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Emergency room

Pixabay photo

By Daniel Dunaief

Daniel Dunaief

The pain in my abdomen climbed from a relatively mild one, which pediatrician’s offices usually represent with a slightly puzzled but still pleasant stick figure face, all the way to a 10, with a crying stick figure in extreme duress, in under five minutes.

Doubled over, I shuffled to my wife’s working station in our house and sat, uncomfortably, in a chair next to her.

She started to talk and then looked carefully at my face.

“What’s wrong?” she asked as I twisted in my seat.

“I have serious pain in my abdomen and back,” I said.

We knew what that likely meant. We’d been through this before, although last time was much more terrifying because we had no idea what was going on. Also, six years ago, the mysterious symptoms, including searing back pain, uncontrollable nausea and vomiting and extreme discomfort, appeared and disappeared. I might have had some reaction to bad food, we thought, or I might have inadvertently consumed my food kryptonite, dairy.

“It’s probably kidney stones,” my wife said, as she stood on my back to try to relieve some of the developing pain.

I twisted on the floor, hoping I wouldn’t have to go to an emergency room that was likely overwhelmed with the latest Delta variant wave of COVID-19.

I did the I’m-okay-and-can-tough-it-out-at-home-but-wait-maybe-I’m-not dance for about 10 minutes before I gave in and shuffled towards the car.

As soon as I got in the garage, I made a quick u-turn and headed to the closest bathroom, where I knelt next to the toilet and vomited.

“It’s another kidney stone,” I sighed in between heaves.

With a bucket in the backseat on the way to the hospital, I contorted my body into different positions, hoping to find one that would offer some relief. The last kidney stone episode taught me that wasn’t likely, as I did everything but stand on my head in the basement all those years ago to ease the unrelenting pain.

Fortunately, the emergency room only had two people waiting on a Friday morning. My wife spoke through a plexiglass shield with the receptionist, sharing my details while I disappeared beneath the counter into a crouched position.

The receptionist directed my wife outside until I had a room. I waited on the floor, with the same bucket at my side, for a nurse to call me.

During the 20 minute wait, the pain eased up just enough to allow me to breathe more normally and to sit on the floor. A chair was still not an option. The two other people in the waiting room were too engrossed in their phones to notice me.

Once I was in an examining room, I called my wife, whose sympathetic eyes and encouraging words eased some of my discomfort. She answered questions from the nurse as I stood on the floor and leaned the top of my body over the hospital bed as if I were praying.

The nurse promised to return with morphine. In the few minutes he was gone, I felt closer to a four on the pain scale.

I considered not taking the narcotic. The roller coaster ride along the pain pathway makes managing kidney stones, and so many other types of discomfort, difficult. Each moment of comfort is like a sliver of sunlight between heavy rain clouds.

The doctor confirmed our kidney stone diagnosis. He thought I’d pass the stone that night or the next day. I didn’t have any such luck, as I fought through symptoms for 10 days.

Finally, the obstruction exited. I was so elated that I jumped up and down in the garage with my baffled son, who was returning from an errand.

As others who have had kidney stones can attest, the experience is extraordinarily uncomfortable and painful. I feel fortunate for all the support from my wife, children, brothers, mother and friends. I can only imagine what people hundreds of years ago must have thought when these stones made their painful journey.

A view of a spine captured using the O-arm. Photo from Alexandra Zendrian

By Victoria Espinoza

Huntington Hospital has been under the leadership of Dr. Gerard Brogan for the past year, and since he assumed his post, the hospital has implemented new surgical procedures, protocols and equipment to ensure patients are offered the most advanced and effective treatment they can get.

Brogan, the executive director, first joined the team at Huntington in January 2015 but has been a resident of the town for the past 20 years.

Dr. Gerard Brogan, has been exectuive director of Huntington Hospital for about 15 months. Photo from Alexandra Zendrian
Dr. Gerard Brogan, has been exectuive director of Huntington Hospital for about 15 months. Photo from Alexandra Zendrian

“My philosophy is I want to work at a hospital where I would go as a patient or would send my family to,” Brogan said in a phone interview. “If anything happens to me in Huntington, I am coming to this ER.”

Huntington recently became the first hospital on Long Island to offer the O-arm, a surgical imaging system that generates a three-dimensional computer model of the spine. This over $1 million equipment helps doctors have a more precise view of what they are operating on during surgeries, like screwing nails into the spine.

During the operation, the neurosurgeon refers to the monitors, which provide real-time verification of the location of surgical tools and implants with submillimeter accuracy.

The first surgery using the O-arm was successfully completed at the end of March, and according to Brogan, six more successful surgeries have followed.

The executive director said this equipment ensures “the ultimate in surgical precision,” and that the use of this machinery is “an indication how cutting-edge our hospital is.”

“If you want to be a leader for excellence, you need this capability,” he said.

Dr. Robert Kerr, chief of neurosurgery at Huntington Hospital, was the first to use the O-arm.

“When you have to place a stabilizing screw into the spine and it passes within millimeters of the spinal cord, nerve root or vital arteries, there is no substitute for the kind of accuracy the O-arm provides to a neurosurgeon,” Kerr said in a statement.

Changes at the hospital are coming in even bigger packages.

A view of a spine captured using the O-arm. Photo from Alexandra Zendrian
A view of a spine captured using the O-arm. Photo from Alexandra Zendrian

The hospital is currently in the middle of creating an entirely new $43 million emergency department, which Brogan said will cut down waiting times, help diagnose patients faster and overall improve the quality of a patient’s stay while in the emergency department.

He said some of the protocol changes have already been implemented in the current emergency department, cutting down patients’ wait time by an average of 48 minutes, due to methods like including physicians when a patient is first being triaged and beginning blood work sooner, but added that he is excited to see further changes implemented.

“I think for the patients, the experience is going to be just phenomenal,” Brogan said.

Awards have followed the success of Huntington, with the hospital recently named a national 2016 Leader in LGBT Healthcare Equality by the Human Rights Campaign Foundation. The hospital is one of 11 named to this list, in the Northwell Health system. The nursing staff at the hospital also received Magnet Recognition for excellence in nursing for the past 12 years, a national recognition that less than eight percent of hospitals worldwide have earned.

“If we are going to do something [at Huntington Hospital],” Brogan said, “we do it as well, if not better, than anywhere else in the country.”

The front entrance of Huntington Hospital's new emergency department that will open in 2017. Photo by Victoria Espinoza

By Victoria Espinoza

The days of dreading the emergency room may be over come Jan. 2, 2017.

Huntington Hospital is more than one year into $43 million worth of renovations for its new emergency department, which was designed to herald in shorter wait times, a separate pediatric section, an expanded trauma center, and private rooms for all patients.

The department is expected to open the day after New Years Day next year, with all state-of-the-art equipment and protocol.

“Most of our admissions come through the ER, most of the people in the building came through the ER, so that’s your face to the community,” said Gerard X. Brogan, MD, executive director at Huntington Hospital and professor of emergency medicine at Hofstra North Shore LIJ School of Medicine.

The plan for Huntington Hospital's new emergency department, which will be more than twice the size of the current one. Photo by Victoria Espinoza
The plan for Huntington Hospital’s new emergency department. Photo by Victoria Espinoza

Brogan said the current ER sees about 51,000 patients a year, but was designed for 24,000. Coming in at around 31,000 square feet, this new facility promises to be bigger and better than anything Huntington residents have seen before, Brogan said.

“So this will be more than twice the size of the current department,” he said.

By far the most common complaint patients visiting the ER have is the wait time. And Brogan said the new layout and protocol would help cut wait time down and expedite the process of a patient being treated.

“Part of that bottleneck starts right up front. You wait to even get triaged and see a nurse,” he said. “This ER has four different triage stations, and at the time of triage there will be either a physician, a physician’s assistant or nurse practitioner there. As you’re getting triaged the workup is already starting. We’re taking blood samples, we’re deciding if you need any X-Rays.”

Brogan also said that by the time a patient is sent to the department to be treated, “your blood is already cooking in the lab, radiology is already coming to find you for an X-ray and a doctor is already started to direct your work up.”

He said the hospital’s current ER has already put this method into effect and has cut down patients’ visit by an average of 48 minutes — about one third of their stay.

“It shouldn’t be a penalty for being sick that you sit in an ER for five hours,” Brogan said.

New staff protocol should also cut down wait times. This includes a new lab testing system that has just been put into use, which brings the quickest results in the North Well health system, according to Brogan. Biofire FilmArray, a molecular multiplex assay, allows for results to be returned within an hour rather than 24 hours. This helps patients spend less time at the hospital and allow for treatment to be administered faster if necessary.

The floor to ceiling windows that will be featured in the special results waiting area in the new Huntington Hospital emergency department that will open in 2017. Photo by Victoria Espinoza
The floor to ceiling windows that will be featured in the special results waiting area in the new Huntington Hospital emergency department that will open in 2017. Photo by Victoria Espinoza

“Determining someone’s illness and beginning to treat it quickly is vital for the patient,” Gary Stone, MD, associate chair of pathology and laboratory medicine said in a statement. “This faster laboratory test will also help Huntington Hospital’s emergency department to diagnose, treat and release patients faster.”

Another way Brogan said the ER plans to keep patients happy while they wait is through additional lounge areas.

“Some tests, by their very nature, take at least 45 minutes to an hour to actually perform, so we will have a special results waiting area with comfortable recliners and floor to ceiling windows,” he said. “You’re not going to be sitting on a stretcher, you’ll be out in a lounge area, looking outside and seeing sunlight or watching the sunset.”

The layout also aims at redoing the current entrance system, he said. There will be two entrances in the new ER, one for ambulances and one for patients and families coming in. “Now, if you’re walking your kid in with a sore throat there can be an ambulance unloading right next to you,” Brogan said. “This way, we keep the dramatic traumas which might be uncomfortable to young children around the corner.”

The new department will be giving patients single rooms that measure up to 11 feet by 13 feet.

“You can close your door, and you don’t have to see or hear or smell any of the other cases going on in the emergency department.”

In terms of the ER, which is now 20 years old, Brogan said nothing has been decided yet as to what it will be used for. But some ideas, he said, included creating an advanced treatment center — which would help patients whose illnesses might’ve taken days to diagnose and treat before — be treated within several hours instead of being committed to the hospital for a few days.

The pediatric emergency department has already been renamed after New York Islanders Hall of Famer Clark Gillies, who committed to donating $2 million to the department through the Clark Gillies Foundation. Staff said they are still hoping to receive other donations to rename parts of the ER including the special results waiting area.

Although residents won’t be able to walk through the doors for another 10 months, staff is already eager to share the space.

“I think for the patients, the experience is going to be just phenomenal,” Brogan said. “You’ll have your own room, auditory and visual privacy, with all the bells and whistles, and monitors in every room outfitted for the most complex patient.”