Three days and three nights in the emergency room of the Hospital del Mar: incommunicado and patients in the corridor

BarcelonaIt was almost nine at night and at the emergency admissions desk of the Hospital del Mar in Barcelona, two people were attending to the patients arriving. There was a third desk, but it was closed because the worker there was chatting quietly with two other colleagues. Perhaps they were talking about work, but the feeling that they were ignoring those of us waiting was exasperating: if you go to the emergency room, it's precisely because you need someone to attend to you urgently. I had the misfortune of having to go there last Friday to accompany my partner.

"Speak up, I can't hear you," said the person who finally attended to us, with contempt, after asking what was wrong. At the admissions desk, a glass safety screen separates the patient from the person attending to them, so you have to speak in a slightly raised tone for them to hear you. I suppose if you've broken your leg, you don't have any problem shouting if necessary. But if you go to the emergency room for a delicate issue, it's not pleasant for everyone in the queue to find out. My partner was going for internal bleeding.

I must say, however, that to my surprise, they let us in quickly. It's also true that there were few patients in the waiting room. Perhaps because it was Friday night and, with the weekend about to start, people only go to the emergency room if they are frankly seriously ill.

In the triage room, two nurses asked us a few questions and then continued talking about their own things as if we weren't there. In this case, they were talking about work: they were complaining about the computer system. The next step was to take us to a cubicle, that is, a cubicle with Formica walls and a door, where there was a bed, a chair, a sink, and a vital signs monitoring machine. The first thing the doctor who attended us did was apologize: they were updating the computer system that day and couldn't access patients' medical records. Fortunately, we had the report of a medical test performed two days earlier, which helped to make a possible diagnosis.

The subsequent action was quick and efficient. Or at least that's how it seemed to me: they examined my partner, took her blood pressure, gave her an electrocardiogram and a blood test, asked her to sign a consent for a possible blood transfusion, and told her she would have to spend the night in the emergency room with serum and medication, connected to a vital signs monitoring machine. At that moment, all our ghosts appeared. It's incredible how life can change in an instant. My confusion grew even more when I tried to call and send WhatsApp messages to report what was happening, and I couldn't because there was almost no signal. The emergency room of the Hospital del Mar is in a basement.

No beds available

The next day, the doctor who had attended us the previous day was no longer there, and the new doctor who examined my partner said she had to be admitted to the hospital, but that it was not possible at the moment because there were no beds available, nor did he expect any to be soon, as patients are not usually discharged on weekends and, consequently, no beds are left free.

So we had to continue in an emergency cubicle which, as the hours passed, became increasingly claustrophobic: without windows and almost cut off from communication. Sources from Hospital del Mar have acknowledged that there are "coverage limitations" in the emergency service and that "an attempt has been made to resolve this by installing antennas to ensure signal strength, but it cannot be guaranteed that all telephone companies can offer a normal service". Later we realized there was free wifi, but our discovery soon turned into disappointment when we found that the internet connection only lasted a few minutes, and once it expired, it was impossible to reconnect.

All in all, we could consider ourselves privileged. Many of the emergency patients were not even in a cubicle, but were being treated in a corridor, where gurneys followed one after another with an identification number. Others were directly in wheelchairs, parked in front of the nursing station or anywhere else where there was a little space. On Saturday night, peculiar patients arrived: a man who had ingested a hallucinogenic cookie, a homeless person who smelled intensely, or a son who was shouting at his mother in a bad way: "Shut up, mom, don't be annoying, don't complain anymore, we already know you're suffocating".

On Sunday morning, after two nights and a day in the emergency room, two stretcher bearers burst into our cubicle and, without saying anything, also banished us to the corridor. "Ma'am, the cubicle must be kept free in case someone needs the machine. If you have any complaints, speak to the coordinator," one replied to my protest about our sudden demotion. Afterwards, I realized that what I thought was going from bad to worse was actually an improvement: if they moved my partner to the corridor, it meant she was improving because they no longer needed to monitor her vital signs.

Despite this, during the days I was in the emergency room, I saw patients in the hallway connected to a machine or who were relieving themselves in bed with a flat urinal, behind a small screen; a doctor who, in front of everyone, asked an adolescent about her possible sexual relations; and auxiliaries and stretcher bearers who laughed or talked animatedly about the last football match, oblivious to the patients they had a few meters away. When you called them, however, they responded quickly. Some showed great dedication. Others could work there like anywhere else.

Sources from the Hospital del Mar have argued that “situations can occur where the arrival of patients exceeds the capacity of the cubicles in the emergency department”. They also justify that, “like the rest of Barcelona's hospitals”, they register “a sustained increase” in patients, which was 3% in the last twelve months, and that during recent weeks it has grown even more with users suffering from chronic lung diseases. “To cope with this increase in activity, the Hospital del Mar centers have reinforced their hospitalization capacity with a total of 52 beds”, they add.

New computer system

Perhaps it was a coincidence, but during the three days and three nights we were in the emergency room, there were always patients in the hallway. We ourselves were there for two days and one night. Also, during all this time, my partner's medication was never administered at the time set by the doctor, but much later, and on one occasion it wasn't given at all. The healthcare staff justified it by the complications of the new computer system. The last night, the doctor ordered total fasting. Despite this, the next morning a nursing assistant showed up with a tray of breakfast. The confusion was also attributed to the software update.

“It is not an update, but rather a large-scale technological transformation process, which will allow for more specialized, integrated tools adapted to the current needs of healthcare. The Catalan Health Service supports the process and also finances it”, hospital sources have clarified. However, they admitted that in the first few days “incidents and operational adjustments have occurred” because “the implementation is a process of high complexity”, which has been “prepared over the last year” and thus “users have been informed”.

On Monday afternoon, fortunately, my partner was finally discharged, after a minor procedure. Upon leaving, at the admissions desk, I then saw a sign that I hadn't noticed upon arrival, which read: “Hello! We are updating the computer system to offer you better care. This improvement may cause some delays in service during these days. More information at the QR code.” I scanned the QR code, but I didn't get any more information. There was no signal.