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Shut up and hurt 

A visit to the emergency room -- two of them

Last Friday night, I walked out of a store at Lenox Square and, my left knee -- which I'd injured seven hours earlier -- buckled. I fell this time onto my right knee, bounced onto the left one, then to my back. I emitted a wail that I'm sure nobody in the immediate area will ever forget.

I certainly won't forget the pain. It was even worse than the pain I experienced a year ago when I had emergency surgery to remove my gall bladder. Now, because I could not move and barely speak as the waves of agony swept over me, I felt like an observer of my own trauma instead of a participant. It was all completely public. I twice startled myself with my screaming, in the way I've awakened myself with my own snoring.

A Lenox Square employee and some security men floated about me, taking pictures as I lay on the floor, waiting for an ambulance. A good Samaritan stuck his shopping bag under my head, then stood upright, talking fatalistically about my knees, as if I couldn't hear. A woman knelt down and remarked that my kneecaps were dislocated. It happened to her husband during a rugby game. He'd been in monstrous pain, she said. She stared at me, then disappeared.

Finally, an ambulance arrived. You haven't lived until you've been borne on a stretcher down the second-floor corridor of Lenox Square. Faces loomed over me. The ambulance workers' radios crackled. I smelled coffee. I craved an iPod.

Soon, I was lying on a bed in the hallway of Piedmont Hospital's emergency room. Now, here's the extra-special-horrible part: I had already spent five hours in another hospital's ER after my first injury that afternoon.

During that time, nobody even looked at my knee, which I'd wrapped in an Ace bandage. I'd said repeatedly that it seemed to be dislocated and that it tended to buckle when I stood up, but the ER doctor did nothing more than stick his head in the door to tell me they'd do an X-ray. Then he had his assistant tell me I had a sprain and should stay off the injured leg as much as possible. For the searing pain: Motrin. While I waited for my partner to pick me up, a woman at the front desk told me I appeared to be in agony. "Don't you want to see a doctor?" she asked. I was too choked with pain and anger to explain that I'd already been "treated."

Now, hours after arriving at Piedmont, I lay on a bed in a semi-dark hallway. The pain was the sort that makes you want to cut yourself. Both my knees were gigantically swollen and felt like they wanted to explode. Whenever a staffer walked by, I asked if I could have something for pain. I repeatedly heard the same thing I heard last year before my gall bladder surgery: "You will have to wait until the doctor assesses you."

Apparently, treatment of pain is not much of a consideration in emergency room medicine. And, of course, you are at the mercy of the nurses. If you protest, they angrily explain that the doctor can't make an adequate assessment if you are medicated. And then they avoid you until it's time for the doctor to see you. So, as I lay on the hall bed, I listened to a doctor assure a woman that her vertigo was part of the cold she had. At Piedmont and most other hospitals now, the public treats the emergency room like a walk-in clinic. The law does not allow the hospitals to turn anyone away.

Eventually, I called my partner, whom I'd sent home, and asked him to bring me the Motrin the earlier doctor had prescribed. By this time, my pain had put me in a stupor. I thought of my mother and the prolonged drama of her dying. I listened to the continual drone of moaning around me and, when someone put a hand on me, I was surprised to realize that the crying I was hearing was my own.

It was a doctor. My anger flared immediately. As had been my experience with my gall bladder, she expressed surprise that nobody had given me something for the pain during my long wait. I replied, angrily, that this was predictable: The nurses blame the doctors and the doctors blame the nurses. She became defensive and said that my crying had caused her to pick up my chart. "I can't do anything about pain if nobody informs me," she said.

The doctor did prescribe something to ease the pain slightly, but I then watched the man on a bed in front of me go through the same drama of being refused any medication. Should I have given him the advice a doctor gave me when she referred me to the ER for my gall bladder pain?

"Ham it up," she'd told me.

Eventually, I was hospitalized and scheduled for immediate surgery to repair both knees. Once admitted, I found the staff more responsive. But generally, hospital people need twice the sensitivity training they receive in listening to patients talk about their pain.

Cliff Bostock holds a Ph.D. in depth psychology.

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