April 23rd, 2019 by Galit Rudelson

It is Sunday, and I have had a very long and fun weekend. But unfortunately I got lazy this week and did not write about my time in the hospital. So I will write today about the hospital, and tomorrow about the weekend.
As I wrote last, on Monday I was in the operating room, aka the “Theater.” The rest of the week I spent in the Emergency Department. This was a big adjustment for me. When I worked at the outpatient pregnancy I learned a lot, and was curious to see the differences from how we did things. But the differences were subtle, and in the end made a minimal difference on patient care. The ER is a different story. It is run significantly differently from what I am used to, so I had an interesting time adapting to it.
Let me be clear, a true, life threatening emergency is treated the same way. Lots of people rush over, vitals are taken, labs are drawn, a story is pieced together from any family or witnesses. The differences are in the non-life threatening emergencies. As many of you know either from medicine or from personal experience, the goal of the ER in America is to get you stabilized and out as quickly as possible. If you need further medical attention you get admitted and moved into the hospital. If you do not need medical attention, you are patched up and sent home. Here that is not the case. The ER is treated almost as a mini inpatient extension of the hospital. Patients who need more tests done, wait for the tests in the ER. If you need to monitor someone for a couple of days, they also stay in the ER. I was surprised to come back day after day to find the same patients in the beds. But that is just how it is done here. It makes more sense to redistribute the work load, instead of throw it all to the medicine doctors. Although to be frank, I am not sure when things end up in the medicine wards then. Im headed there tomorrow, so Ill update after.
Also, I should mention the general flow of the ER. Once a patient arrives, the nurses do the initial assessment, and call a clinician to let them know there is a patient. The patient can be staffed with a physician assistant, deemed stable, then wait for the physician to assess again later. The physician arrives around 10am every morning and does rounds. So this means that we had a patient come in with a dislocated shoulder, and sit with her shoulder dislocated throughout the night, until the physician came. Basically if you are not actively dying, you may have to wait to see the physician for over 12 hours. And afterwards you may stay there for a couple of days for observation. This seems like Im talking negatively about their system. This is not the case. They are making do with what resources they have. There are only 2 ER physicians for the entire region. Therefore it is not possible for the ER to be staffed 24/7 by a physician that is trained to handle any incoming case.
What was the most shocking to me though, was who cares for the patients. We are all used to the nurses taking care of us when we are sick. If we cannot go to the bathroom, the nurses help. If we need help changing clothes, we expect the nurses to help. This is VERY different from the expectations here. Here it is expected for the family to do everything. To change the patient, to bathe them, to help them to the bathroom, to change diapers if necessary for the elderly. Everything must be done by the family. If a patient needs to be repositioned every 2 hours to avoid bed sores, this is communicated to the family members! Again, it seems that I am talking negatively about the system. But in reality this frees up the nurses time to do all the initial evaluations on the patients, and other things that are handled by physicians in the United States. Making do with limited resources.
Of course, there are times when family members cannot always be present. In these cases the situation became a little dicey a couple of times. I have felt vaguely at ease throughout the culture differences, but this is one time I have felt uncomfortable. I have felt the need to do some of the “family responsibilities” and have in fact done some while family was not around. I still am not sure if I overstepped boundaries. But in my opinion we are all humans, and deserve to be treated that way. So if I have the time and ability to step in and help, I will do so.
All in all, the ER was a huge learning experience for me. This week I am moving onto the general inpatient wards, and looking forward to it!