Listening to our patients: The sounds of an emergency department

The emergency department (ED) is a cacophony of sounds. We have ringing phones, overhead announcements, bleeping monitors, alarms, blaring televisions and people talking. Sometimes folks are yelling. We have babies crying and patients retching. Those of us who work in this chaotic setting learn to tune out the noise. Occasionally, we miss an alarm or a signal of importance. When we want to finish a task or enter a note into the electronic record, we need to concentrate.

I recall one particular afternoon when the din of the ED was pierced by one plaintive sound: sobbing.

The buzz abruptly ceased. Heads turned to that side of the room. What was going on? This was not an infant or toddler. Was a patient in need? The heartbreaking wail came from an area away from the patient treatment area. Even the most cynical among us could not ignore that sound.

A cry for help

One of the nurses was taking a history from the wife of Mr. Caputo, who had just been placed into one of the beds in the ED. The husband was being treated for esophageal cancer and was unable to take or keep down any food or fluids. He was in distress, in pain and, understandably, miserable. His fight against cancer was sidelined by the strenuous task of just trying to survive. Mrs. Caputo, for that moment, allowed all the sadness, frustration and helplessness she felt for her husband and herself to erupt in a torrent of very loud and public bawling.

Esophageal cancer and cancers in general are diagnoses that the team in the ED do not normally treat. We do, however, treat people who are in pain, experiencing shortness of breath and suffering from dehydration due to their underlying cancer. When the symptoms of cancer and dehydration become so strong, the patient and their family can lose all hope and endure overwhelming feelings of defeat and sadness. We have remedies that address the secondary symptoms that the gentleman was facing. The team moved to start intravenous fluids. I ordered medications to relieve his pain.

Managing a full caseload

Some lives begin in the ED and some lives end there. We try to do our best to ease the pain and comfort the families. Unfortunately, the comforting part can get sidelined or minimized when the department gets busy, and families are placed into waiting areas or parking lots. Sometimes stewarding a patient and their family near the end of life is the most humane approach we can take. We do what we can do for our patients and their families.

Often, physicians and nurses in the emergency department suffer because we personalize our patient’s illness by believing we are responsible or to blame for some outcome we cannot change. We question and criticize ourselves for not doing enough. Sometimes, all we can do is provide a sandwich, a warm blanket, a chair or a kind word.

On this particular afternoon, I had a full board of patients. The department was filled with all the usual folks getting treated for coughs, abdominal pain and injuries. The activity of the staff and the buzz level quickly returned to the usual volume. I arranged for Mr. Caputo to get admitted and we were waiting for a bed to be assigned so he could be transferred out of the ED.

Before the end of my shift, I intended to circle around to Mr. Caputo’s room to see how he was doing and to say goodbye. Before I got a chance, my attention was drawn once again to another loud sound coming from that very same area. The heads of the technicians, nurses and physicians turned almost in unison to the piercing sound. Above the abrupt silence of the busy ED, the noise came directly from Mr. Caputo’s room, which had its curtain drawn open.

Sounds of joy

I saw Mrs. Caputo sitting by her husband’s side with her head tilted backwards. This time, I heard rare and magical bursts of laughter coming from them both. Mr. Caputo’s condition had improved, he was feeling better, and he was chatting with his wife when something in the conversation made them both erupt in laughter.

It’s a joy when the buzz of our busy emergency department is interrupted by the sweet peals of hearty belly laughs.

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