I recently wound up unexpectedly in the Emergency Room with a hideous stomach bug. Aside from the painful physicality of the experience, much of it was psychologically and emotionally infuriating. A shortage of beds, an undignified waiting room experience, an inadequate initial assessment, and a narrowly averted administration of the wrong drug was enough to remind even the most complacent visitor that our health care system needs a major overhaul. It also could have been a lot worse had I not spoken up for myself.
Fortuitously, this abrupt encounter with the medical system happened amidst my planning for the upcoming “Powerful Words around Health” retreat, which Women’s Voices Worldwide, Inc. is offering in partnership with Staying in Balance. The November retreat (in western Massachusetts, U.S.A.) will bring together a small group of women to find support in developing confident self-advocacy skills on their journeys to wellness. My trip to the E.R. deepened my appreciation for the importance of empowered speaking within the health care system and has compelled me to share a handful of communication strategies should you ever find yourself acutely ill or injured:
1. Bring an advocate. Having someone with you whom you trust and who has your best interests at heart is not only good for morale but increases the likelihood that your needs will be communicated to care providers. Particularly when you are consumed by pain or sickness, you are often less able to think clearly or speak up assertively. Your advocate can be your voice when you don’t have the energy or the clarity to engage.
“Excuse me! Nurse! The doctor said someone would be in soon to give my partner pain medication but we’re still waiting and she is becoming delirious. Can you send someone in right away?”
2. Pick an advocate who is confident asserting him/her/xerself. Your partner or best friend can (sometimes!) be good for morale but may not necessarily be able to advocate well. If he/she/xe is uncomfortable in hospitals, indecisive, timid, or deferential to authority, he/she/xe may not be able to take the initiative to advocate effectively. Spend time in conversation with other more assertive trusted friends, family members, neighbors, or colleagues who might agree to be “on call” should you ever need them in an emergency.
You: “Sarah, can you see what’s taking them so long with the pain medication? I don’t think I can handle this much longer.”
Sarah: “They are so busy, though, I don’t really want to bother anybody. I’m sure they’ll come as soon as they can. Besides, I don’t really see anyone near our part of the hallway. Just hang tight… I’ll hold your hand…”
Sarah: “Definitely, I’ll be right back… Okay, the nurse is heading over right now. They had lost the order.”
3. Communicate with your advocate in advance. Talk with your advocate about your history, needs, and wishes should an emergency ever arise. The more they know about your medical history, medications, and allergies the more prepared they will be to answer questions or remember important details if you aren’t able. The more they know about your preferences, the less you’ll have to expend energy to explain or argue when you’d rather be focusing on getting through the pain or discomfort. Having this history, preferences, and even a contact list with you in writing can be invaluable, especially if your preferred advocate isn’t available.
“I don’t like to be touched or talked to when I’m in pain. Just knowing you’re there is enough.”
“When I’m feeling scared, I prefer to be distracted with stories and jokes—anything to keep my mind off of what is happening.”
“If I’m ever in the E.R., will you please keep my parents and sister updated every hour or so? Here are their numbers.”
3. Ask, ask, ask for whatever you need, and don’t take “no” for an answer. Just because something (an extra blanket, anxiety medications, a bed pan, another conversation with the nurse, etc.) isn’t offered, doesn’t mean that it isn’t available or can’t be made available. The E.R. is a hectic place, and even the most well-meaning, compassionate staff will be compelled to interact briefly and cover only the most critical needs. You will get more of what you need if you proactively give voice to it. If you ask for help walking to the bathroom and the nurse has not returned in awhile, press the call button or send your advocate out to find and remind him/her/xer. It’s not pushy or rude. It’s making your needs known.
“Can someone please re-do my I.V. catheter? My arm is feeling really uncomfortable.”
4. Give unsolicited information. Doctors and nurses are usually smart and compassionate souls and they want to figure out what is wrong with us and find the best plan for healing. But they are not perfect and there is no magic formula for making a diagnosis or predicting a treatment outcome with certainty. Particularly in the fast-paced context of an E.R., the time spent in conversation is often rushed. Don’t passively assume that their list of questions will necessarily lead to the information they need to know. If you have more to share, do so. A similar discomfort last month, a strange reaction to a recent drug, a new exercise routine, a loss of appetite this morning, an undiagnosed condition in childhood, a strong intuition about the cause, may all be relevant details that could be missed by a standard check list.
“I also want to be sure you know that I have a history of anemia and I’m worried that might be exacerbating the problem. Also, I’m a competitive swimmer but I haven’t been in the water in over a week. I’m wondering if my body is reacting to the sudden change in activity level.”
5. Question everything. This isn’t about being contrary for the sake of being contrary; it’s about having an important voice in your own care. You are not expected nor required to consent to every test or treatment plan offered, though sometimes such plans will be presented as a matter of fact. It’s easy, especially if you’re feeling overwhelmed, to simply go along with it. Instead, ask for more information about the purpose of a test, the reason for a particular drug, the necessity of a specific treatment. Often, the plan will be agreeable, and with a clear understanding you can feel more informed, in control, and at peace with the process. You might very well be set at ease that a scary procedure turns out not to be so scary after all. Sometimes, the proposed plan will not be agreeable, in which case you can express your concern and talk with the doctor or nurse about a different option. The simple questions “What is this?” or “Why do I need this?” can be incredibly empowering.
A nurse comes in and asks you to hold out your arm. You ask “Why are you giving me an I.V.?… (‘To administer a drug the doctor ordered for you’)… What drug is it? (‘It’s called Zoloft’)… What does Zoloft do?… (‘It helps with the nausea’)… Oh, actually, it’s not the nausea that’s bothering me; it’s really just the pain. And I think I’m super dehydrated. If that’s the only reason to give it to me, I’d rather not take it… (‘Oh, ok, let me check back with the doctor. She may just want to give you fluids for the dehydration.’).”
Whether in the E.R. or in any situation when you could benefit from self-advocacy, remember this: You matter. What you have to say matters. You have a right to say it. You are not being rude by asserting your needs. Don’t let the fear of sounding pushy, demanding, or ungrateful (criticisms often leveled unfairly at powerful, assertive women) leave you silent. Continue to treat others with kindness and respect, and speak your mind anyway.