7.30 p.m.

Piroska celebrated her 89th birthday in July 2024, but she was remarkably active and energetic for her age. A few months later, on September 5, she was tending to her potted plants on the terrace of her son’s apartment in Buda. At 7:30 p.m. she suddenly felt a sharp, radiating pain in her back.

She was frightened because this had never happened to her before. She lived with her 67-year-old son, but he was not at home at the time. He had gone to a jazz concert at the Várkert Bazár by bicycle, but fortunately, Piroska managed to reach him. He had just passed the entrance when his phone rang. “Please come right away, I feel very ill, my back hurts so much, I’m suffocating,” the elderly woman said to her son, with fear filling her voice.

The man was alarmed and immediately sensed that something was seriously wrong, because Piroska was not one to speak idly. If she said she felt ill, then she really was ill. Leaving his bike behind, he got into a taxi so he could get home to his mother as quickly as possible.

On the way, he called the ambulance. Agitated, he told them in short sentences that his mother was “feeling unwell,” that her “back hurt,” and that she was “suffocating.”

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After calling her son, Piroska called an old friend too who used to work as a nurse.

“I can’t breathe, I’ve never had pain like this before, even though I’ve given birth to two children. Come help me, because I’m dying,” she said, frightened on the phone. At that point, she was still sitting on the terrace because the pain had completely drained her strength and she was unable to go inside the apartment.

Her friend had no doubt that something was seriously wrong. She called Piroska’s son, and they agreed to meet at the hospital.

Piroska’s son arrived home around 8:00 p.m. His mother was close to fainting, sweating profusely. She said that she felt a radiating pain in her back and chest. She was also burping frequently, but this was a recurring, unpleasant symptom for her, for which she took antacids. She was moaning loudly, which frightened her son, as he had never seen his mother in such a state before.

When the ambulance arrived, Piroska told them about her symptoms: suffocation, sharp, radiating back pain, and chest pressure. “We’re taking your mother to the hospital,” said one of the paramedics. Piroska was placed in a wheelchair in the back of the ambulance. Her son sat next to her and tried to reassure his mother that they would soon arrive at the hospital, where she would be treated.

The paramedics filled out the case report and chest pain was written as the referral diagnosis.

8:30 p.m.

The emergency room at Szent Imre Hospital was only a few hundred meters away from Piroska’s home, so the ambulance got there quickly. Although she was in a lot of pain, the woman calmed down somewhat because she felt that she was getting help quickly and her son was with her. Szent Imre is one of the largest and most modern hospitals in the country. Piroska was confident that she was in good hands.

Piroska’s son’s emergency call to the National Ambulance Service – Source: Direkt36

Her friend arrived at the emergency room around 8:30 p.m. She went over to Piroska and gently touched her face, which was covered in sweat. She saw fear of death in her eyes. Piroska’s friend was terrified; she had never seen Piroska like this before.

They had known each other for twenty years. They were introduced by one of Piroska’s neighbors. Although Piroska was 21 years older than her, they had a close friendship. They were both from Transylvania and quickly found common interests.

Before retiring, Piroska worked as an elementary school teacher. She and her friend often went out for coffee, to pastry shops, and to the theater. Piroska paid special attention to her appearance and pretty clothes on these occasions, spending a long time getting ready before they left. She would put on her pearl necklace and hat, and joked that as she got older, she had to spend more and more time preparing.

However, she did not need any help and, apart from her rheumatism, she had no chronic illnesses. A month before she was admitted to the hospital, she was still walking around without any problems, going to restaurants, and eagerly awaiting the upcoming birth of her great-grandchild. She made sure to keep her mind sharp: she was cultured, loved to read, often did crossword puzzles, drew, or tended to her flowers.

She also crocheted. Her friend’s grandchildren received handmade figures from her, which they keep under their pillows. She said she “crocheted love into them.”

Piroska’s crochet figures made for Easter. The photo was taken in 2021 – Photo: Family photo / Direkt36

8:46 p.m.

Piroska’s hopes quickly vanished after arriving at the hospital. She had a series of upsetting experiences after being wheeled through the emergency entrance into the waiting room of the emergency department in Building A.

A young hospital worker greeted her with the words, “There are no beds available here,” and Piroska could not get a wheelchair or a stretcher because “they are for other purposes.” The bright red, uncomfortable plastic chairs in the emergency room were all occupied by patients. It was difficult to move around in the crowded space. There was an oppressive silence, broken only by Piroska’s voice. “Oh, I’m suffocating, oh, I can’t breathe,” she cried out loud, and another patient gave her their seat.

Ten to twenty minutes after her arrival, at around 8:45 p.m., Piroska was called into the examination room, where her friend accompanied her. Here, the hospital staff performed the so-called triage, during which they decide how urgent the treatment of patients is, depending on their condition.

The triage was performed by two young nurses wearing white uniforms in a bright blue-painted room filled with papers. Piroska was seated on a chair in the cramped room, with her friend standing next to her. The two men did not introduce themselves. One of them performed the examination, while the other recorded the results. Piroska and her friend explained that the elderly woman was experiencing severe, radiating back pain, chest pressure, and fear of death.

However, the nurse recording the results did not enter some of these symptoms into the hospital system, while considering it important to note the burping twice. On the triage sheet, she wrote in dry, concise medical terms: “Since 7:00 p.m., stabbing pain in the shoulder blade area, radiating to both shoulders. It started while sweeping. Meanwhile, burping began. No dyspnea. Stomach tightness.”

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Dyspnea means shortness of breath or difficulty breathing. The handwritten paper states that Piroska did not have this symptom, even though she explicitly indicated that she was suffocating. Chest pain was not recorded on the triage sheet either, even though it was indicated as a referral diagnosis on Piroska’s case sheet, and Piroska also told the nurses that she felt pressure in her chest.

The elderly woman sat hunched over in her chair, sweating and becoming increasingly pale. She mentioned to the nurses that she sometimes had problems with her gallbladder, and the nurse was inclined to believe that this could be the cause of her pain. “It’s definitely gallbladder pain,” she said. Piroska’s friend, who was a trained nurse, was not convinced. “It’s either gallbladder or heart,” she replied, fearing that Piroska might be having a heart attack, but the hospital worker did not respond.

“It would be good to do an ECG,” Piroska suggested, as this device can quickly detect a heart attack.

“I know what would be good,” replied the man. He also refused to give the woman painkillers, despite her requests. “You should have taken that at home,” he said.

Piroska and her friend were completely stunned. They were not prepared for this insensitive behavior.

The nurses measured Piroska’s blood pressure and took a blood sample. They did not perform an ECG, a test that measures the electrical activity of the heart. An ECG can detect a heart attack in a matter of minutes, while blood test results can take up to an hour, even in urgent cases.

A heart attack occurs when part of the heart muscle does not receive enough blood, which can cause chest pain, shortness of breath, high pulse, stomach pain, panic attacks, and pain in the neck, back, shoulders, or arms. These symptoms can occur in any combination and may differ between women and men.

According to a previous publication by Semmelweis University, women often experience “atypical heart attack symptoms” and do not necessarily experience severe chest pain in all cases. Therefore, it is advisable to perform an ECG even in cases of atypical symptoms. In addition, blood tests also help to detect heart attacks, as high levels of troponin in the blood indicate damage to the heart muscle.

Public health websites emphasize that the longer it takes to restore blood flow, the greater the damage to the heart muscle, which can be fatal.

It is difficult to say how seriously the hospital staff performing the triage took the possibility of a heart attack, but Piroska’s hospital records confirm that no ECG was performed:

Detail from one of Piroska’s examination documents. The ECG examination is not marked – Source: Direkt36

The nurse concluded the examination by saying that they had to wait for the blood test results and that it would likely take “6-8 hours before it was her turn.” He said that Piroska would not see a doctor until then. On the triage sheet, he checked the box indicating that it was a “less urgent” case.

“You can’t be serious!” Piroska’s friend was outraged. She wanted to be polite, but she couldn’t control herself. Instead of responding, the man put the patient’s papers on the farthest shelf on the top shelf. The friend was shocked by this dramatic gesture. They left the examination room devastated. Piroska felt humiliated and had to continue to struggle with her increasingly severe pain without treatment.

9:38 p.m.

Piroska’s son did not witness any of this. Leaving his mother in the care of Piroska’s friend, he hurried from the hospital to his car, quickly picked up his bicycle, which he had left in front of the Várkert Bazár, and then drove to the hospital so that he could take her home when she was discharged. He returned to find the two women sitting in the waiting room, confused and discouraged.

He felt helpless, seeing that his mother was still in pain and afraid, and yet she had not received prompt assistance. The two of them had always been close.

Piroska, who came from Transylvania, was born in a small village, attended a strict Catholic girls’ school, and later graduated from teachers college. The slender woman with thick brown hair married at the age of 19 and had two children, a son and a daughter, who currently live in the countryside. Her son played ice hockey, skated, and skied as a child, and he has never lost his love of sports. Piroska moved to Hungary in the early 1990s to be closer to her children. Her grandchildren were also born here, and it was very important to her to be close to her family.

Piroska and her son had been living together again since 2015. Although her mother was completely independent, her son still felt it was his duty to take care of her. There was no tension in their shared household, and they got along well in the man’s spacious, three-bedroom, second-floor apartment. The economist and IT specialist always traveled a lot and worked hard, so even the forced confinement caused by the coronavirus pandemic did not strain their relationship. They often planned activities together, attended the Bartók Festival, and frequently went for walks in Normafa or had coffee in the city center.

Piroska’s son realised that despite his efforts, he could not help his mother this time. Together with his mother’s friend, they tried to get further tests or medical help for Piroska, but they were unsuccessful.

The assistants sitting by the window opposite the waiting room chairs kept repeating that the patient had to “wait her turn.”

According to the hospital’s guidelines, the average waiting time at the Szent Imre emergency room is six to eight hours, but in some cases it can be as long as twelve hours. They also point out that patients are treated in order of the urgency of their condition. As we wrote earlier, the department is struggling with a severe shortage of staff, and the employees are overworked. Several hospital employees told Direkt36 that it is common for 20-25 inpatients to wait at the same time in the emergency department because there are not enough beds in other departments to treat them.

“Patients are lying on spare beds of the spare beds,” said a doctor familiar with the emergency department’s operations. In addition, several doctors resigned recently from the department, so internists are trying to fill the gaps. This overload and shortage of specialists means that there is less time and attention to examine each patient. The waiting room was full that evening when Piroska was admitted to the department.

The woman’s pain did not ease. She was paralyzed by the hostile atmosphere and the thought that she had to wait up to six hours to see a doctor. She became increasingly frightened. Her son was no longer sure that his mother would survive the night if she stayed there. He asked one of the hospital staff if it was possible to transfer Piroska to another hospital by ambulance. He was told that it is not possible, because the ambulance brought her here according to her place of residence and she would not be accepted elsewhere.

Piroska became increasingly desperate. “Take me home, I don’t want to die here, I can’t wait any longer,” she begged her son. Her friend tried to convince her to stay a little longer, in case she would be treated before the estimated six to eight hours, but the woman was adamant.

Piroska’s friend told the staff at the administration desk window that they wanted to leave. No one tried to stop them. The nurse said that Piroska had to go and sign a paper stating that she was leaving at her own risk. The woman, who by then had almost no strength left, clung to the chairs to get to the window to sign the paper.

Her son also felt that they were wasting time at the hospital. He thought that as soon as they got home, they would ask for help from a private emergency service. There are several such providers in Budapest, and the man had heard that they promise quick help precisely because the waiting times at public emergency services are very long. Piroska had a list of various medical phone numbers at home that could be called in case of an emergency.

The man hurried to fetch a wheelchair. Piroska left the waiting room, holding onto the backs of chairs, her friend supporting her by the shoulders. Near the exit, the woman tried to hold onto a heater, but then she collapsed and fell onto it. Her friend reached under her from behind, caught her, and then shouted for help. A man dressed in white and a man dressed in green hospital gowns walked past them, their arms linked. “You shouldn’t go home!” one of the men said to Piroska. The men then walked past them.

At half past nine, they left the hospital at their own responsibility.

11:42 p.m.

After returning home from the hospital, Piroska went to bed. Her friend sat down on the edge of the bed, while her son began making phone calls. He tried to arrange private care for his mother. Among others, he called Swiss Clinic, a private healthcare provider, who replied that due to the heavy workload of the public emergency services, they also had a lot to do, so they would definitely not be able to come before seven in the morning. Another provider ended the conversation with a similar explanation.

The general overload of Hungarian emergency departments has long been a problem. According to the Hungarian Medical Chamber’s survey in 2017, there was a shortage of approximately 460 suitably qualified doctors in emergency departments across the country. According to Tamás Svéd, secretary general of the chamber, no similar survey has been conducted since then, and there are currently no official statistics available to the public on exactly how many more doctors are needed in this field in Hungary.

According to Svéd, a contributing factor to the overload of hospital emergency departments is the gradual downsizing of other departments in hospitals. The reason for this is a shortage of specialists: fewer doctors and specialist staff can treat fewer patients, so the number of inpatient beds is being reduced. As a result, some of the patients arriving at the emergency department cannot be transferred to the relevant departments. The problem may be further deepened by the debts of hospitals. Due to these debts, there are not enough resources to replace equipment or purchase new devices that would allow patients to be examined faster.

The 7 a.m. appointment promised by private providers seemed impossibly far for Piroska’s son. He kept calling services desperately.

Twenty minutes before midnight, Piroska went to the bathroom. When she came out, she was even weaker than before. She sat down on the edge of the bed, put her hand on her heart and her eyes rolled back. Piroska’s friend shouted to her son from the room: “Come, she’s getting worse!” The friend performed CPR on the woman on the bed while her son called the ambulance again.

A young woman’s voice answered the phone. Piroska’s son told the emergency dispatcher in a flustered voice that his mother was unconscious, unresponsive, and that “either they come quickly or it will be too late.” Piroska’s friend then took over the conversation, and the woman on the other end of the line helped her with the resuscitation and reassured her that the ambulance was on its way. “Hang in there a little longer,” she said, promising to stay on the line until the professionals arrived. “Her lips are turning white,” Piroska’s friend replied desperately.

At 11:55 p.m., the paramedics arrived in about ten minutes. They walked up to the second floor. A female doctor and two male paramedics laid Piroska on the living room floor and tried to resuscitate her with a machine for another half hour. Her son couldn’t bear to watch and went into his room. He knew it was too late.

Piroska died 28 minutes after midnight.

Piroska tends to her flowers on her terrace. The photo was taken in July 2024 – Source: Family photo / Direkt36

00:31

A few minutes after the paramedics pronounced Piroska dead, her son’s phone rang. He answered it, and a man’s voice said he was calling from Szent Imre Hospital because the blood test results were in. He did not introduce himself, just like no one else at Szent Imre Hospital had done throughout the evening.

“Bring her back, she’s had a serious heart attack.”

“It’s too late.”

“Oops,” said the voice, and hung up the phone.

Epilogue

The family and friends cannot accept the woman’s death without questions. They do not understand why the paramedics and hospital nurses did not record all of Piroska’s symptoms, such as the suffocation, which they mentioned several times. They feel that her terrible pain was not taken seriously, and they do not understand why the medical staff always highlighted the burping in the documents. According to a publication in a medical journal, this symptom can also indicate heart problems. They also do not understand why an ECG test was not performed. There are also contradictions in the hospital records, as “chest pain” was listed as the referral diagnosis, but the hospital worker performing the triage did not write this down.

Piroska’s son turned to a lawyer and requested his mother’s documentation from the hospital. In response, he received a dry, legalistic letter from the director explaining the official procedure for requesting data. “No condolences, no apology, no promise that they would investigate what happened,” Piroska’s son said.

In early March 2025, he filed a complaint with the National Center for Public Health and Pharmacy (NCPHP) requesting that the authority investigate whether the hospital had been negligent. The man’s lawyer expects that after the NCPHP’s investigation, a decision may be made that could form the basis for a successful lawsuit. However, the NCPHP has extended the deadline for the investigation four times so far. The last deadline was November 21, 2025. The NCPHP did not meet this deadline either. Since then, the authority has simply disappeared and has not sent any more responses. In January 2026, the lawyer sent a reminder to the authority, but they have not received a response since then.

The NCPHP did not respond to Direkt36’s questions either. However, the South Buda Center Hospital – Szent Imre University Teaching Hospital had already provided information about the case to the NCPHP on June 12, 2025. The hospital wrote to Direkt36 that their “investigation found no professional negligence in connection with the case.” Piroska’s son was not informed of this.

The hospital did not respond to our detailed questions about Piroska’s care.

In its response to Direkt36, the Ministry of the Interior wrote that several developments in recent years have aimed to improve emergency care, which, thanks to these, has “become significantly stronger and faster. Today, every patient in Hungary receives professional care appropriate to their condition,” the Ministry of the Interior stated, but did not answer most of our questions.

In response to Direkt36’s inquiry, the National Ambulance Service replied that “based on the information received when the first ambulance call was received, no acute life-threatening situation was identified.” They also stated that the ambulance transferred the patient to the emergency department of Szent Imre Hospital within an hour of the emergency call. After the second emergency call, an ambulance was dispatched, and the ambulance crew “attempted to save the patient with advanced life support measures, unfortunately without success.”

Swiss Clinic confirmed Piroska’s son’s call, but declined to comment the article. We also sent questions to the National Hospital Directorate, but did not receive a response.

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In addition to the legal proceedings, Piroska’s son tried to settle his mother’s affairs after her death. He donated some of her clothes and rearranged the living room. However, he left Piroska’s room almost untouched.

Above her beige upholstered bed hangs a small wooden crucifix wrapped in a rosary, and on the shelf hangs the old copper key to their house in Transylvania. Next to the door of her room stands her antique wooden toolbox, in which she kept needles, buttons, scissors, and various materials. Above it hangs an old, faded family photo taken at the beginning of the last century. Piroska wrote the names of her family members in handwriting on the back of the photo.

The man also sent a letter to the family doctor, thanking him for taking care of Piroska’s health for many years. He informed him that her mother had died.

“I read your letter with deep sadness! I did not expect this, we did not expect this. […] This is an unexpected death, she had no known chronic illness that would explain this death,” replied the doctor.

The woman’s loved ones have been wondering ever since what they could have done differently. The friend still feels guilty about what happened. “How could I have done more? I couldn’t save Piroska.”

Her son has similar thoughts. “If I could turn back time, I would do things differently. I wouldn’t have followed the rules, I would have taken her to another hospital’s emergency room,” says the man, who himself is seeing a psychologist to help him cope with his grief. “You prepare yourself for your parents to grow old, but they didn’t even give her a chance to survive, and that’s the hardest thing for me to come to terms with.”

Piroska’s hats still hang on the coat rack today – Photo: Kamilla Marton / Direkt36