Italian Emergency Room (Pronto Socorso)

     May 23, 2012 This morning when I woke up I checked to see how my aunt was feeling. She said she doesn't feel the palpitations like she did last night. They had me take her manual blood pressure again this morning because my uncle wasn't able to hear it. I also had a little trouble, but for her it was a little low today. We also checked it with the automatic pressure just to double check because she needs to determine if she is able to take her diuretic pill this morning. Her heart rate is still running fast and a little faster than it was last night. If she continues to stay tachy like this for the rest of the day I think I am going to tell her she needs to go to the hospital, so that they can medicate her with some different meds, that we won't be using at the house because they need to be used in a more controlled environment. Hopefully she will not have to go, so we are hoping that she feels better. One thing I have noticed when my famiy speaks about anything having to do with anything medical I am able to understand almost everything they say. Here the general public uses medical terminology and it is not just used for those in the medical field. At home only those of us that work in the medical field communcate via medical terminiology. When we need to communicate with our patients, family,or friends we then change the vocabulary to layman terms so that it is easier for others to understand what we are talking about. I like how I do not need someone to translate all of the medical information here for me because I am able to understand most of it myself.
     By the time I was dressed and ready for the day this morning, my cousin had decided it was time for my aunt to go to the emergency room because her heart right was continuing to run high. When we got there my uncle drove us right up to the door. Roberto was already at the hospital because his wife was getting ready to deliver a baby, so he met us at the front of the emergency room. He took my aunt to 1 small window (triage) and gave them her name, birthdate, and the reason why she was there. After that she had to wait for a little bit until they called her name to the back. I found an Italian triage tag sitting at the window that they use to triage their patients and took a picture to show the difference. This obviously wasn't my aunts because her acuity was red "fast", and not "when possible". Here in the emergency room the waiting room out front is for family, and only patients are allowed to enter the double doors into the actual emergency room.When they called my aunts name my cousin called me and told me to hurry. He told me to go with my aunt, but when they got mad that I was there I would have to go out. I got a quick glimpse of how the ER was ran. To me it looked disorganized. First they have no patient identifiers they just call your name and you answer. When they opened the door to the ER there was a long hallway and on the ceiling were colored signs hanging that read Codice Verde (Code Green)

these specified the patients level of acuity. When we first walked in they had my aunt and I go into a room on the right. When we walked in there were two gurneys each with a patient on it and no curtain for privacy. We had to sit against the wall behind a patients gurney and wait for the nurse to call my aunt. I was asking my aunt questions about how things work plus I saw tons of people in white running around in white scrubs. She explained to me that everyone in white are nurses, and the people in green are the doctors. It sure felt like home for an instant listening a woman next to us probably with dementia talking to herself and yelling random things aloud. The area on the opposite side of the hallway directly across from us was another waiting room with just chairs for patients to sit and wait. At this point they still have not checked my aunts vitals. We were just told to sit in the room. Oh and here they also have morbidly obese patients like we do at home. Once they called my aunts name I walked with her into the Code Red room which is a higher acuity. I stepped back out of the way hoping they would let me stay.There was about 6 nurses in this room, and one asked another if it was ok for me to stay. The other nurse started talking to me very fast that I was only able to understand a little bit. My aunt told her I didn't understand a lot, so they asked me to go get my aunts medicine for them and then I would have to wait outside. I think if I would have understood they would have let me stay because I think she was trying to tell me I could stay in case the doctor had questions, but when my Zia Giovanna took them my aunts medications they wouldn't let her go in either. With the quick glimpse of the room that I could see in that 1 minute was a table/bed with a sheet in the center of the room, and carts and machines all around the outer walls. It looked like an operating room. Now was my time to leave.
     Like our hospitals we are not suppose to take pictures, but I put my phone on silent and snapped some quick photos when I could and as best as I could to share my experience. Hopefully my cousin or uncle will be able to get me in their again before I leave. My cousin Roberto was going  back and forth between his wife and his mom to give us information. My cousin told us we could go home and eat and then he would call us when my aunt was ready to be picked up, or if he had any information. While we were outside talking to him an ambulance came through and I saw them pull out the gurney with a normal blanket on it. I asked him if they use that same blanket for everyone and he said unless it's dirty, so they probably don't change the sheets either. I told my mom heaven forbid we need to go on  a stretcher, we are taking our own linen! Before we left my mom wanted to go visit a friend of hers who is in the hospital for a problem with her knee and whom we have not been able to see yet since we have been here.

     Walking into the patients room was crazy. I swear it is like they are living in the old days. They are definitely behind the times here. I walked into the room and there were 4 beds with 4 patients. NO curtains/patient dividers, NO doors (except the one we entered), and NO privacy! My mom's friend said at one point there were 6 patients in her room. Also when I asked her what they do when someone needs privacy she explained that here the word privacy doesn't exist. My Zia Giovanna did try to help me sneak some photos. She had me pretend I was talking on the phone instead the camera was open and as she grabbed my arm and turned me around I kept snapping pictures. Only got one or two and not as good as I would have liked, but at least it is something to prtray what I saw.
     After lunch and while we were waiting to receive information on how my aunt was doing, I was spending time with Veruska. After we picked up Karol from school and were on our way to their house Veruska saw that the Air Ambulance was getting ready to land, so she drove me all the way to the top of the hill to see it. They did not land on an actual helipad though. She explained to me that they landed on a road that was an entrance to another hospital. In order for the helicopter to land they close the gates at the entrance and exit, so that traffic can not go through. The ground ambulance met the helicopter at the top of the hill. They then transferred the patient from the helicopter to the ground ambulance, and the ground ambulance would then transport the patient to the hospital.

     My mom attempts to explain to me things going on with my aunt, but I have trouble understanding her or she doesn't know how to explain a certain word in English. When I talk to my cousin Roberto and he explains the medical things to me I understand. If I don't understand what he is saying I have him write the word down so that I can see it, and I then realize what medication he is talking about or what blood tests they were doing. After talking with my cousin I found out that they were treating my aunt with Amiodarone today to control her heart rate. They were going to let her go home, but then saw that her troponin levels came back elevated, and talked about admitting her to the hospital. They gave her medication to control these enzyme levels, and after my cousin talking to the doctor they decided that instead of her staying overnight in the hospital they would send her home, but tomorrow morning she would have to return to have her enzyme levels checked again. The EKG showed an inverted T wave and they are suspecting and MI, but they are still unsure. All of the other blood work  (CPK) came back normal, and it was just the troponin that was high. Tomorrow when she returns to the hospital if the troponin is still elevated she will be admitted to the hospital until they can get her numbers under control. Please keep my aunt in your prayers and that her heart rate and enzyme levels go down, so that she will not have to be admitted into the hospital.