Almost a day in the emergency room waiting for a visit and a diagnosis, which – in the end – didn't happen. It happened to an 80-year-old woman who arrived at the Santissima Trinità in Cagliari last Monday . The old woman's nightmare in her daughter's letter, written to our editorial staff, which we report in full:

«Nothing new for those who are forced to attend hospitals (against themselves). Fortunately, however, perhaps it is for others more fortunate who do not need hospitals. Monday of delirium at the Is Mirrionis emergency room . 80 year old woman , with a health problem for more than a month, treated at home without any improvement, contacts 118 on the advice of her family doctor. The ambulance arrives and after having presented the situation to the staff the woman decides not to accept the transfer to the polyclinic (whose wait according to the regional application on emergency rooms was estimated at >6 hours) and to go independently to Is Mirrionis (time waiting time 2 and a half hours). Arrives at 11.30, pre-triage with Covid swab. Negative result therefore "able" to call from triage. 12.30pm triage. After 8 hours you sit in the chairs in the waiting room and after several reminders at 8.00 pm they call us for medical advice.

Inside, a world of chaos and suffering opens up: beds and stretchers along the walls of the corridor, rooms occupied by beds, armchairs and wheelchairs on which from time to time patients are seated who have passed through the waiting room and are waiting to be visited, receive treatment, be transferred to the departments for consultations. We enter for the interview with the doctor on duty. The first part lasts about 10 minutes and includes a description of the problems and possible solutions. A few interruptions from health workers and nurses, a few phone calls, a few problems (loss of a medical record when transferring a patient from the emergency room to the ward). Then the visit is interrupted: shift change, the new doctor arrives. Other questions, some interruptions for cell phone use and consultations with health professionals and nurses. They make the patient lie down and insert the cannula into her arm for routine blood tests.

Another interruption, the technician arrives to change the non-working lamps: the medical staff goes out into the corridor, the patient remains lying down. Outside laughter, jokes, jokes without any problem, in front of patients and companions . 20 minutes later the staff returns to the clinic where the 80-year-old woman was left alone, waiting for the visit which, however, will not be carried out. After 10 minutes the patient comes out and is taken to a room where there are 8 stations including armchairs and wheelchairs. Almost all occupied. Here the painkillers are administered and you wait to be transferred to the departments for consultations, and it is here that you witness the best of the experience. Naive in thinking that the waiting room was the worst that could happen to us.

Continuous arrivals of suffering people , almost all alone , some with mental distress perhaps due to pre-existing problems, or to the state of suffering, or to age. Not very staffed and not always up to the task of managing the complexity of a place that exists as a place of pain, of illness, where whoever enters is objectively in a state of weakness. You cannot work in these places just by shielding yourself, managing other people's pain without getting hurt cannot generate indifference and superficiality. A few hours pass. Around midnight, gastroenterology consultation. Transfer by wheelchair to the upper floor of the same building. The interview with the doctor lasts a total of fifteen minutes including breaks and the time to write down what is hypothesized. No medical visits, just verbal instructions. Return to the emergency room in the treatment room.

We find the same faces and some new ones. Even in the corridor someone is new and some beds are empty. The hours are marked by a succession of disconcerting events. I have seen operators mock patients who are not completely in themselves and lucid, underestimate their discomfort to the point of repeatedly ignoring their complaints, I have seen inattention in front of patients who were trying to escape from their beds, I have seen a patient faint and fall dead weight away from the eyes of those who should have taken care of him, I saw a patient who had disappeared repeatedly being searched for when he returned from the consultation to the ward, I heard the diagnosis in the corridor "it could be pancreatitis" and after a few hours "it's not pancreatitis".

I have seen carers and sick people replace the staff and intervene to support those who are more fragile and would not have been able to counteract further difficulties (such as having a blanket, some water, a cable to recharge their mobile phone, covering them because they lack suitable clothes and are unable to to do it). I saw serious, kind, caring, understanding, friendly staff who were excessively underestimated due to the complexity of the situation. Hours pass. Around 4.30am counseling for infectious disease patients. Transfer of the patient to the ambulance, I reach the place on foot. The doctor on duty reads the documentation and listens to the problems that brought us to the hospital at 11:30 in the morning the day before. He makes hypotheses but above all he finally visits the patient. He makes her lie down on the bed and touches her, palpates her, asks, listens, suggests solutions.

After about half an hour we have to go back to the emergency room, he greets us and tells us that he will call the ambulance for the transfer. We wait, we wait, I look out into the corridor and I don't see anyone. I go to look for the staff to get news but nothing. After 50 minutes I push the wheelchair towards the lift and head towards the emergency room. It's 6, it's 17 degrees and it's cold for those of us who wear clothes suitable for 11:00 in the morning. When we arrive at the emergency room we find several new patients, someone ready to be discharged and above all the authorization to leave the place that has engulfed us for 20 hours. While they remove the cannula from the arm of the elderly woman destroyed by illness and experience and hand her the resignation paper, I go to get the car. When I return I find her outside arm in arm with a nurse who didn't want to leave her alone. We must always find beauty in experiences, even in this one there was some but really too little.

I conclude with a reflection. A civil society should be called such in that it takes care of the weakest, the sick, the elderly. Unfortunately, what I have seen is the opposite. PS. Discharge without diagnosis and without a cure, only further tests. I foresee paid visits bypassing public health. Public health is perhaps dead and not by natural death, but by private interests. The fragile will die with her."

Stefania Dessalvi

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