I had a “surprise ED visit” on January 3rd. My oncologist and I have been struggling to control my blood pressure since last summer. Avastin often causes high BP.

Unfortunately, it was my oncologist’s day off Friday. So, when I called the office with an update on my high BP of 170/96, I got a consult with his partner who does not know me. He first suggested I go see my primary doctor whom had not been managing my BP and whom I have not seen since last July. I told him, at best I would see the PA and since it was already 12 Noon, it seemed remote. Besides I wanted to see a doctor, since chemo complicates everything. So, he said he wanted me to go to the ED. I suggested a visit to Urgent Care instead but he would not budge, so off to the ED I went.

When I went to the ED, my BP was very high (210/110) with a slight headache on arrival. (I have “white coat syndrome” which means your BP rises due to anxiety whenever you visit a healthcare provider).

The ED was very busy with many patients waiting, in much worse shape than I. About 1/3 were wearing masks. 25% were in large rolling chairs. One friendly fellow was on oxygen. I later discovered he had been put on the oxygen on arrival to the ED for SATs of 88%. (Normal is greater than or equal to 92%. The oxygen did help.) He had not been able to sleep for 3 nights because everytime he laid down, he felt short of breath. He was not seen by a provider until he was there for 9 hours! He thought he was going home but I was pretty sure he was not going home on oxygen. I did not have the heart to tell him. Another gentleman in a rolling chair with a mask had a BP of 77/44. (A dangerously low BP) He had no other symptoms and he finally got a room one hour later. (No action was taken in the waiting area to correct this low BP.) Another nice fellow, in a rolling chair wearing a mask disappeared, after leaving for a CT scan. His wife finally tracked him down several hours later. They had put him in a room without informing his wife who was anxiously looking through the glass doors from the lobby every few minutes.

Visitors were required to leave the waiting area and wait in the lobby because there was not enough room for patients. Some visitors were very angry about this. One patient and his wife walked out about 30 minutes after they arrived because of this policy. Another young lady came into the triage area sobbing with her Mom. The young woman looked like she was in her late teens or early 20’s, started sneakily smoking vape cigarettes. This bothered the gentleman with oxygen and when he insisted she stop smoking, she and her Mom walked out of the ED. Despite all of this, most visitors were understanding of being asked to wait in the lobby.

I got my chest x-ray, history taken and EKG done piece by piece. They were unable to start an IV or get my lab work done. (I have terrible veins. An ED nurse tried twice and could not start my IV. This meant labs would be delayed until my port could be accessed.) You need to be in a private room to have a port accessed since it is a sterile procedure. The problem was very few rooms and way too many sick people.

I believe the day shift staff in the waiting area was making every effort to do what was best for the patients. They were making rounds on the people waiting to be seen by a provider and taking vital signs on each of us every hour or two while triaging patients at the same time. My feelings of frustration ranged from considering at what point I would give up and walk out and a deep desire to throw on scrubs and jump in and help. The standard of care was much lower than mine. For example, giving an IV bolus, off a pump when you are unable to monitor the patient closely is not safe practice. The bag was over the patient’s head and he could not see if the bag was empty. I did clamp the line off when the bag was empty and the patient was close to getting an air bolus in his vein. I immediately told the triage nurse afterward, who did not appreciate it, since I was no longer an employee there. (I would do it again.)

When night shift arrived around 7 PM, the focus of the nurses was triaging patients, no vital signs were taken between 7-9pm on the people waiting to be seen by a provider. Thankfully, I got a room at 9PM.

If the waiting room was like purgatory (which it was) then my ED room was like heaven. The staff were friendly, caring, skilled and professional. Unfortunately, the RN was unable to get blood from my port so he started an IV on the second stick. I watched a Modern Family marathon (a comedy) to help me relax so my blood pressure might drop some. After a few hours, my BP was down to 170/80 without any medication, which was near my initial BP taken at home. The PA (gee, still did not see a doctor) ordered a diuretic to take in addition to my ace inhibitor. The RN who discharged me tried (quite strongly) to give me Hydrocodone to take when I got home. I told her several times I was not hurting and that I was there for high blood pressure. I was supposed to be put on Hydrochlorothiazide. I finally told her she must have the wrong patient. She initially blamed the provider and the computer but returned admitting that the error was hers. She said she “assumed” it was Hydrocodone since the word started with “Hydro”. This speaks for itself. Grateful it was me and not someone who may have not questioned her.

I left after midnight per Uber since I can not drive at night safely. I had called Bambi, my neighbor, friend and chemo driver, just before 9PM and thanked her for offering me a ride home but it was getting too late and I had no idea when I would get a room in the ED.

Bambi gave me a ride back to my car a few days later. (She is taking me to chemo on Tuesday too!)

The ED needs more support, including more staff and more rooms for patient care. It is a very busy time of year. They are doing their best. My recommendation is avoid the Emergency Department and use it only as a last resort. If you must go, bring a positive attitude and a large dose of patience.