The Cat 4s

By Genevieve Yates

Winning entry into the national “Are you a Scribe?” competition, run by Medical Observer, published on 6th December, 2013.

Perched on a somewhat precarious looking stool, she surveys the waiting room, her domain, rattling off the platitudes she spews out countless times a shift to those who dare approach her…

“We’re very busy at the moment.”

“Patients are seen on a priority needs basis.”

“The doctors will see you when they can.  They are tied up with seriously ill patients.”

“Perhaps you’d like to go home and see your GP in the morning.”

It takes a special type of person to be a triage nurse, without a doubt.  A nightclub bouncer of the hospital world sans the steroid induced musculature.  A human shield, protecting the emergency department’s precious doctors from stampedes of the mad, the bad and the slightly unwell.  Sorting, prioritising, gatekeeping.  There has to be an element of enjoying the power… just look at her slightly bored and rather haughty expression, her air of superiority.  Just like the last one.  Is it part of their training or a job prerequisite?  Chicken or the egg?

I reach the front of the queue.  Her ID badge reads “Darna”.

“What brings you here today?”

“I have a headache.  It came on suddenly about three hours ago.  Never had anything like it.  Really sharp pain.”

“Does it feel like a migraine?”

“Wouldn’t know, never had a migraine.”

“How bad on a scale of one to ten?”

“Seven.  I took two Panadeine but they didn’t help.”

“Any fever?  Flu-like symptoms?  Vomiting?”

“No.”

“OK, take a seat.  There’ll be a bit of a wait.”

She types her verdict.  I sneak a look at the screen.

“Headache.  ?Drug seeking.  Cat 4.”

The feeling of déjà vu is almost overpowering.  Same emergency department six months ago, except it was “Tanya” not “Darna”.  Identical symptoms presented, almost identical questions asked, no examination performed, same conclusion reached…

“Headache.  ?Drug seeking.  Cat 4.”

We waited six hours on these same hard plastic chairs bolted to the lino floor, my wife increasingly distressed with the worsening pain in her head.  It comes back to me almost involuntarily…

“How long will it be?”

“I can’t say.  We’re very busy.”

“But my wife’s pain is getting worse.  She needs to see a doctor.  She needs something for the pain.”

“You must be patient sir.”

“You’ve let in eight people in the past fifteen minutes and we were here before all of them.”

“They have more serious ailments than a headache.  Category 2s and 3s.  You’re a Category 4.  People are seen in order of priority, not arrival.”

How long am I going to stay here today?  It will be on my terms this time.  The knowledge fills me with calm.  I won’t rush it.  The system deserves a second chance.  I can afford to bide my time, stretch out my legs, calmly inhale the antiseptic-laden air, soak up the ambiance.

I glance around at my Cat 4 companions, an eclectic mix of vulnerable human beings: an exhausted mother with a coughing infant, a young man holding a blood stained teatowel against his lacerated forehead, a middle aged woman with an icepack on her ankle, four family members each holding ice cream containers and looking green around the gills, a dishevelled man of indeterminate age pacing up and down and muttering about the listening devices the aliens implanted in his brain.

Strangers find themselves waiting together in so many different situations: waiting for a plane at the airport, waiting for the gates to open at the football, waiting for a restaurant table on a Saturday night.  Lumping an often disparate group for a common purpose inevitably creates a camaraderie of sorts.

Nowhere else, however, has the same mix of desperation and exhaustion that pervades the atmosphere of the hospital waiting room.  In a place where everyone is suffering and no one wants to be, good manners, patience and cheerfulness can prove elusive for many.

The latest arrival, a teenaged girl sporting peer-group-appropriate body piercings and tattoos, is a case in point.  After trying in vain to convince nurse Darna that her needs are “super urgent”, she stomps towards us, colliding with a frail octogenarian clutching a wheelie walker on her way.

“Hey, watch where we’re you’re going.  You could have hurt my baby…. I’m pregnant you know.”

Arthritic hands trembling and struggling to catch her breath the elderly woman replies, “Oh I’m sorry.  I didn’t see you there.”

“Maybe you should get your eyes tested.”

Despite wanting to keep a low profile, I cannot help but jump up to assist the poor old dear.  The teen sits in my vacated seat and proceeds to subject us to her inane chatter.  I can’t work out whether she is brazenly narcissistic or just ignorant and self absorbed.

“This sucks.  I’ve got, like, the sorest throat ever and a really, really bad cough… oh and my nose is running, like, heaps.  The man at the chemist said I couldn’t have any, like, cough syrup or cold and flu tablets ‘cause I’m pregnant.  How unfair is that! So I’ve come here to get some antibiotics from a doctor but that Nazi bitch nurse said I’m wasting everyone’s time.  She told me I should, like, go home and see my doctor in the morning.  How am I supposed to get any sleep when I’m, like, so sick?”

“Ignore her,” I plead silently to my Cat 4 comrades. “If no one engages with her, she’ll shut herself up soon enough.”

Alas, my unspoken warnings are unheeded.  Someone asks, “How far along are you dear?”

 “Nineteen weeks,” the teen replies. She becomes animated, her cold forgotten. “I can’t believe I’m going to, like, be a Mum in just like a few months. I can’t wait to have a baby too.  All my all friends do.  We are going to have play dates and, like, babysit for each other when we want a night out.  And baby clothes are, like, so cute.  We are going to, like, dress them in matching outfits and buy them those little T-shirts with the funny messages on them.  You know, like ‘If you think I’m cute, you should see my Mum’.  It’s gonna be totally awesome. And then there’s the baby bonus.  Did you know you get, like, $5000 just to, like, have a baby?  $5000 for free!  Why wouldn’t anyone do it?

“Peter Costello has a lot to answer for,” I mutter, going against my own advice to stay quiet. 

“Who?  My boyfriend’s name is Damon.  Why do people always, like, question who my baby’s father is?  I’ve been faithful to Damon for, like, six months!  And I’ve never slept with anyone called Peter.”

It seems to me that the trouble with our society is that, by and large, the wrong people are the ones having most of the kids.  There seems to be an inverse relationship between IQ and family size.  Darwinism in reverse.  Survival of the dumbest.  Someone should put a little chlorine in the gene pool.  OK, I admit, that’s going too far.  I didn’t used to be so bitter but since I lost Emily my once half-full glass is now decidedly empty.   My optimism has been damaged beyond repair.

I’m tortured by pregnant women in particular. Emily desired nothing more in the world than to have a baby.  She wanted to start trying years ago. I put her off, convinced her to wait until ‘the time was right.’  Now the time will never be right.  She will never be a mother and I’ve been left without even a piece of the woman I love.  I’ve got no one for whom to keep Emily’s legacy alive.  Why was I so adamant that we should wait?  I don’t remember.

My eyes are drawn involuntarily to the clock on the puke-green waiting room wall.

The second hand limps around the clock face agonisingly slowly. I feel as though I am trapped in a parallel universe where time has been stretched to double.  A minute feels like two, an hour like eternity. Paradoxically, the clock is running five minutes fast, according to my watch.

We all know that long waits are to emergency departments like fees are to banking – inevitable.  There are some who accept this with a zen-like calmness.  I admire them.

Three hours.  It’s been long enough.  I sidle up to the nurse’s desk.  Darna is updating her Facebook status and barely looks up.

“We’re very busy.  Don’t know how long the wait will be.  A doctor will call you in when he can,” she drones habitually.

“Is Tanya still working on triage?”

“Which Tanya?”

“Tanya Harrison.”

“Yes, she got back from holidays last week.”

“Holidays?”

“Yeah, went to Bali.  Got a great tan and had a pretty wild time from all accounts.  You a friend of hers?”

“Not exactly.”

Darna takes a closer look at me.

“An ex eh?” She chuckles almost maliciously.  “She has plenty of those floating around.”

“No.  I was… involved… with the incident six months ago.”

“Incident?  You’ll have to be more specific.”

“The collapse and subsequent death of a thirty-two-year-old woman in this very waiting room.  On Tanya’s watch.”

“Doesn’t ring a bell.”

“Complained of a headache, waited six hours, ruptured cerebral aneurysm?”

“Oh yeah, that’s right.  I remember hearing about that.  Bit of bad luck for Tanya.”

“Bad luck?”

“Well it wasn’t her fault.  She was just following protocols.”

“Were the protocols changed?”

“I don’t think so.”

“Did the triage nurses receive extra training in assessment of headaches?”

“Wasn’t considered necessary.  Why the twenty questions?  Yes it was sad, but these things happen.  Aneurysms kill people.  It’s not Tanya’s fault.”

“The doctors said that if she had been seen earlier they could have operated and that my wife might have lived.”

“Look, I’m really sorry you’ve lost your wife.  It is tragic.  Hanging around here is not going to help though.  You need to let go, move on.”

“I can’t accept that nothing has been done about the system’s failings.  That the same thing could just as easily happen to someone else.  That my wife’s death was in vain.”

“It has nothing to do with me.  I’m just the messenger.”

“And sometimes the messenger has to be shot.  Metaphorically speaking.  To send a strong message.  To effect change.  I’m sorry Darna, but this will give you quite a headache.  Perhaps deserving of prompt assessment and some pain relief.”

Before she is able to press the panic button, I take the hammer from my backpack and deliver three short sharp blows.

Am I seeking revenge?  Perhaps.  I like to think I am trying to knock some sense into the system.  Speaking up for the Cat 4s.

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