On Saturday, I fell. No big deal, right? I wouldn’t have thought so, except that when I fell, my left foot slammed down on the ground. My toes started bruising almost immediately, as did many other places that didn’t even hit. My mom tried to get me to go to the ER, but I didn’t want to. Going to the ER generally leads to a 3-4 hour wait, a possible trip to radiology (isn’t always a guarantee for me), and then a rude dismissal from the staff (about an hour and a half after being taken to the back–if I even get that far) because I’ve ended up wasting their time.
‘My foot would get better’ was my initial thought. I fall quite a bit, and usually I’m okay within a few days. Instead, by Sunday, the bruises and swelling were worse, as was the pain. I was also having some stiffness in the joints that connect my toes to my foot. Still, I didn’t go to the hospital.
On Monday morning, I called the UAB Clinic folks so that I could see my family doctor (or another family doctor in the clinic). Well, I just so happened to call on the day that at least 2 of the doctors who were scheduled had decided to take a sick day. (I’m sure they didn’t just decide to take a sick day, and that they were actually sick.) So, they were too busy for the staff they had and couldn’t see me. Instead of saying that they would see me another day, they told me that I needed to be seen ASAP. Well, before they could say where I could go, they had to know what insurance I had. I told them it was Medicare & Medicaid. Apparently, none of the walk-in clinic are into the whole Medicare-Medicaid combo, so the only other place to go was (cue dramatic music) the ER.
The ER on a Monday is not the best place in the world to be. It isn’t necessarily the worst, but it’s pretty damn close to the worst place you could be in town. I went in and, after filling out a form where I put the symptom as “left foot & ankle”, was immediately triaged, which wasn’t necessarily a good thing. From the first nurse in triage, everyone ignored the foot part of the symptoms and just focused on the ankle. I thought it was weird that they would do that, though I don’t know why it would surprise me.
After being triaged, I sat in the waiting room for another 3 hours. I got to people watch, which was fairly entertaining, but not exactly what I wanted to be doing. There were some interesting people there. A guy was sitting across the room, under one of the HD televisions, laughing and talking to himself. My dad and I tried to figure out what to call the guy. (Please don’t tell me that it is rude to talk about people in a waiting room. This can sometimes be the only source of fun when you’re in a waiting room.) We debated between Charlie (for Charles Manson), Jesus (for, well, Jesus Christ), and some others that were related to the guy’s main look–long, wavy-ish dark brown hair, a dark beard, and a look of being in touch with something “else”. We ended up calling him Jesus. My dad thought the guy was probably just crazy. I thought that he was probably high, but might also have some craziness. I regretted referring to him as Jesus later, because though I thought that Jesus might wear acid wash jeans and a matching jean jacket, I didn’t think he’d wear sneakers. (Jesus would definitely wear sandals.) There was a group of people that we (and a lot of other folks) paid attention to as we waited. It was a group of about 10-15 people, who, among other things, were very loud. The security guards chastised them at one point for being so disruptive. They tried to bum-rush the back to see their friend, who had apparently been beaten up. Of the five or six people that were part of that rushing past the door when it unlocked for one or two to go back, only two were allowed to stay back there. Apparently, the ER rule of two visitors per person was lost on the group. Though this group of people had gotten there at the same time as me, they left about an hour ahead of me. The only employee that we ended up watching was one of the security guys who’d rolled me into the ER. He was confiscating any wheelchairs that had been abandoned, even if the person was in the bathroom. I made sure to hold on to my wheelchair. (I’ve learned that the staff doesn’t take hurt feet very seriously if you’re not in a wheelchair.)
By the time I was finally allowed to go back to a room, everyone who’d been there before me was already either seen and discharged, seen and waiting on a diagnosis, or had given up on the process and had gone home. Several of the people who’d come after me ended up being seen before me.
When I got to the back, they kept talking about my ankle, even when I showed them where on my foot I hurt. I found out that x-rays had been ordered about 2 hours earlier, but that there was a very long wait for the whole hospital to get seen in the radiology department. (I didn’t understand why they couldn’t send people to one of the other connected facilities [via the tram] that has a radiology department, but apparently that wasn’t a possibility.) The doctor, who I saw for a grand total of ten seconds, just told me that it was taking forever to get the radiology department’s attention. A few minutes later, a radiology tech (or someone from transportation) took me down to the department. I, then, waited for about 10 minutes for someone to wheel me into the room for the x-ray.
The x-ray was done on my ankle, which I was really perturbed by, but I couldn’t get across to anyone that the brunt of the fall had been “absorbed” by my foot. (I had, by this time, learned that you never give too much information on those little sign-in forms.) So, after the x-ray was done, I was taken back to my room. There had been a shift change in nurses while I was in radiology, so I met my nurse at about the same time that the nurse practitioner came in to tell me that my ankle was fine. My father and I gave him a weird look that should’ve given him a big clue that my ankle wasn’t the part that was really hurt. (This is why physical exams, which had never taken place, are important in diagnosis.) He asked what was wrong. I said that my foot was the problem. He said that he would check the x-ray again, but the ankle x-ray usually shows the foot.
That is what a standard ankle x-ray shows. That little area of where the foot meets the lower leg. That probably hasn’t changed since I first started getting ankle x-rays over 10 years ago. That kind of view doesn’t show the part of the foot where the toes (phalanges) meet the foot (metatarsals). It barely shows any part of the metatarsals at all. It shows the tarsals, aka the ankle. If an ankle x-ray was the same as a foot x-ray, then there would be no need for calling them different things on forms and there would be no need for different views.
Well, the nurse practitioner, who was sure that the x-ray showed the right part of my foot, was proven right–though, this happened while he was out of the room and with no input from any other medical professional. I could’ve complained and refused to leave, because I’ve done that before, but it generally ends with the doctor or a supervisor coming in and defending the position of the staff member who made the shoddy call. (Generally, it is a call made by a doctor who hasn’t been attentive or this particular nurse practitioner–I think he may have been part of the team that made the decision with my mom’s first ankle break to send her home over the weekend, even though she couldn’t bear weight.)
Now, I know that nurse practitioners can do a lot. And I know that they are generally really good at their jobs, but this guy didn’t do an exam and acted like there wasn’t really anything wrong. And his end diagnosis? My foot is bruised and I have a sprained toe. I’m not exactly sure which toe is sprained, since 3 of them have been in a lot of pain and 1 has been in a bit less pain than those 3. Only one hasn’t had any kind of pain, bruising, etc. On the discharge orders, I was told to take Tylenol for the pain, because I guess it works better for pain than Tramadol. (That was sarcasm.) I was also told to follow up with a family doctor. The discharge orders were signed by the same doctor who’d spent 10 seconds talking to me, and was also the same doctor who (on the day my mom had to come back in with the first broken ankle) had written me a prescription for Ibuprofen (can’t take NSAIDs) and spent 10 seconds with me and all of the other poor end-of-the-spectrum pain cases in the same room. Of course, that day I didn’t get an x-ray, which I kind of feel like I didn’t get yesterday–except that I know that I did get one, even if it was the wrong one.
The Huntsville Hospital ER has really gone to shit.