Trapped in the E.R.

Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this morning, her head hurt badly. Her mouth was dry, and when she tried to get up to go to the bathroom, she felt like she was getting faint.

She attributed all of this to drinking too much the night before—normally she has one or two drinks when she’s out with friends; last night, it was her roommate’s birthday, and she did three or four shots and had a few beers on top of that.

“The last time I had a hangover was a couple of years ago, and I think this was how I felt then,” she says. “My roommate Jackie told me to drink lots of water.”

Throughout the day, she felt too nauseous to eat or drink. When the headache didn’t go away in the afternoon, she called her mother. She doesn’t have a doctor in Boston because she doesn’t have any other medical problems and still gets her yearly check-ups over the summer when she’s back home. Her mom convinced her to go to the ER to make sure everything was OK.

Every provider who saw the Danielle knew exactly what she had: a hangover headache. She received some IV fluids and was texting away on her phone. However, her doctors were following a “pathway”, a cookbook recipe for what happens when someone comes in with a headache—they needed to “rule out” a bleeding in her brain. Danielle got ordered for a CAT scan of her head. It was negative.

This was good news—or was it? Soon, she was being told that she needed to stay for a lumbar puncture: a spinal tap. The doctors began pulling out needles to put into her back. At some point, she excused herself to go to the bathroom. That was the last time she was seen: as far as we can tell, she escaped out the window of the bathroom. She left all of her clothes and shoes, and ran out in her hospital gown.

All of us can sympathize with Danielle. She was young and scared, and she didn’t want a procedure that she didn’t really need. Instead of a rational discussion with her doctors where she could make sure her story was heard and ask about the risks and benefits of testing, Danielle felt forced into doing something she didn’t want to do. She felt trapped—literally—by the doctors and nurses, by the hospital, and by the medical system.

We do not believe such an approach is conducive to good patient care. We believe in a partnership approach where decisions are made together, not simply based on worst-case thinking or mindless adherence to a depersonalized recipe. Danielle’s story is unfortunately far too common. We hear it every day single day, and we write our book to help Danielle and patients her so that they do not have to feel trapped--but are rather empowered--to take control of their healthcare.