ER Follow-Up

Here is a comment I received from a colleague regarding my last post about the cutting edge ER in Maryland:

I spent Saturday morning in the emergency room at "Memorial Hospital" (the name has been changed to protect the guilty) because my ward had fallen and had cut her head. The nurse was awful insisting that she “settle down” so they could do the stitches. I kept telling the nurse that she has dementia and that her agitated stage was normal. I asked if they could give her something to sedate her. The nurse said they did not sedate patients for stitches and that she was just going to have to relax otherwise they would not be able to do anything. What an experience. Fortunately, the doctor came in, saw what was going on, had her sedated, an stitched her up. When we got her back to the nursing home, we discovered her hip was very swollen and bruised – something they did not see in the emergency room. Wish they had an emergency room like the one in the article she could have gone to.

One of the many things that is upsetting about this story is that my colleague is a social worker; she is someone who knows how to be an advocate, someone who "knows the system", and yet in this case had no influence at all with the nurse. If she can't get the professional in this instance to do what is right and best, how can someone without her skills and knowledge advocate for a loved one in a similar situation?

My initial response to my colleague was that this is the very reason I think all nurses and social workers, and really all health care workers, need mandatory training in geriatric issues. The nurse appears to have been more concerned with protocol than with listening to the patient or to the patient's guardian. This nurse's actions seemingly fly in the face of one of the basic tenets of medical ethics: Do no harm. Luckily for the patient, the ER doctor was able to place her needs ahead of protocol, and did what was necessary to make a frightening experience less so.