Not Knowing

I took this picture while I was lying on a hospital bed in the emergency department the other night (I fancied it up using a photo editing app). It’s a picture of the ceiling over my bed in my little curtained off area, a ceiling that I stared at for a good number of hours until I was moved to a different room. The new room had the same ceiling. I took a picture of the ceiling as I lay there because I was thinking of all the people who had laid in that bed, in that curtained off area, staring at that same ceiling, wondering what was happening to them.

As I laid there wondering about my own diagnosis, my mind wandered to thoughts about our Residents who go to the emergency department. We send people to hospital all the time. Often they do not have friends or family to meet them there and wait out the long stretch of hours it can take to get answers. I thought about them laying there alone and it made me sad. I am fortunate that I have so many people who love me and who want to be there for me that I have to actually decline visitors. This is not the case for many others. I wasn’t incapacitated by my illness so I was present, I could understand what was being said to me, and if I hadn’t the people with me could and they would advocate for me if need be.

So much of what I do as Executive Director is about running a business, unfortunately I sometimes get lost in the work and forget that I am in the business of caring for people. I have never really thought, in all of my 15 plus years, of a Resident laying in the emergency department alone – and how that must feel for them. A number of our Residents are experienced hospital goers, so not all of them would view lying there staring at the ceiling as anything but normal. But it’s not normal. Hospital emergency departments are a kind of suspended reality. When you come into the emergency department every other aspect of your life grinds to a halt and you exist in this strange, often scary space of not knowing.

Realizing that I hadn’t really thought about my Residents being alone in the emergency department doesn’t change anything really, other than give me a new reason to feel like we aren’t doing enough for them – we simply don’t have the resources to send a member of our team with them.

I know from my own experience, because I am quite the hospital goer of late, often choosing to wait alone, that there isn’t much in the way of comfort offered by hospital staff while you lay away the hours. This is a commentary without comment; of course hospital staff don’t have time to check in on your mental health while they are rushing around trying to do all that it takes to care for the physical health of too many sick people.

Many of our Residents who go to the emergency department are not only physically ill but also very mentally ill. Many have anxiety and panic disorders and other mental health diagnoses that would be exacerbated by the stress of being physically ill, amplify that by the not knowing why they are ill.

Often people don’t realize that having heart issues can also bring on issues with depression. Having lung issues can bring on issues with anxiety. Having allergies or allergic reactions can bring on both depression and anxiety. Our physical health impacts are mental health enormously, and conversely, our mental health can significantly impact our physical health.

While I waited the other night I heard a Woman crying a few beds over. I couldn’t see her and I felt badly that I didn’t ask if she was ok. If you’re like me in situations like these, you debate with yourself if you’re being intrusive, if you should mind your own business or if minding our own business has gotten in the way of compassion. I felt like I should have at least asked from outside the curtain if she was alright. She’d have said yes I’m sure, not wanting to be a bother. Or maybe she would have been grateful to have another person to share her fear and pain with.

Long wait times in the emergency department is another post. This is not a post about logistics, it’s a post about people. No one should have to wait for hours to get help, but for a lot of us sitting there, it’s not the wait that’s hardest to bear – it’s the not knowing.

The medical model that hospital emergency departments exist in has no room for mental healthcare. This is a separate conversation from using the emergency department to access mental healthcare, as we have no choice but to do when we are in crisis. This is about caring for the whole human. Imagine having been alone for hours and hours to have a doctor come in and tell you that you have a “mass” and that you’ll need to follow up with this doctor and have this test and that test, and to be alone while you try to wrap your brain around the fact that your whole life might have just changed in that instant. What if instead we had a compassionate care partner that could go through that with you? Imagine a healthcare system that embraced a care partnering model that provided for not only physiological care, but for the psychological as well. A model that provides humanity: someone to check in with you while you wait, to hold space with you if you need it, someone to be there when you get test results (good or bad), help you process what you’ve been told and ensure you have a way home.

I have no data to support an argument that offering a care partner for people in the emergency department would improve overall health outcomes – but I suspect it would. But even if it didn’t, shouldn’t we want to do it anyway? I’m appreciative always of the offer of a warm blanket from a harried nurse as they quickly check my vitals, sometimes the offer comes from a well-intentioned volunteer, but what I think people really need when they are scared and hurting is the warmth of a reassuring smile from someone whose job it is to know how hard it is not knowing.