{"id":8151,"date":"2017-08-31T09:35:24","date_gmt":"2017-08-31T09:35:24","guid":{"rendered":"https:\/\/3080.pdarrington.net\/F17\/?p=8151"},"modified":"2017-08-31T10:31:16","modified_gmt":"2017-08-31T10:31:16","slug":"toulmin-argument-model","status":"publish","type":"post","link":"https:\/\/3080.pdarrington.net\/F17\/3080\/toulmin-argument-model\/","title":{"rendered":"Toulmin Argument Model"},"content":{"rendered":"

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Mr. M~, Mr. P~, and Mr. M~:<\/div>\n
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I write to report what I perceive is a serious problem with your Emergency Room services at North Hospital. What I experienced last week, up until yesterday, as I accompanied my father to your ER, is a culture toxic to the notion of \u201cexcellent care.\u201d<\/span><\/div>\n
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First let me say that I am wife to an emergency room nurse practitioner who has worked at Grady Hospital in Atlanta, Georgia for the last four years. I am sensitive to the difficult work of ER staff and I respect the detachment required of the job. I literally love ER people. Nurses surround me in my life, and I listen closely to the way they talk about their patients. I try to inject some healthy empathy when I can, when it\u2019s needed. The poor treatment my father received at your ER I recognized as a lack of empathy, perhaps even a whole culture of othering that contributed to four trips to the ER and the onset of renal failure before my father got the attention he needed.<\/div>\n
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My father, Mr D, was scheduled for vascular surgery in the heart hospital on Wednesday. I flew in from Atlanta on Tuesday to see him through the surgery. Tuesday afternoon, after a normal morning, my father went to rest in a rocking chair. I was right beside him when he experienced what was likely a grand mal seizure. My call to 911 had me giving him CPR until the paramedics came.<\/div>\n
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I followed the paramedics in my father\u2019s car to your ER. When I arrived there, the front desk staff told me frankly that he wasn\u2019t there. Something about a \u201credirect.\u201d The girl was curt, if not rude, and oblivious and\/or uncaring to my own trauma. She asked me no questions and offered no help. As I turned to leave, the older woman with her decided she could look up my father\u2019s name on the computer to see if he had been seen in the cardiac ER.<\/div>\n
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The heart hospital ER was amazing. My father\u2019s care, his surgery… I was so impressed. Within the hour I\u2019d seen a neurologist, his heart surgeon, his vascular surgeon, and the ER doc. I heard them talking with each other in the hallway. It was excellent. They kept my father. His surgery went well. Turns out he\u2019d had a 99% blockage in his carotid artery. A miracle he survived, let alone without brain damage. Post-op on Thursday they let him leave too early. He wasn\u2019t peeing much, but they let him go anyway. And that\u2019s when the trouble started.<\/div>\n
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My father was uncomfortable at home, but we\u2019d only been given instructions about how to manage the pain from the surgery, not the pain of constipation. Dad knew to expect that to some extent, so he let the pain build and build. We tried treating his constipation with over-the-counters. Nothing worked. By two am on Friday morning, I called his surgical team. The on-call doc instructed me to take my father to the ER if he was in that much pain. That was our first visit.<\/div>\n
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This is the visit I can speak to personally, because I was there. Our nurse and the doctor seemed to have decided what the problem was without even asking questions. My father was just another old man, post-op with bowels slow to wake up. They never asked him the level of his pain. They never asked him if he had peed! Or how much. These questions weren\u2019t on their radar. It\u2019s difficult for me to believe that the nurse or the doctor gave much time to his records, to the fact that he had an enlarged prostate. My father had been prescribed Norco, for instance, but he hadn\u2019t taken any because he didn\u2019t want to make his constipation worse. And we had been given absolutely no instructions about how to manage\u00a0this<\/i>\u00a0kind of pain. On the way out, our nurse would say to my father, \u201cTake a couple of Tylenol.\u201d<\/div>\n
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This is how oblivious she was. In fact she acted more like a waitress in a slow diner, nice but in a cranky-because-you-interrupted-my-peace-with-your-complaints way. She was just there to give my father a shot to \u201cawaken\u201d his bowels.\u00a0\u00a0<\/span>He was told it would take effect in about an hour, that there would be some grand explosion. While we waited for the x-ray, I had to walk my father to the restroom. He felt like he needed to go all the time of course. He was so exhausted from the pain and lack of sleep, and so was I. I\u2019m smaller than my dad, and I\u2019d just gone through the trauma of doing CPR on him. I was nervous to have him lean on me. We had to walk down the hall to the restroom. The ER wasn\u2019t busy. A gaggle of nurses and other staff chatted and joked in the workspace behind the desks. They watched me. I\u2019m sure I gave them dirty looks.<\/div>\n
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My husband and I have talked about that\u2014the need for staff to have a place to be and live during long work shifts, separate from the constant empathetic pulls of patients. I understand that it\u2019s not just being rude to laugh and joke while someone is suffering. But…clearly I needed help and my father needed help, physical help moving to the bathroom.\u00a0\u00a0<\/span>He was weak and I was weak. Your staff was tuned out. Unavailable but for the minimal attention they\u2019d pre-determined he needed.<\/div>\n
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I waited in the waiting room for about an hour, hoping my father would relieve himself; if he blew out he\u2019d be taken care of and not feel embarrassed in front of me. While I was waiting, I witnessed two young girls leave the ER. They had been waiting for care in one of the front rooms with the glass doors. What is that, triage or something? When the nurses came out to see where the girls had gone, the front desk staff proceeded in gossipy tones about the girls. The conversation was short but catty and unprofessional and certainly made me feel like I was in enemy territory. I\u2019m sure I would have left, too, had my father not been in your hands.<\/div>\n
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My father ended up returning to the ER for a total of 3 or 4 times (I think once he got there but didn\u2019t stay to be checked in). The final time, yesterday morning (Saturday) I\u2019d had enough. I called the surgical team again demanding they call the ER and have my father admitted until he could function independently and without pain. I spoke with Dr. W who voiced concern that he hadn\u2019t been contacted by the ER docs. When I heard back from Dr. W it had been determined that my father\u2019s issue involved a backed-up bladder. Your ER had totally missed it. He was going into renal failure and needed to be admitted.<\/div>\n
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As I write this, my father has been discharged. He is on his way home. His kidneys are looking good, I guess, though he\u2019ll have the catheter at home for a couple of days. He likes the urologist he saw and he\u2019s out of pain. But of course I worry about bladder infection and the pain that comes with that. Most of all I\u2019m worried that he\u2019ll have to return to your ER and deal with people who have lost all imagination for what might be going on with others, the people who come into their space for care.<\/div>\n
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I\u2019m no expert of course and cannot offer recommendations for how to address the problems that led to my father\u2019s specific misdiagnosis. Furthermore I understand to some extent that the nature of medicine, particularly in the ER, is a matter of guesswork, very educated guesswork. But I would like to suggest to you that the problems extend beyond one nurse or one doctor. Obviously this is true; my father\u2019s multiple trips to the ER likely meant he was in the care of different nurses and doctors there. The problems suggest a culture ripe for this kind of experience to happen again, if not consistently. I hope you will address the issues, particularly because I would like to rely on North without feeling anxious about it. We live in the neighborhood of North (both of my parents used to work there, actually). But right now my confidence in your ER is just about nil.<\/div>\n
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Sincerely,<\/div>\n
PDA<\/div>\n

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Mr. M~, Mr. P~, and Mr. M~: I write to report what I perceive is a serious problem with your Emergency Room services at North Hospital. What I experienced last week, up until yesterday, as I accompanied my father to your ER, is a culture toxic to the notion of \u201cexcellent care.\u201d First let me […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[1500],"tags":[1552],"class_list":["post-8151","post","type-post","status-publish","format-standard","hentry","category-1500","tag-toulmin"],"_links":{"self":[{"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/posts\/8151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/comments?post=8151"}],"version-history":[{"count":8,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/posts\/8151\/revisions"}],"predecessor-version":[{"id":8165,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/posts\/8151\/revisions\/8165"}],"wp:attachment":[{"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/media?parent=8151"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/categories?post=8151"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/3080.pdarrington.net\/F17\/wp-json\/wp\/v2\/tags?post=8151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}