Sunday, July 20, 2008

An Emergency Room Experience

I have suffered with eczema and asthma since childhood. As a child I would regularly get shots for my asthma either on an emergency basis at the Doctor's office or regular shots to keep my asthma under control. At one point in time my Mother learned to give me the shots, although not a pleasant experience for a child to go through.

Over the years I have had to make only a few emergency visits to a Doctor for my skin condition. One time when making meatloaf I rubbed my face without washing my hands, which left my face in an itchy rash. Ever since that disasterous experience I use a wooden fork to mix ingredients without physically touching the ground chuck.

Usually my hands are the worse in the winter months, but the past few months my face was suffering from flareups constantly. When shopping at Walgreen's last Saturday for some redness relief moisturizer lotion the cashier told me she had a similar experience that got better after she went to the Emergency Room for a shot of Cortisone.

I had not considered going to the Emergency Room for my facial swelling, even though most mornings my eyelids were swollen. I read through my Health Maintenance Organization (HMO) Handbook trying to decipher what constitutes an Emergency Room visit.

It is clearly spelled out in the Handbook not to use Emergency Room for routine health care services. The steps to use Urgent Care are also discussed, starting with a call to your Primary Care Physician (PCP), identify yourself as a plan member. Ask to speak to the Doctor on-call about what has happened. If you cannot get in contact with your PCP contact the Health Plan.

Urgent Care is what you need when a condition, illness or injury is not life-threatening, but needs medical care right away. Emergency Medical Condition is a medical condition manifested by acute symptoms of sufficient severity (including severe pain), such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health or unborn child in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any body organ or part. This includes psychiatric disturbances and symptomos of substance abuse.

I still was not certain my visit to an Emergency Room would be covered by my Insurance plan, since I would be going to one near my residence that is not part of the network. I started by calling an Emergency Room at a Hospital not too far from my house. I inquired to the length of wait since my kids both are on the Autism Spectrum and not familiar with the place. I was told by the Emergency Room Personnel that we should probably try another location.

I wanted to go to the Hospital my youngest son has been a patient of three times, as well as a few trips to the Emergency Room. I figured this would be less stressful for my kids and I would feel better going someplace we all were familiar with. I started by calling the PCP, which had no answering service or machine. I let it ring for several minutes before realizing I would not get anyone on this line.

I used the phone number on the back of my Insurance Identification Card that says for 24-hour authorization. I figured this was the number the Hospital would call to get approval. I gave my ID# and explained my situation with my skin and my two kids. The person told me this would be covered to go to the Emergency Room at the Hospital of my choosing and they would call to get autorization once I got there. She also stated it was not unusual for the PCP to not have a message service.

I packed a backpack of reading material for us, diapers for my younger son and water and snacks. I brought along the medications I had been taking, as well as some cosmetics and lotions I had recently purchased. We got to the Emergency Room at 2 pm on Sunday afternoon. Within forty-five minutes I was assessed by a Nurse, had my blood pressure checked and temperature taken. I was given a wristband with identifying information and told to go to another waiting room at the end of another hall.

This was the waiting room for another section of the Emergency Room for minor conditions. I was not happy to learn that my inflamed face with swollen eyelids was considered a minor issue. There were families coming in with several children running around. Several people were ahead of us in this room, that seemed to take each one in the order they appeared. We were given paperwork on our situation and placed these documents in a box for a Nurse to remove.

I was called into the Emergency Room section by 5pm and quickly seen by an Intern. She mentioned some courses of treatment for me and needed to see her Attending Physician to determine which method would work best for me. She told me one shot would work quickly where another one would take longer to work. Luckily I did not have to make the decision since I wanted fast results.

The Attending Physician came awhile later to look at my swollen face and they went off to consult. The Doctor returned to tell me which method would be used and that the Nurse would give me an antibiotic and then get the shot from the Pharmacy. They would then have to keep me longer to make sure there was no allergic reaction to the shot and then I would get prescriptions.

This whole process took longer than the actual wait in the waiting room. It was more than an hour to get the shot and then like another one for them to check me out for reactions. Initially I was told the shot would be in the arm, but the Nurse learned from the Pharmacist that a shot would have to be in the muscle of my torso.

This freaked my kids out since he wanted to pull the curtain. My son did not want the door closed and once the gloves went on the Nurse he paced about thinking they were coming for him. There turned out to be some problem with the computer and my financial information, so I was not released until 8:30 pm. My face was burning and it seemed worse to me from what I could see in my little mirror.

The Nurse told me they were short staffed and very busy. Each person that came into the Emergency Room after us was seen by the same Doctor within five minutes. It looked like the Nurse was the busiest person in the Emergency Room with the Doctor handling the caseload in rapid succession.

My paperwork said to see a Dermatologist in 1-2 days for follow up care. The Nurse had told me the shot was slow released giving me twelve hours of medication. He said my face would look better the next morning. My face was worse with both eyelids swollen. The Doctor told me to stop taking the Prednisone I had been taking that did not seem to work for four days and to take the Antibiotics for ten days. They did not give me any creams or ointments to put on my face and said they were working from the inside.

Turns out the Hospital office building only has a Dermatologist on Tuesdays and the Nurse at their office would not give me an Emergency appointment. I called my PCP to get a referral and was told I had to go in to see the PCP to get one and this would take too long.

In the end I went through the yellow pages and found a Dermatologist that charged $135 and could see me at 3:30 that afternoon. Driving to Rite Aid for the Rx was hard to do with my swollen eyes tearing up, so we headed to the Dermatologist in a taxi during a rainstorm to get some care - this the day after being at the Emergency Room for over six hours.

This Dermatologist told me to start back on the Prednisone and stop the Antibiotics and to put ointment on my face twice a day. I am happy to report that by Thursday my face was clear and has continued to be that way. I did not have to pay $95 for a follow-up visit with the Dermatologist on Friday, but will be making an appointment soon to keep the eczema under control before an emergency arises.

On Tuesday morning we had a power outage at 4 AM from the overnight rainstorm. With my skin starting to mend I did not want to suffer without ventilation in my house. I have air conditioning in the bedroom plus a ceiling fan and fans throughout the house. We ended up staying at a Super 8 Motel overnight that had ample Air conditioning, as well as cable Television for the kids, microwave and refrigerator. I had such a pleasant sleeping experience in that cold room I am sure it helped in the healing process.

My Insurance plan does not have a nurse hotline. As a home health care worker for the State my plan includes only County Hospitals. I was tempted to call the Blue Cross Hotline from my previous Insurance plan, or to contact the hotline for my kids insurance. Instead I perused over the Insurance Handbook and went directly to the plan for assistance in determining whether my situation was an Emergency.

I encourage people to read over your plan and familiarize yourself with Urgent and Emergency Care steps so you will be able to obtain the proper care for when a situation mounts. I had not contemplated an Emergency Room visit until the cashier at Walgreen's mentioned she had done the same thing. It helps to get feedback from others and take advice where you least expect it.

1 comment:

Stacy said...

Your post is surprisingly calm ----- good for you. If I'd had that experience, I'd be writings in CAPS with lots of !!!!!

I'm thinking this is just more evidence that the American healthcare system isn't working.

Hope you're feeling better.