6 Days Surviving in the Emergency Department

Our child was too unsafe to transport ourselves to Seattle Children’s Hospital so we decided to take him to the local Emergency Department where they could arrange for transport. This was part of his emergency plan developed by the doctors and therapists 3 weeks prior when he had previously been admitted to Seattle Children’s PBM (Pediatric Behavioral Medicine Unit) – Take him to the nearest ED if he is stable enough for us to do so, or Call 911 or the King County Crisis Line if he is not.

We arrived at our local ED on a Saturday afternoon. When they talk about Emergency Departments in this country being overcrowded they aren’t kidding. The ED was overcrowded to the point where beds line the hallways within the ED and recliners line the halls outside of the ED. We spent the first 24 hours in a hallway surrounded by adult psych patients.

I have a lot of compassion for people who experience mental illness, I experience mental illness myself, but this was an inappropriate setting for a child of 11. Patients were screaming about wanting to have bombs removed from their body, devils attacking them and much more. There was no sheltering our child from this.

We were told that the PBMU doesn’t release patients on the weekends but they should have a bed on Monday. Unfortunate but understandable. So we prepared to endure the weekend at our local ED. We were finally placed in a room which helped muffle the sounds of the other patients. Monday dawned and the PBMU said they didn’t have any beds and it was unlikely they would have any on Tuesday but Wednesday they should. Tuesday came and they said that they had a lot of releases that day and he was #1 on the admissions list and that they should definitely have a bed for him the next day (Wednesday). 6:30am the social worker came into our child’s room to tell us that no, they don’t currently have a bed but to call after 3pm. They had a couple releases today and *maybe* they might have a bed.

At this point, I’ve had it. We’ve been stuck in this ER since Saturday and it is now Wednesday. I called the PBMU myself and spoke with the admissions director. He said they had a duty of care to accept patients from their ED first. (Our local hospital had been begging them to at least transfer him to their ED which would be far more appropriate for him.) We would have to continue to wait until there was a bed available if there weren’t admissions from their own ED first. I asked how long we could be looking at. The admissions director avoided my question. I called him out on that and asked if it could be weeks. He admitted that it could be and said that we were not the only ones in this situation, that there were many others across the state that were in a similar situation.

What we didn’t know at that time and had we, we would have made different decisions, is that once in a neighborhood ED, Seattle Children’s PBMU will not accept your child until they have a bed available. Finding a bed available is problematic as they frequently fill the PBMU completely from their own ED. You are forced then, to stay at the local ED until such a time as a bed opens up and Seattle Children’s ED doesn’t have another child waiting to take it.

Because my child is under the age of 13 Seattle Children’s Hospital is the only place in the state of Washington that will admit him. There are other options once your child is 13, but until that time it’s only Seattle Children’s Hospital for us.

Our local ED, even though I’m not usually a fan, really did everything they could for our child. Their own Psychiatrist wasn’t allowed to see and treat our child because he wasn’t Pediatric Board Certified. They contacted other Child Psychiatrists, offering hospital privileges to see if they would come and see our child so we could go on to the next stage of care. Everyone turned them down.

If we had called 911 and had an ambulance come and take him to the hospital, we would have still ended up at our local ED as regulations state that they have to take the patient to the nearest ED. If we have called the King County Crisis Line to come do an assessment, their response time is two hours minimum before they can get to you. By that time my child would have broken down the door to our bedroom where his sister and I were locked in for safety, and done some real damage.

Once we had my child calmed down from his meltdown and into our own room he was pretty good. His good behavior was due to our being stuck in an ED, where in order to survive he was able to watch TV to his heart’s content. Any time he was hungry the nurses would bring him whatever he wanted to eat and as much as he wanted to eat. (They didn’t want to live with him screaming about how hungry he was.) These are the two biggest things he has meltdowns about. It really got out of hand. (When we did finally get him to the PBMU and they drew blood, they were alarmed at just how high his cholesterol had become and thought they were going to have to take him off some of his medicines. I told them to just give it a few days. It was diet-induced from him getting to eat only what he wanted and as much as he wanted, and I was right.)

On Thursday we discharged him against medical advice from the local ED and drove him to Seattle Children’s ED ourselves where he was admitted.

Why should you care about what is happening to children like mine in Washington State? Because ours is just one of many stories that are happening not just in our state, but across the country both with children and adults. We need a better system. ED’s are not equipped to deal with and service the needs of these people on an ongoing basis. We spent 6 days not getting our child the help needed because we couldn’t get to where he needed to be.

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