Tag Archives: Manchester Triage

Don’t Run with a Stick…ER in Portugal

This is a cautionary tale.  One you have heard before, but indulge me because the pay off involves a trip to a Portuguese ER and catching a liar.

Last night, Pippa was supposed to be in bed, but she asked if she could go downstairs and give her visiting grandparents one more kiss goodnight.  It seemed like a simple and sweet request, so off she went.  I remained upstairs laying out Maggie’s uniform for the next school day.  It seems I am the only member of the family that knows what school uniform is required for each day.  I digress.  Moments after descending the stairs, Pippa appears at the top of the stairs again.  She is purple.

She is desperate for air.  She can’t seem to breathe. I immediately think she is choking.  I try to assess what is happening, but it appeared extremely urgent and I didn’t know why.  I grabbed her and she started crying.  She is getting in air at least.  I asked her what happened.  She is still far too upset to speak.  After what seemed like forever, she says that something flew into her mouth.  What?  She said it felt like a knife.  For the record, knives don’t typically fly around our house.

In the process of trying to calm her and settle her labored breathing, I asked her if she could show us what flew into her mouth, since she said she spit it out.  She thought about it, all the while still crying and clutching her throat.  She took us down the stairs and reluctantly pointed to this stick.

How did a hard plastic stick that is supposed to be a tent beam for an American Girl tent end up flying into my 7 year old’s mouth?  Curious.  Pippa is clever, like freaky clever.  She has a high schoolers brain, but she is still a little girl.  She is fast on her feet and she can be a pretty deft liar. This time, she failed miserably.  She was walking with a stick on the stairs and bumped into the railing.  The stick, in her hands, got hit against the wall and thrust into her mouth with force.  This, after much prying, was the truth.

Pippa is tough.  She doesn’t cry when she cuts herself or needs to give blood at the doctors or gets stitches…she just deals.  She is extremely logical, so if you explain what is happening, she’s fine.  This time however, was different.  You could see the fear in her eyes.  She was scared.  She was in pain and she begged to go to the hospital.  I used my phone’s flashlight to look into the back of her mouth and there was a gaping hole right next to her uvula (that thing that hangs down at the back of your mouth).

There is a lot of blood and it is hard to tell what the damage is truly, plus Pippa is gagging and still clutching her throat.  Portugal has universal health care and since my priest is employed here, we are considered residents of this country and we therefore have free health care.  We had never stepped foot in a hospital or doctor’s office since our arrival here in September.  Pretty decent record.  We decided we better go.

Meanwhile, Maggie had disappeared.  She gets really anxious if anyone gets sick.  Pippa, although at times considered an annoying baby sister, is the love of Maggie’s life.  I send my priest to find Maggie.  He finds her in a ball on the bathroom floor, clutching a picture of her sister all while hysterically bawling.  She does not do well with stress.  He calms her down and we leave her with my parents as we head for the Cascais Hospital.

As we arrive at the hospital, a mere 5 minute drive from home, we see three doctors out front, stethoscopes and scrubs on, smoking cigarettes.  Not the most inspiring imagine.  You immediately have to take a number from an automated machine.  You press what your emergency is and receive your number.  We are called to the front counter.  The man can speak English, so things are good.  He makes a lame Donald Trump joke, but I laugh anyway hoping to get a priority position if I think he’s funny.

He takes our health number and sends us to the  pediatric waiting room.  Pippa is in my arms and when we get to the door to enter the guard says one parent only.  My priest sulks away to wait in the car.  As a side note, after we enter every kid has two parents but us.  He was just screwing with us because we were clearly foreign.  Not cool dude.

Next step is waiting until the triage nurse calls your number.  There are kids with puke bags everywhere and intensely crying babies.  We wait.  There is a screen overhead that gives the wait times and tells you where to go.

We get called to triage and I describe what happened.  They can clearly see that Pippa is struggling with breathing and swallowing.  They give her a yellow bracelet and the give me a pink one (this links us so no one steals my kid).  They use a system that they claim is worldwide called the Manchester Triage system.  They prioritize patients based on urgency.  You don’t even sit in the same waiting room as people who have different concerns…like all the kids puking are kept away from the kids who are not.  Pretty sweet.  I make extremely nice with the nurses.  I offer them some of my fancy scented American hand sanitizer.  They have never seen fancy hand sanitizer, it doesn’t exist here.  We are fast friends.  Pippa gets a yellow band.  High priority.  We go and sit in a special waiting room.

The most urgent band is red.  They need to be brought in by ambulance for that.  Next is orange and that seemed reserved for sick infants.  Then yellow.  Green and blue follow and they are low priority,

As we waited in the yellow waiting room, we watched the screen which told us which number was being called and what priority the number was.  I loved this system.  It made sense.  I wasn’t angry if someone was seen before us because the assessment was clear and priority was established.  In American and Canadian ER’s, I’ve been to both too many times, it seems much more random.  It might not be, but it just feels less logical.  This was clear.  People seemed calm.  Parents watched the screens  and waited.  Times were updated frequently.  When we arrived yellow bands had to wait 23 minutes, by the time we left they had to wait 29 minutes.

Pippa was called quickly.  The doctor spoke English and gave a thorough exam.  He said we may need to see an ENT and that none were there currently, but he was pretty confident in his diagnosis.  The part of her anatomy that she punctured, is very sensitive.  He said that it constricts when damaged and that accounts for the breathing difficulty.  He also then cracked a Donald Trump joke.  That seems to be a hot comedy item at Cascais Hospital.

He spent about 20 minutes with us.  He gave her prescriptions for pain and to numb the wound letting her eat easier.  I also found out that he paid only €1,000 per year for medical school ($1200).  He works 40 hours a week.  Usually one 24 hour shift.  He likes to surf and walk on the beach.  It was practically a date…remember my priest was waiting in the car.  He gave me his phone number if I had anymore questions.  I gave him some hand sanitizer.  Fast friends.  I took my patient home.

The moral of the story…never walk/run with sticks (obviously), don’t lie and say something flew into your mouth and go to a hospital in Portugal…fast efficient service with a super cool system.

In the end, I stayed up all night watching my daughter and worrying and my priest slept like a baby.  I now need coffee intravenously.