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Mikko’s story – In the emergency room with stomach pains

A fictional story of Mikko, who seeks treatment at the emergency department due to stomach pains.

Mikko gets out of bed. His stomach has begun to hurt during the night, and he cannot help it getting worse. Self-care medications has been no help and he is starting to feel awful. Mikko calls the 24-hour medical helpline and is instructed to go to the emergency room to be examined.

Mikko parks at the hospital’s parking area and enters the emergency department. The registration machine fortuitously provides him with the queue number 112. When sitting down, Mikko sees the numbers up on the board shift. “Five people before me”, he thinks.

Mikko looks around. The emergency department looks busy, but the queue to the assessment of the need for care is progressing steadily. Luckily his stomach pains seem to subside somewhat for the moment. The number 112 comes up on the board and Mikko gets up. At the door of the reception room, a registered nurse in blue scrubs, seemingly in a good mood, meets him. “Hello, I’m Seija, a nurse. Please step right in!” she tells Mikko. Mikko sits down on the chair in the room. The nurse asks Mikko to fill her in with details on his stomach pain, asks questions about his stomach function and urinary situation, as well as if any chronic illnesses, medications, or allergies are a factor. Mikko tries to detail his condition as well as possible. “Have you had any symptoms apart from pain, for instance fever, vomiting, or diarrhoea?” asks Seija. After the interview, Seija says his symptoms and condition do require some medical tests to be done at the emergency department. Mikko gets officially taken in by the hospital and his contact information is updated. A patient bracelet with his name and personal identity code is put around his wrist. The nurse makes sure Mikko is good to wait for his turn seated and directs him to the adjacent waiting hall.

Your condition seems to be stable right now and you are not in intense pain. You can calmly wait for us to get started on your treatment. Please let us know at once if you start to feel worse or the pains wells back up”, says the registered nurse.

Examinations and procedures

People walk back and forth along the hallway. A moment later, Mikko gets called in again. This time, a different registered nurse, who says her name is Sanna, asks him to join her in the examination room. “Please sit down, You can hang your jacket up there”, says Sanna, pointing to a hook on the wall. Sanna asks Mikko some questions about his stomach pain and his medical history. After the interview, she measures Mikko’s blood pressure, pulse, and temperature. Sanna asks Mikko to lie down and strip down to his waist for an electrocardiogram. Nothing alarming turns up in the measurements.

Do you need a painkiller? It may take a moment before the doctor can see you”, says Sanna.

" Right now it feels I don’t", says Mikko, because his pain is not that intense at that moment. Sanna reminds Mikko he can always ask for medication later if the situation changes. “Please don’t eat or drink anything before the physician sees you”, says Sanna, and gives Mikko instructions to get to the laboratory for a blood test and a urine sample.

Mikko follows the signposts to the laboratory. There is no queue there, and after a moment of waiting, he is called to the testing room. The test administrator directs him to sit down in the chair and places a pillow under his arm to support the correct position. His sleeve is rolled up and the skin in his elbow fold cleaned with a wipe. Mikko is scared. The last time he had blood work done, it took several tries to get a good sample, and he hates being poked with needles. However, the lab tech’s calm demeanour helps Mikko relax as well. It only takes one sting to get a good sample. After also providing a urine sample per his instructions, Mikko returns to the emergency department’s waiting hall.

To pass the time, he leafs through a magazine. A child can be heard crying at a distance. The old man sitting next to him keeps sighing, his eyes closed and his head propped up against the wall. A moment later, Sanna walks through the waiting room, stopping to chat with the old man: “How do you feel? You look exhausted.” Soon, Sanna and the man leave the hall to get him to an observation room situated some doors away.

Mikko feels his stomach pain flaring up again and looks at his watch. The laboratory technician told him the answers would be done in a few hours. Only one hour has passed. He flags down a passing registered nurse. “Hey, I was asked to tell a nurse if I get worse. I’m in a lot of pain again”, says Mikko, wincing. The registered nurse asks him to follow and points him to a vacant bed. The nurse makes sure he has no allergies to medication and hurries towards the office. The returning nurse brings some pain medication, also telling him the results are not ready yet. Mikko takes the medicine and is happy to be allowed to wait in the bed. The nurse measures his blood pressure and pulse.

Your numbers look fine, do not worry. The queue should be moving a bit faster now. We had a busy spell here because there was an accident on the motorway, but things seem to be calming right down again”, says the nurse.

Mikko closes his eyes for a moment and dozes off. He wakes up to someone calling his name. “Hello, Mikko. My name is Jani, I’m the doctor on call”, says a physician in a white coat. He asks Mikko to accompany him to a reception room further down the hallway. Mikko remembers seeing a poster asking people to not shake hands to keep viruses from spreading. He sits down at a chair in the reception office. Jani asks him to talk about his symptoms and asks some more specific questions. Next, Jani asks Mikko to lie down on the examination table and presses down on his stomach. After examining Mikko for a time, the physician says his inflammation markers are elevated. In order to discover the reason for his stomach pains, an ultrasound study needs to be conducted on an urgent basis. Mikko says his stomach pains have been getting worse and he has not been able to eat since yesterday.

Let’s get you on IV rehydration. I will ask Sanna to give you more pain medication. That is going to help. We’ll continue once you have been to the ultrasound”, says Jani.

Waiting and waiting some more

Mikko returns to his bed and lies down. After a moment, Sanna returns to prepare him for rehydration and more pain medication. Mikko bravely keeps his arm stiff and still as Sanna places a venous cannula in the back of his hand. Luckily that procedure is short. Sanna measures his blood pressure and pulse again and administers pain medication through the cannula. Mikko looks up to his bedside. As a clear liquid drips down into the hoses, he feels a little better. “I hope I get to have that ultrasound soon”, he thinks.

After a wait that seemed very long, a patient transportation orderly shows up to transport Mikko for his ultrasound study. The study is conducted at the imaging department. The radiologist runs the ultrasound device over Mikko’s stomach in a dimly lit room, talking quietly in terms Mikko does not really understand. After the study, he his transported back to the emergency department.

As patients in the observation room come and go, Sanna and other registered nurses peek through the curtains from time to time, asking about Mikko’s and the other patients’ condition. From the corridor outside, Jani’s voice can be heard summoning yet another patient. Sanna arrives to swap out Mikko’s fluid bag for a new one, and Mikko wakes up enough to look at his watch. He has now spent hours in the emergency department. This seems like a long time, and he mentions this to Sanna.

The wait must seem long, I’m sure. But quite a few tests and examinations have been done and your condition has been and is being monitored. Have the painkillers and the IV fluid been of help?” asks Sanna.

Mikko says he is feeling better already. “The radiology people have been busy, but I should think their report will be done soon. Have just a little more patience”, says Sanna before leaving to tend to another patient.

A reason for the symptoms is found

After a wait that seemed like an eternity, Jani arrives to share the results of the ultrasound study. The radiologist has found signs of diverticulitis, an inflammation of bulging pouches in Mikko’s colon. This also explains his elevated inflammation markers. However, the inflammation is not severe, and Mikko can be discharged. At this point, a course of oral antibiotics and pain medication will be a sufficient treatment. Jani hands Mikko a stack of papers, wishes him well, and reminds him that he must seek further treatment if his condition does not improve in a few days with the prescribed medication. Sanna arrives to remove the cannula and makes sure Mikko has understood the self-care instructions.

An e-prescription has been filed for your medication, so you can pick them up at any pharmacy. If you feel worse again, contact us. You can, for instance, call the same medical helpline you called before coming out here”, says Sanna.

Mikko heads out of the emergency department, happy it only took one visit to get to the bottom of his stomach issues. If there’s something he’d change about his visit to the emergency room, it would be not needing to wait so long. “I took four hours in the emergency department, not for nothing, but it felt like watching a pot that never boils”, thinks Mikko as he heads back to his car.

Updated 1.5.2021