An insider's guide to a hospital stay

The emergency room

Although people sometimes use the emergency room for a routine doctor visit, it's really a place for… emergencies. If you need to go to an emergency room, you'll first be "triaged." That means that based on your symptoms or type of injury, you will be assigned to a status that will determine how quickly you are seen and treated. Chest pain, a sudden severe headache, bleeding from a wound that doesn't stop, shortness of breath: these are all emergencies, and these patients will be seen immediately for urgent evaluation. If you have a cold or a sore ankle, you'll be assigned a less urgent spot, and may wait hours before being seen. Unless it really is a true emergency, it's best to call your primary care provider first. She or he can help determine if in fact you need an emergent visit, and can call ahead and let the medical staff know that you're on your way and what's wrong. This may expedite your care.

Once you are checked in, you'll start with an assessment by a nurse, and then a medical assistant may check your blood pressure and heart rate, as well as your temperature and pain level (vital signs). You may be assessed by a physician's assistant (PA). These health care professionals will examine you and take a careful history, and will then present your situation to the emergency room attending, the senior physician in charge. He or she will likely check in with you as well, but most often, a PA or house staff (doctors in training who are often specializing in emergency medicine) will manage your care. Each person who enters your cubicle — and there may not be much privacy — should identify him/herself to you. The team will order and interpret any testing needed, treat your acute issue, and decide whether you need to be admitted or (hopefully) go home with a care plan and follow-up arranged. Never leave the emergency room unless you know exactly what to do if you feel worse or develop new symptoms.

Admission: A hospital sleep-over

If the team decides you are too ill to go home, you'll stay at the hospital (be admitted).

An ICU stay is for patients who are unstable and need to be closely monitored. ICUs are busy places. Each patient has his/her own nurse. The medical team usually includes interns, residents, and fellows (doctors who have completed residency but are getting additional training). Less-experienced physicians are carefully supervised. There may be PAs or nurse practitioners on the team, and the senior staff physician (attending) has ultimate responsibility for your care. The team may call in specialists (consultants) to help determine your diagnosis and treatment.

If you are more stable/less sick, you'll go to the floor with a similar team of health care professionals caring for you. Many hospitals have only private rooms, but not all. When you feel sick and vulnerable and are lying in a bed wearing a johnnie (hospital gown), a roommate is probably the last thing you want. You have the right to have your room be quiet, and if your roommate has visitors, they need to respect your comfort as well. Every day, you'll have a nurse who is responsible for caring for you and other patients.

Both in the ICU and on the floor, a group of doctors and nurses will likely visit you early in the morning as they make rounds, checking on each patient and planning care for that day. Again, if you have a roommate, you'll have no privacy during medical visits to your bedside. There is an unwritten code of silence, but patient confidentiality is quickly sacrificed when you're admitted.

Going home: Discharge from hospital

When you are ready to go home (be discharged), a member of the medical staff will review a care plan with you. This might include follow-up visits with your doctor or specialists, prescriptions, home care instructions, and (for some people) arrangements for a visiting nurse to help during your recovery. Don't be afraid to ask questions, no matter how small or silly they might seem. Write down the answers, or have a friend or family member write them down for you. You want to be sure you leave feeling a lot better, and empowered, than when you arrived.

Insider tips for your hospital stay

• If time and your situation allow, bring reading material, phone chargers, and a list of all your medications when you go to the emergency room.
• Make sure your primary care doctor stays informed during your stay, and gets written documentation when you are discharged.
• Ask any and all questions. Use the nurse call button if you are in pain or need anything (for example, if you're feeling worse or need help using the bathroom).
• Make sure the staff knows how to reach your family or health care proxy.
• If you don't already have a health care proxy in place, create one as soon as you finish reading this blog post. You want to have someone you trust understand your wishes for medical care should you become unable to express them yourself.
• If any member of the medical staff says something that you don't understand, ask for an explanation. It's useful to repeat back what you have heard, so that you are sure you are clear on the explanation.
• Although you sacrifice some of your own autonomy as a patient (you are vulnerable, feeling ill, lying in a bed), take what control you can. Ask each person who cares for you who he/she is, what role that person has, and to explain what is happening (for example, the purpose of any test or procedure).
• There are often services available to help you during your stay, but you need to know about them. Most hospitals have a patient-family liaison who can guide you. For example, you can request a spiritual visit, a pain consult, or a nutritionist to help with your diet. Many hospitals have social workers who can help identify resources when it's time to go home.
• Some aspects of care may not go as well as possible. Communication may be the biggest problem. Strong emotions such as fear, guilt about being sick, confusion, and anger are common. Your doctor recognizes what a tough experience this is, and it's okay to share these emotions with your treatment team. Tending to your emotional health is a part of getting well.