On Pride and Prejudice in the Medical World

2:30pm, a public hospital emergency ward.

The parking lot is full, as usual, just like the emergency room itself. As the receptionist spots us, her hand immediately reaches for the box with surgical masks. Before we can say anything, we put the mandatory masks on our faces. Important, when you’re dealing with an emergency. After explaining our case, we’re told to take a seat in the waiting room, the one with the old wooden chairs, slightly crooked and kind of fitting in an already uncomfortable situation. I stare at the words on the floor, “espere seu turno”, as the hours pass by. I analyse the colour system on the wall that determines the level of urgency and the accompanying waiting time. I wonder which colour they assigned me.

Then starts the usual game in my head: Should I go to the restroom now or should I wait til later? What if they come to call me right when I’m gone? This game plays through my mind for quite some minutes, until, after 20 minutes or so, I reckon they surely won’t come in the few minutes that I’m gone.

As I see the state of the toilets, I wonder why I was told to wear a mask on my face. ‘When must have been the last time they cleaned these?’, I think to myself. The seat is kinda wet, grimy. When I turn to flush the toilet, I notice the button is broken. ‘But at least the soap dispenser is automatic.’, I think, realising a second later that the tap has a more rustic look to it.

Right when I leave the bathroom and head for waiting room 1, a nurse crosses my path. Before I can finish the thought that pops up in my head — ‘She’s not gonna…’ — I hear my name. “Uh yes, one moment!”, I stutter as I run for my stuff. Of course… I always pick the best of timing here…

The Formalities

We’re led to “Box 3”. “Animals are also put in boxes.”, I remark to my husband. I’m told to change into the hospital gown and wait. I examine the room while sitting on the bed as I feel the cold air on my exposed back. Rustic… Like the tap in the restroom.

A doctor comes to inform us about our situation. We show the blood work from the private health clinic as we feel the air change. “So you came from private health care, huh?” I wonder why that matters, considering that we just showed her that my hemoglobin levels are almost at 5. “Aren’t you the ones who were here last year and then you went with private health care?”, asks the emergency room doctor. My husband calmly explains how we found a surgeon in Madrid who can do the surgery within short notice since the situation seems to be quite urgent. “Oh, so you’re doing the surgery in the private sector in the end? Well, that’s OK with me.” I almost believe her.

Finally, we move on to the emergency at hand: The far below the safe minimum iron levels in my blood. As my surgery is around the corner, we agree that the only option is a blood transfusion. Although we have the data, including my blood type, from private clinics, I cannot escape another round of test tube tapping. The private doctor yesterday had no issues at all finding a vessel to place the needle. I barely even noticed, as she kindly asked me where I was from and how I was doing. Today is different. As I got used to in Burela, the search for a vein in my body to pinch always makes the nurses nervous. They always end up blaming my veins. So, to say I was feeling uncomfortably self-aware in that moment, would be an understatement. The search started in my left arm since my right already had a pinch mark. As I felt the nurse getting more and more nervous, I suggested trying in my hands instead — it worked quite well last time. No matter: My right arm got picked yet again. Several test tubes were drawn and the plug was left there to soon hook it up to the IV. She left. We wait.

I study the large, discoloured spot on the ceiling. They must have had humidity problems… The nurse comes back in. “This is the consent form I need you to sign. Are you able to get up?” I’m not sure why, but I flew to my feet as if someone had just pinched me. Maybe the extremely low iron in my blood had put me into animal survival mode. I quickly signed and laid back down again. She left. We waited. I observed the sober-looking cabinet with chipped paint. Rustic… The metal sliding door also looked kinda rusty… Then, another nurse entered through that same rough-looking door, wheeling in a wheelchair. “Let me take you to a more comfortable room.” It’s like she had read my thoughts. For some reason, I always struggle with wheelchairs. Perhaps handing over full control to someone — just sheepishly sitting there, waiting to see where they’ll take me — makes me feel helpless. As I was being wheeled around, it all felt like a blur to me. We stopped next to a room full of medical staff, who were actively chatting while analysing data. ‘Small children and animals are also transported around in carts like this…’

To my relief, we continued down the hallway. It felt eternal. At the end of the hallway, we turned right and entered a space with a front desk and several beds. I was placed in front of the desk. I heard my name. They were discussing my case and what they were gonna do with me. Next thing, the nurse wheeled me to a bed. I saw a woman sitting in a chair in an area hidden by another curtain next to what was now my bed. The nurse started preparing the bed, pulling back the sheets. I looked at my shoes. ‘I guess I’ll have to take off these…’ As I’m still thinking about my shoes and pants, the nurse already tells me to take them off and store them somewhere. I didn’t expect to be lying in a hospital bed, covered with sheets, and only wearing a gown and my underpants. ‘I guess I’m gonna be staying for a while…’

While I’m still trying to get used to the bed, the nurse leaves with the wheelchair. Soon another one comes, running around and speaking way faster than I can follow. She asks if I was informed that I’ll get a dose of iron and then two bags of blood. I simply stammer, “No.” To which she surprisedly exclaims, “Well, didn’t they tell you anything?!”, as she turns to my husband to ask if we understand what she’s saying. “Yes.”, I say, “I just didn’t know about the iron, only the blood.” “Yes, also iron.”, she blurts out as she continues running around, grabbing supplies left and right. For the third time in two hours, my blood pressure and temperature are measured. I already know the steps: Lift my left arm for the armband, open and close my armpit for the thermometer, and offer a finger for the heart rate meter. By now I don’t even notice the discomfort in my arm as the armband rapidly ramps up the pressure. More test tubes of blood are tapped from my right arm. “To know your blood type.” ‘I thought they’d already checked that…’ The nurse runs off with the tubes. We wait. “Couldn’t they have used the other blood for your blood type?”, my husband wonders.

Yet another nurse comes in. “It’s merienda hour!” ‘Oh… we’re gonna have a snack first and then do the IV with iron? I guess tradition goes before anything, even in the emergency ward.’ Meanwhile, I hear my neighbour behind the curtain exclaim, “I need to pee!” As one nurse goes to hand the potty to my neighbour, another comes with a serving platter with my snack: Warm milk with cookies, a sachet of instant coffee, and a packet of sugar. As I’m staring at my milk with cookies, I hear my neighbour moaning as she pushes out the pee and gases. I start to laugh. The nurse comes back because she thinks I said something. “No. I think it was over there.”, I say as I point to the curtain next to me. She thinks I’m pointing at the controls to adjust the bed. Next thing I know, she starts adjusting the bed and puts the tray with cookies and milk in front of my nose. She’s already gone before I can do or say anything. I examine my merienda as I hear my neighbour, still farting. “Do you want any cookies?”, I ask my husband. “No, thanks.” I actually never eat a snack and I limit grains, sugar, and dairy. “Do you want coffee?” “Oh, there’s coffee? I thought it was milk.” “It’s basically one big cup of milk and this coffee.”, I explain as I lift up the sachet. “Oh, instant coffee? With all the chemicals?” “The best kind.” “So, sugar to block the iron and milk to raise the estrogens?” “It’s the perfect combination to spike my blood sugar right before they give me iron…”

The Treatment

We listen to our neighbour talking to her caregivers. We wait. I stare at the milk with cookies. The merienda nurse comes back. “Oh, you didn’t eat your snack?” “No, I’m not hungry…” “Oh, ok.” She leaves with the platter. The other nurse comes running in with the iron. ‘Finally…’, I think to myself. 5pm. We’ve started with the iron treatment! Every 15 minutes or so, we repeat the same pattern: Armband, thermometer, clip on finger. Then, the doctor unexpectedly appears around the corner. “Are you doing ok?” “Yeah.” She nods and leaves as unexpectedly as she appeared. My husband goes to look for a supermarket. I kill time by writing a note with one hand on the phone, as the nurse told me the remaining iron will take about another hour. Time kinda starts feeling like a blur. I’m so glad when the nurse comes to unplug the empty iron bottle. “Now you can drink. Make sure to do it now because you’re not allowed to eat nor drink when we give you blood.” As soon as she’s removed the IV on the right and the armband on the left, I reach for the water bottle. “Can I go to the bathroom?”, I ask. “Yeah, sure, it’s over there.” I struggle to put on my shoes. As I head towards the restrooms, the nurse comes back. “Should I accompany you?” “Ummm…” “Or should we wait for him?” “Ummm…” Every time she responds faster than I can think. “Are you feeling dizzy?” “Ummm…”, I try to determine how I’m feeling. “You’re feeling dizzy. We’re going back and you can pee in the bed.” I think of my neighbour. But I’m not feeling so bad… I struggle to take off my shoes and lie back down. The nurse comes with a large, white, plastic object. She starts fiddling with the bed to adjust it to the right position. I’m wishing I had just gone to the toilet. When she’s finally satisfied with the preparation work, she takes the white object. I quickly lift my bottom and wonder how I’m supposed to position myself. She reminds me to pull down my underpants. ‘Oh right, of course…’ It feels strange and uncomfortable, lying on the plastic. She hands me a cloth, “To dry yourself.” She pulls the sheets over me, tells me to press the call button when I’m done, and leaves. I feel afraid to pee. What if I’m positioned incorrectly and I pee all over the bed? I take my chance… It feels weird that I can’t see what I’m doing and I can barely move. As I’m trying to wipe myself, I hope I don’t accidentally tip over the thing. This is so much harder than going to a toilet… I carefully put my underwear back on and gently push the object to the end of the bed, trying not to spill anything. I quickly check under the sheets. Thank God! It looks like all went well… I stare at the call button. I know the nurse is standing right beside me behind the curtain, taking care of my neighbour. I don’t want to disturb… I reach for the button but pull my hand back again. It somehow seems silly to call when I know she’s busy. I reach out again… reluctantly, I press. I wait. After some minutes, the nurse comes to pick up the big white object. Phew! That was that.

5:30pm. My husband comes back with good news: He’s got tuna empanada, mussels, arugula, and 85% dark chocolate for me! I tell him about my peeing adventure and that they will soon start the blood transfusion. The nurse comes running in with the supplies. She starts hooking up the blood bag and explains the procedure. “We’ll start very slowly because the blood is cold. You’ll notice. If you have trouble breathing or your face starts itching, you’ll tell me, ok?” I think to myself that I hope I’ll recognise the signs. We do the same riddle again: Armband, finger clip, thermometer. This will repeat itself for the coming hours. Our neighbour has fallen asleep and constantly whispers indistinguishable utterances. Maybe she’s praying? “It’s already 7pm.”, I exclaim. The next 1,5 hours feel like a blur. I try to focus on my breathing. They try to convince our neighbour behind the curtain not to pee in the bed. A woman with ulcers is brought in. I see her infected feet, red, white, unpleasant to look at. I close my eyes. My husband studies the blood bag. We’re curious how much they’re giving. “Half a liter…” That reassures us a bit since I do need to recover a lot. “It says “Santiago de Compostela”.” “Oh, Santiago? Holy blood!” We’re glad when the nurse comes running in to speed up the IV drip. “Only 10–15 minutes from now on.” That sounds like music to my ears! It’s already nearly 20:30pm. Meanwhile, I’m starting to feel the effects of the iron and the fresh blood running through my veins. Each movement feels lighter, easier. I can barely keep up with the speed at which my brain observes and processes everything. I notice every detail, every colour, every sound. It’s like I’ve come back to life. The colour has flooded back to my face, my hands, my feet; making my skin look tanned, red even. How I’m feeling could be summed up in one word: Alert.

20:40pm. The nurse comes running in with her supplies. As she starts removing the blood bag, she tells me now it’s time for my dinner as she makes a gesture of moving her hand to her mouth. I say ok, reluctantly, though I’d rather skip it and continue with the treatment. The cookies with warm milk don’t give me much hope for what’s to come. But I decide to not say anything and just embrace what’s to come. Soon, the merienda nurse comes in with a serving platter. She explains I can either sit with my legs over the edge of the bed and the table by the bedside, or in the bed with the top of the bed in an upright position and the table positioned over the bed. My brain goes into overthinking mode, trying to figure out all the pros and cons of both options while muttering unintelligible gibberish to the nurse. She explains both options again without much result. In the end, she suggests the second option. I mutter, “Yes, I think yes.” She arranges the setup for me and leaves. Meanwhile, the other nurse is also there, preparing for my second round of blood transfusions, shoving the blood pressure armband behind my pillow. I fiddle with the water bottle and cup, uncertain where to start with my dinner. As I try to position myself better, I notice how difficult it is. I’m in a kind of cavity and my lower back hurts more than I’d realised up to now. I check the note that lists today’s menu:

• Soup with pasta
• “Merluza Romana” with fresh tomato
• Yogurt

Well, that’s not so bad actually. As I start eating the soup, I notice how hungry I really am. I feel like a ravenous animal. Within minutes, I finish the soup, fish with tomato, and yogurt. My husband hands me a piece of chocolate. I feel like he’s just smuggled a forbidden good to me. I quickly devour my chocolate and try to erase all traces of having eaten it with my napkin and the water. Done. No one saw. The merienda nurse comes around the corner to pick up the platter. ‘Just in time!’, I think.

9:15pm. The nurse goes to get the second blood bag. We wait. The meal made me quite tired. I close my eyes. The nurse comes running in with the supplies. She plugs in the tube and tells me we’ll start slowly again since the blood is cold. She checks if everything is flowing well. It isn’t. She starts positioning the tube with more tape, trying different angles. Without a warning, she starts yanking on the tube. I try to ignore the pang I feel from the needle, each time she pulls. She’s not satisfied, so she runs to get more tape. For minutes she tries different combinations of tape, cotton pads, and a towel under my elbow. She twists my arm so it’s stretching down. There! Now she’s found the angle she’s looking for. She explains that she didn’t want to pinch me again, so she had to get creative with what she had. “It’s more complex than I thought…”, my husband remarks. “10–15 minutes and then we speed up the drip.” I close my eyes, glad it’s working now. To entertain myself, I analyse the tube and the IV drip mechanism. I pick a point of reference to monitor whether the blood is flowing. After some minutes, everything still seems normal, so I rest my head. The doctor comes to check on us again. “Looking good. Very soon it’ll be done!”, she says reassuringly as she gives us a friendly wink. She stands there for a few more seconds, then turns and disappears behind the curtain again. “They make very long shifts…”, I say admiringly. 10pm. We hear how the nurses are changing shifts, briefing each other on the patients. My nurse runs off.

The Surprise

As I’m discovering the new-found agility of my body — who knew I could turn my neck so far? — I find out that I can see the time on the heart monitor. During the coming hour, my eyes shift from the time display to the drops of blood falling down. The back pain increases. My limbs and head are burning from the effect of fresh blood flowing through my body. I start sweating like crazy. We struggle to fight the sleep that’s starting to creep up on us. A new nurse comes in. She needs to do the usual procedure: Armband, finger clip, thermometer. However, she seems even less familiar with it than us. The tube of the blood pressure meter gets stuck, equipment falls to the floor. She takes my temperature twice with a strange-looking thermometer. She insists on putting the finger clip on my middle finger — that’s a first… I think everyone’s glad once we’ve made it through all the steps. Soon after, the head nurse comes to check on me, looking kind of concerned. She checks my temperature while remarking, “For a moment I thought you had caught a strong fever, but that cannot be… You’ll be ok though, corazon.” We wait. And wait. Then comes the long-awaited thermometer beep: “36 degrees. All good!” We wait. I watch the drops slowly falling down. Someone vomits. “I think the new nurse was not told that she should speed up the drip.”, my husband thinks aloud. He goes to analyse the second blood bag. “Ohhh, Santiago is just the address.” “Oh. So not holy blood.”

We wait a bit more until my husband goes to ask. The new nurse seems a bit unsure but agrees to speed up the drip. “Notify me if you notice anything strange, ok?” I feel a sense of euphoria as I see the drops falling down faster. The doctor appears around the corner again. As she sees my head frantically turning from the drip to her and back again, she remarks, “Now you’re more doped than a cyclist!” She laughs. I only caught “cyclist”, so laugh sheepishly. My husband is in a better state to reply to her. I have to admit, I don’t remember much of that interaction. All I know is that one moment she was there, the next she was gone again.

10:50pm. “I think we might be done at 11!”, I exclaim in a relieved tone. “Let’s hope so!”, my husband replies. As the drops keep dropping, I see the minutes ticking away. I discover that when I move my arm, I can make the drip go faster. “Come on! Let’s go!”, I urge the drops as if they’ll listen. 23:03pm. “I think we’re done!! The drops are slowing down and I’m starting to see the air bubbles!!” It’s hard to suppress my excitement. “I’m going to the toilet.”, my husband replies. I wait. As he comes back, he informs the nurse. I can hardly contain myself, as she starts to remove the IV drip and the needle in my arm. “You can get dressed. The doctor will come to check on you. Please press here.” She closes the curtain. I try to press the cotton ball long enough to prevent bleeding, eager to start getting dressed. I lift myself out of the hole that was my home for seven hours, my back as stiff as a broom, while I quickly check if I didn’t leave any traces on the sheets. I get dressed, nearly falling over. “I think I need a walk in fresh air…”, I say as we’re tidying up the space, trying to make it look like we were never there. We wait. Minutes creep by as we pace next to the bed. The doctor appears and hands us several papers to inform us about the next steps we should take. Suddenly, I feel overcome by a deep sense of gratefulness. For the doctor and her patience, for the nurse who wheeled me in, for the nurse who spent her whole shift running around with supplies, the merienda nurse who tried to decipher my muttering, the night shift nurses who turn their routines upside down to serve others. So many people caring for us with all they can… burdened with immense pressure and responsibility. I’m called back to reality as the doctor warmly says, “I wish you all the best and that everything may go very well for you!” Deeply humbled, all I can do is nod and smile. ‘What if all this time the biggest pride and prejudice was coming from me?’, I think to myself, as I see the doctor disappear behind the curtain.