"So, who hit you?”

I wouldn’t have expected less from my primary care doc, Herbert Brennan, as I removed a bloody wad of tissues from my nose. A sense of humor goes a long way when dealing with a medical issue.

 I hadn’t planned on seeing Hub, but when my nose started bleeding for the third day, I texted. He responded and soon after Heather from his office called and asked if I could come in.

I felt somewhat silly because the bleeding had stopped. This wasn’t a life threating situation.  What would he do, look inside my nostril, tell me there was signs of bleeding and warn me not to blow my nose?

When I pulled off the highway, it started up again splattering on the steering wheel before I could reach the towel I’d brought along. Well, now I felt better for inconveniencing him.

Hub has a way of explaining what your body is doing. Using the paper covering the examining table, during annual checkups he’d draw backbone discs to illustrate when compressed how they can pinch nerves to produce pain in the legs, arms and neck. On Thursday he held up three fingers to represent the blood vessels in each nostril, naming each. His plan was to identify the ruptured vessel and cauterize it. The tricky part was finding it in all the blood.

“I’m an optimist,” he declared extracting the swab at the end of a thin stick from my nose, “I think we’ve got it.” Heather who helped with the procedure smiled. They dabbed blood from my nose as well as black globs caused by the silver nitrate used to cauterize the vessel.  After a 15-minute observation, I was set to go. If the bleeding returned, Hub said I should go to the Kent ER where they would insert a plug in my left nostril.

I didn’t get far before the steady dripping returned. I drove straight to the ER at Kent.

The nurse in charge took one look, pointed me to a chair and handed me a towel. She buzzed off on another mission and returned shortly to take down my information and affix a green clip to my nose. I was then taken through a set of doors and directed to a cubical with a view. An elderly woman, accompanied by her son, was shone to the adjoining cubicle. One nurse, assessing her condition, asked if it was day or night and a series of benign questions. Rachael nailed them all and then started chattering how she happened to fall. She blamed it on the TV stand.

“Mom, it wasn’t the stand.” She insisted that was the problem she wanted to get a new one.  Meanwhile, Dr. Diane Reali Marini, who had assessed my situation and would return, arranged for Rachael to have a cat scan.

Mike explained, Rachael said she didn’t care for cats. They laughed.

Hospital emergency rooms have a reputation for interminable waits. Kent’s reputation isn’t the best and as we reported in an interview with Kent CEO Dr. Paari Gopalakrishnan last May almost 2 percent of people reporting to the emergency room were leaving without being treated. Gopalakrishnan targeted reducing stays at the hospital so as to open up rooms and deal more efficiently with the influx of patients.

Here was an opportunity to view first-hand how the ER system operates. From the vantage of my cubicle (triage #1), with three walls and draw curtain, which was left open, and comfortable seat, I got a glimpse of some of the pesky issues staff face such as finding the printer where they sent a document to be printed. Evidently, protocols have changed creating some confusion. Traffic was minimal. A pair of Warwick EMTs, with a patient lying flat on a stretcher, wheeled into a cubical. There wasn’t a sense of emergency although there were periodic intercom calls for doctors to report to rooms. I didn’t get the impression people were taking their time. Nurses crisscrossed the hall. Nobody was idly waiting. It was 11:45 a.m.

Dr. Reali Marini returned with what appeared to be a long narrow syringe. She called it a “balloon” that would be inserted in my nostril and inflated to stop the bleeding. I was told not to try to remove it and to have my primary care doc or the ER take it out in two days. She ably inserted and inflated the balloon. The procedure couldn’t have taken more than a minute. My nose expanded. I was ready for the circus. It was 12:15.

I was directed to a hallway waiting area, which the nurses call the PIP, where Dr. Reali Marini would come and check on me. Soon I was joined by Mike and his mother.

“It’s not Mallet, like a hammer, it’s Mallette. It’s French,” he said to the nurse taking down information. Now I had an idea of who my companions were, family members of former City Tax Assessor Ken Mallette. Indeed, that is the case: Mike and Ken are brothers.

Rachael, who was sporting a shiner from her fall, filled in some more family details. Rachael was escorted for her cat scan. Mike and I turned to our cell phones to check messages.  Nobody else showed up at the PIP.

Jennifer, who I learned is a traveling nurse and dreams of going to Hawaii, took my blood pressure and disappeared. Dr. Reali Marini returned to report I would be discharged shortly. Rachael returned from her cat scan. Mike told her not to get her hopes up; they could be waiting for hours. Rachel was silent for a moment until Mike turned to his phone to display a huge 88 on the screen.

“That’s how hot it is outside,” he said turning to his mother.

“They ought to open a window and let some of that in here. It’s freezing.”

“Mom, hospitals are always cold.” Rachel didn’t argue.

The nursing traffic didn’t stop. All of it seemed to be purposeful. There was no eye contact, it was as if the PIP crowd – well, all three of us – weren’t there. Then, to my surprise, a nurse stopped and handed me a box of tissues and a container to put them after swabbing my oozing nose. Up until then, I had been using paper towels from the bathroom on the other side of the corridor. Five minutes later a man pushing a cart filled with linens handed me a face cloth that worked even better. It was 2 p.m.

Dr. Reali Marini checked on me again. This time she had a strip of tape to adhere the tube from my nose to the side of my face. She said I would be discharged shortly. She delivered the same news to Mike and Rachel. Mike was skeptical.

Then Jennifer showed up for another blood pressure test. It must have been my fifth since arriving.

“So, is it good?”

She seemed to question whether to tell me then said softly “high.” Maybe that’s what this was all about, ensuring the patient was ready to be discharged. But why not just say that?

Finally I was released at 3 p.m.

On Saturday I was back to have the balloon removed. I joined ten people in the waiting room. To my surprise they called my name in five minutes. I was shown to a chair across from my earlier cubicle. I was outfitted with a bib and in no time, I was breathing easily.

I was told to go to the PIP.

“What does that stand for?

No one had an answer and some guesses were thrown around. 

I knew exactly where to go. I found a seat. A nurse soon called me aside to go through some paperwork and had me sign a document. It was efficient. I returned to my seat in PIP to get another blood pressure test and was handed clips to use on my nose should the bleed return. The doc who removed the balloon was back to check on me. I was free to go.

I told her I had the definition for PIP: patients in purgatory.

She laughed. But I tell you, it felt like heaven leaving the emergency room.