The Benefit of the Doubt



Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.

My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.

She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.

The clerk responded,

“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”

My friend replied in a soft voice,

“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”

Tears fell softly from her face as the clerk rolled his eyes at her.

“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”

My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”

“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”

And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.

The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.

The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”

My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.

She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.

“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.

Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.

Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”

“Yes please!” said my friend, hoping that some relief was in sight.

“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.

The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.

Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.

That night, my friend did not even receive the benefit of the doubt.

Val Jones, M.D., is the President and CEO of Better Health, LLC. Most recently she was the Senior Medical Director of Revolution Health, a consumer health portal with over 120 million page views per month in its network. Prior to her work with Revolution Health, Dr. Jones served as the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal. She currently blogs at Get Better Health, where this post first appeared.