Adventures in Stigma in the ER
I have a mental illness. I’ve also been having a slew of physical health problems lately. Doesn’t seem that complicated, right? Well, apparently to some people, psych patients don’t have physical health problems. Essentially, once a psych patient, always a a psych patient; stigma in healthcare is alive and well.
Treatment-resistant depression has become a part of my life. Even at my best, there’s a lot of duct tape involved in holding me together, and it takes very little for that duct tape to pop open, letting all hell break loose. Experiencing stigma is certainly enough to bring out the crazy.
Over the last couple of years I’ve been having some odd physical symptoms that I assumed were psychogenic. Then I got some bloodwork done a couple of months ago that showed that I may have lupus or some other sort of autoimmune condition. I started having difficulty breathing, and it was steadily getting worse. Tests my family doctor ordered didn’t show a clear cause. One day in January I went in to see him and he decided things had gotten bad enough that he wanted me to go into emergency to get further testing done and hopefully see a specialist to figure out what was going on.
After waiting for about an hour and a half, I saw an ER doc. He asked about 5 times what the point was of my GP sending me in. He didn’t seem to listen to anything I had to say. In the end, his plan was to repeat the tests I’d already told him my GP had done, and then refer me to an outpatient clinic. Given that it was really difficult for me just being in the high stimulus emergency department, sticking around for things that had already been done didn’t seem like a very appealing. I felt totally invalidated, and that triggered the waterworks. I walked out of the ER sobbing.
Two days later, the shortness of breath was a little bit better, but I was so dizzy I could hardly walk. My blood pressure was extremely high. I really didn’t want to go back to emerg, but things were definitely not good. I knew that I was too dizzy to walk to the front of my building to catch a taxi, so that left an ambulance. I was still hesitant, so I called the provincial nurse-line to get another opinion. She said call an ambulance and go to hospital.
The paramedics came pretty quickly, and they wheeled me out on a stretcher to the ambulance. They checked my blood pressure and it was still high, but not scary high. I started freaking out. I knew with that blood pressure the ER wasn’t going to take me seriously, and they were just going say there was nothing wrong with me. I was crying and saying I didn’t want to go to hospital, that I wanted to get out of the ambulance. I knew in the back of my mind that the problem with this idea was that I’d end up sprawled on the floor in the entryway because there was no way I was going to be able to make it back to my apartment unaided. The paramedics assured me that my physical concerns definitely needed to get checked out, and eventually I agreed to go to hospital.
At the ER, the paramedics offloaded me into a chair near the triage area. I was feeling way overstimulated, but there I sat for 3 hours. Then someone asked me to follow her into a room. It turns out that she was the psych triage nurse. The ER triage nurse, who hadn’t talked to me at all, had triaged me as being there for a chief complaint of depression. Wow.
I was only minimally coherent, but said I wanted to make a complaint about the triage nurse, because this was all about stigma. The triage nurse was patronizing, a common type of microaggression identified in stigma research. She assured me that yes in fact I was there for depression, and proceeded to shoot down the physical symptoms that she didn’t believe I was having. When I accused her of stigma, she said that she couldn’t possibly have stigmatized views because she has friends with mental illness. Well award her a medal! At this point I was crying and having a hard time figuring out how to defend myself, which of course just reinforced the notion in her mind that I am “just” a psych patient.
I told her I wanted to talk to her manager. It was a weekend, so the only person available was the charge nurse. She was just as patronizing, and kept shushing me because my expletives might offend the elderly patients nearby. My parting uncreative words were “this is bullshit”, and it didn’t make for a very strong and proud departure as I slowly, dizzily stumbled my way out.
What have I learned from this experience? Stigma around mental illness is alive and well in health care, and is used to justify the attitude that psych patients don’t have medical problems. What is the consequence? I could be having a heart attack, or be highly suicidal, and there is zero chance I would voluntarily go to hospital.
I suppose I could have filed a complaint, but this is the same organization I quit working for three years ago because of workplace bullying, which they did absolutely nothing about. If complaining would bring about no result other than increasing my stress, it’s not worth it. Unfortunately, I think that’s the case for so many of us with mental illness. As individuals, people with stigmatized attitudes will find excuses not to hear our voices.
That means that we need to speak up en masse. Not about me, or about any other individual’s situation, but about the systemic problems in health care that disadvantage those of us living with a particular type of illness. We are more than psych patients, and we need to be loud enough that people can’t help but hear us.