose consciousness. I arched my head back, and breathed as though I was in labor. A warm ray of sun struck my face, and I squinted at the sky. The moment seemed surreal.

"Want me to call someone?" the woman asked.

I said, "All right" and gave her my wife’s phone number.

The leg was limp below the knee, as if paralyzed. The reality was starting to become clear. This was a serious injury, not a sprained ligament or even a torn meniscus, but a full rupture of the patellar tendon. The surgeon later informed me that it looked as if a small hand grenade had exploded within the tendon, sending shards of tissue in all directions.

An ambulance pulled along the curb in front of me. "Hey dude," the first EMT said as he walked over to me. He knelt. The badge clipped to his shirt read Ricky. "This could be your lucky day. Just happened to be passing by."

A second EMT pulled a stretcher from the ambulance. Ricky noticed my scrub shirt and said, "You a doc here?"

"Just started."

He gently placed the palm of his hand on my knee. "Not such a good start, I’d say."

Carefully, they loaded me onto the stretcher. I had never been in the back of an ambulance before. As I laid on my back, the EMT sitting beside me seemed to tower above me. He asked about some medical history, then took my pulse and blood pressure.

The drive around the back of the hospital took about 30 seconds, and with a jolt, I was rolled into the emergency department around 5 pm. Every seat in the waiting area was occupied. Many more people milled about, some in small groups, some alone. The sounds and smells were familiar. Sullen faces glanced up at me. I was now one of those faces. For the first time in my adult life, I was a patient.

The second EMT finished checking me in at the front desk. I was wheeled deeper into the jungle: steered around other stretchers, between people sitting in chairs, and through groups of rounding doctors. I ended up in the far back corner.

"Take care," Ricky said.

"Good luck," said the other. "You’ll need it."

They walked away. I looked for a familiar face, but saw none. Bodies were strewn about, like an army camp after a bloody battle. A nurse walked by and said, without slowing her pace, "I’ll be with you shortly." I never saw her again.

In front of me, several stretchers down, a man shouted, "Fire in the hole!" He had restraints on, and his gown had twisted off so that he was covered only by his underwear, which was torn and stained. Two security guards appeared at his side.

I motioned to a young woman in scrubs sitting nearby, scribbling notes. I assumed she was a resident. I said, "Could you get a phone to me?"

She slowly grabbed the metal handrail and pushed my stretcher alongside a desk. "Where’d you get the scrub shirt?" she asked.

"Same place you got yours," I answered, but she didn’t appear to hear me. She placed a black phone on the desk next to me and said under her breath as she walked away, "I should have been a nurse."

I punched in my home number. "I got a call from some woman," my wife Kris said quickly. "Are you okay?"

"I’ll live," I said. "I wasn’t sure if she’d really call."

"I didn’t believe her at first," Kris said. "I thought it was a prank. Can I bring you anything?"

"Maybe a book," I said. "I don’t know how long this will take."

Kris arrived at 7:30. The first person to see me after that was a tentative second-year resident at 9:15. "I think I ruptured my patella tendon," I said.

He looked at the scrub shirt. "You work here?"

"I’m a fellow," I said. "Neuroradiology."

"Welcome," he said, placing his hand on my knee. "Can you move your leg?"

"Nada."

He looked around. "I’ll call orthopedics."

While I was waiting, the underwear man started to scream at no one in particular. At one point a young woman put her reddened face in his, nose to nose, and raised her index finger. She said, "You just be quiet, you hear. You are bothering everybody in this hospital. You just shut your mouth. You hear?"

He spat in her face.

At 10 pm, a white-haired man announced, "Time for an X-ray." He wheeled me out the door and down a long hall, which, in contrast, was incredibly quiet. The radiologic technologist pushed me into the X-ray room. He wielded a film cassette. "I’ll get the shot right on the stretcher."

I waited a moment and said, "Now I get to see you guys in action."

He looked at me and then at my name on the request slip. "You’re Dr. Gray from upstairs?"

"I’ve spoken to you on the phone several times, I think."

"Checking protocols." He extended his hand. "I’m Jimmy."

"Glenn."

He proceeded to shoot three views of my knee, pulling and twisting the mangled limb to get the best possible angle. The pain was exquisite.

"This isn’t as easy for you as I thought," I said.

"Or you. And you guys always want repeat films."

"Maybe we should spend a little time down here."

"Would be nice," he said, eyes squinting. "You just might learn something."

After he was through, he wheeled me back into the corridor. I was dumped back into the ER. Kris and I waited.

At 12:15 am, a second-year orthopedic resident arrived. He quickly examined the knee, and then discussed several treatment options, including having the knee operated on the next day, Saturday, by the service team. He told me the service guys were great. I decided the operation was a good idea, figuring the sooner I had it, the sooner I could get back to work. "I’ll talk to my senior," he said. "They’re in the OR. I’ll be right back down."

I didn’t see him for three hours.

Kris and I decided that she should return home. She had to pick up the kids who were at our neighbor’s apartment. I kissed her goodbye.

After she left, the night began its slow spiral downward. Fatigue and hunger were dominant forces. I faced the prospect of surgery in the morning. I tried to sleep, but I couldn’t. My bladder screamed in agony.

At 2:30 am, a nurse took my temperature and hooked up an IV. She stuck my arm and missed the vein the first time. Finally she got the line in. At my request, she transferred my stretcher into a cubicle with a curtain.

"Mr. Gray?" someone said through the curtain at 3:15 am. It was the orthopedic resident. "Or should I say Dr. Gray?" He handed me a consent form for surgery. I was a bit surprised since we’d never really finished our conversation about the plan of action. However, I was numb with exhaustion and pain. I figured what the heck, and I signed it without so much as glancing at it.

The resident wrapped my knee with an ACE bandage and secured an immobilizer around the leg. I asked myself why I hadn’t just left earlier with Kris.

As he turned to leave, he said, "I’m not sure we can do the surgery tomorrow. Might have to do it Sunday. We had an add-on case. Emergency fracture."

"Sunday?"

"Sorry. There’s a room for you upstairs."

"Whatever." I hated being jerked around. But then I wondered, how many times did I say something similar to a patient when I was a surgical intern? Even so, it was at this moment that I felt I must leave. And the word I muttered to myself in the middle of the night in a dark corner of the emergency room was–escape.

At 4:00 am, a middle-aged woman poked her head through the curtain. "Time for your chest X-ray."

I did not smile or speak or even look at her. A transformation was occurring, some kind of metamorphosis. Jekyll to Hyde, man to fly. Actually, I was transforming into something far more horrible. I had turned into a disgruntled patient.

I got back to the cubicle at 4:20 am, and my transformation was complete. I was now a patient, and doctors were the enemy. At this point, not only did I want to escape, but I was feeling trapped, bordering on claustrophobia. Air was running out.

I had to escape soon, but I didn’t have crutches. My leg felt as if it was hanging off below the knee. I hadn’t seen a doctor for hours. I looked at the IV in my arm and thought, "I am a physician and I shouldn’t pull this thing out. I should go through the proper channels and act professionally."

I thought again. I ripped off the tape, hair and all, unleashing a feeling of euphoria. I slipped the IV out of my vein and covered the small hole with the tip of my index finger. I grabbed a nearby box of tissues and stuffed a wad of paper into the crook of my arm and flexed my elbow. With the other hand, I draped the loose tubing over the IV pole, which dripped water onto the floor. I loosened the Velcro on the immobilizer and rolled my cut-up pants down over my leg. I refastened the immobilizer and slid off the stretcher.

I hopped on one leg to the curtain and peeked outside. I saw two residents sitting at a counter in the distance. I said, "Excuse me."

They didn’t acknowledge me. I was no match. They were hardened to the sound of disobedient patients. To them, I was nothing but trouble lurking in the dark shadows of the emergency room. The nurse appeared. "Crutches," I said. "I need crutches, please. I’m checking out."

She looked confused. "Does anybody know?"

"Nope."

"Hold on." She vanished and reappeared moments later with two doctors.

"Everything okay?" the first doctor said.

"I gotta leave."

He hesitated. "Leave?"

"Leave. Home."

"You sure?"

My mouth smiled, my eyes did not.

He grabbed his chin. The two doctors looked at each other, then back at me. "Let me tell ortho." He and the nurse walked away.

The doctor came back a minute later with the nurse who was holding a pair of shiny silver crutches.

"Ortho said fine," he said. "Just don’t eat. He said he’ll call you later if they can do the surgery today."

The nurse held the crutches out in front of me, like some kind of peace offering. A gift.

The doctor said, "Good luck," and stepped back.

I stuffed the crutch pads under my arms.

"Thanks," I said, already on my way. I was exhilarated, and my senses began to heighten. I hopped through the electric doors into the lobby.

I was free.

Glenn Gray. What could be worse than a night in my ER—as a patient?.

Medical Economics

2001;6.