Leadership Lessons from the ER

This week did not go as planned.

After a fun-filled day on Monday, I was struck out of nowhere with severe stomach pain shortly after dinner.

By 10pm, there was no position, sitting, standing or lying down, that was comfortable.

Desperate to avoid a long night in the ER, I frantically googled my symptoms in search of answers.

By 2am, doubled over in pain, I had to reluctantly face facts. This might actually be an emergency.

We all know the smart move is to call an ambulance.

Paramedics can evaluate and often start treating you right on scene. They can also facilitate your entry into the hospital.

But one of the city’s top hospitals is less than 10 minutes from my house at that time of night, so my husband grabbed his car keys and we raced over.

Leadership Lesson #1: Constantly Evaluate your Priorities

We’ve all spent miserable nights in a packed emergency room.

Hospitals operate on a strict triage system and, like a local news channel, if it bleeds, it leads. Those of us with less dramatic or non-life-threatening conditions must sit and wait.

But North York General, one of the busiest hospitals in the city, has adopted a smart new approach to triage.

As soon as you arrive in Emergency, patients are immediately assessed and dispatched to one of several zones in the hospital.

Red Zone for Urgent/Critical cases, Yellow Zone for serious issues that may not require hospitalization and another zone (Blue?) for less critical/time sensitive conditions.

Within five minutes of walking in the door, I had been assessed, admitted and sent directly to the Yellow Zone.

Once you’re in the Yellow Zone, you’re no longer competing with Red Zone cases. You’re now triaged against other Yellow Zone patients.

Given the severity of my symptoms, I rose quickly on the priority list.

The issue seemed to be gastro, but a wide range of conditions… gallstones, kidney stones, pancreatitis, diverticulitis, appendicitis and even ovarian cysts share very similar symptoms. They definitely needed more data.

My bloodwork and a physical exam led the first doctor to suspect appendicitis.

But they’d need some imaging to confirm that diagnosis. I was told that a CT scan would not be available until 8am and we’d just have to sit and wait until then.

With a double dose of pain killers barely making a dent in my pain, I knew it would be a long five hours.

Leadership Lesson #2: Don’t Assume the Worst

Knowing the intense burden that the pandemic has placed on our already over-worked and underpaid healthcare teams, I anticipated short-staffing, minimal service and an atmosphere of palpable burnout.

That is NOT what I experienced.

To a person, every single staffer I encountered that night was personable, patient and attentive.

I realize that privileged white women often receive better service than others, but let me clarify that I was NOT there in executive mode that evening, with a designer handbag and a mild case of strep throat.

Nope. I was UGLY sick. Projectile vomiting. Racing to the washroom, puking in my own mask, sick. A total nightmare.

I share those personal, humiliating details reluctantly.

Because even though they had to discreetly page Housekeeping every time I emerged from projectile vomiting in the washroom, I was treated with nothing but courtesy, care and respect.

Leadership Lesson #3: Over-Communicate in a Crisis

After I had my CT scan, I was told it might be an hour before a doctor would be back to share the findings.

In spite of being given two IV bags of morphine, I was in tremendous pain and projectile vomiting a single ice chip.

I sat there in agony, dreading what I might hear.

While we waited, I noticed that routine medical updates were being delivered by the doctors in the waiting lounge itself.

Those who were being called into a small side room down the hall were clearly receiving more sensitive or “bad news” updates. I saw several patients emerge from that room looking visibly upset.

I told myself that if a doctor came out to the lounge to share my findings, it couldn’t be all that bad. But if they called me over to that side room and pulled the curtain, I should probably brace myself for worse news.

When my time finally came, we were asked to follow a nurse down a hallway, past the “bad news” room and through a whole new set of doors. I was led into a new waiting area and told the doctor would be by “shortly” to speak to us there.

As we waited, I looked around at my new surroundings.

My heart sank when I noticed… I was now sitting in the Red Zone. 

That can’t be good.

We sat there for 45 minutes, waiting for a doctor to appear with a Red Zone update.

That may’ve been the longest 45 minutes of my life. 

I’m not sure the hospital fully considered what message is sent to a patient when you escalate them into the Red Zone. To then make them wait 45 minutes for any information whatsoever seems like cruel and unusual punishment.

Note to NYGH… You’re doing so many things right. But may I respectfully suggest that you don’t escalate a patient into the Red Zone emergency room until a doctor is actually available to speak with them.

When the doctor finally arrived, I was prepared for the worst.

What I wasn’t prepared for was the doctor introducing himself as a Surgeon.

This new surgeon informed me that the CT scan did not reveal a tumour, mass, cyst, or even a ruptured appendix.

What it showed was a complete twist in my small bowel.

Somehow my small bowel had managed to wind around itself that evening and was now totally blocked.

Which explained the stomach pain. And all the vomiting.

As I struggled to take this in, he explained that I needed emergency surgery immediately to untwist my bowel.

Leadership Lesson #4: Always Have a Plan

He then walked me through the surgery plan.

He would first attempt to resolve the situation laparoscopically… which would involve three small incisions in my abdomen.

If that didn’t work, he’d have to make a call right there in the operating room to cut me open, pull out my small bowel and untwist it directly.

After carefully explaining all of the potential risks, he asked if he had my permission to book the ER and proceed with the surgery.

I looked him in the eye and asked him pointedly if he felt confident that he could successfully perform this surgery.

With not even a hint of bravado, he assured me that he did.

So, I gave him the go-ahead to book the ER and prep me for major surgery in the next half hour.

This was happening.


To be continued…