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Emergency in Slow Motion

The woman in the wheelchair across the room writhed in pain, tears dripping onto her faded blue dress. Her husband wearily patted her shoulder, his face lined with worry for her.

We had come to the emergency room with my 83-year old father who had begun to have chest pains early this Saturday morning. When we arrived at 11:30 AM, there was no one at the darkened counter immediately inside the ER door. We stood there long enough to register our confusion and soon another patient pointed to the sign perched on the counter.

“Fill out the white form and turn in at the desk. Fill out the yellow form and keep with you until called.”

That seemed easy enough. But once the white form was completed, which desk?

As we walked in the direction of three computer terminals behind half-glassed counters, two of them unmanned, another helpful patient pointed to an unmarked black plastic bin. No arrow, no sign, just a bin full of white forms. After depositing our form there, we found seats amidst the crowd. Crying children, their faces flushed with fever, folks crumpled over in pain, some silent while others groaned in discomfort or agony, a room full of people in need.

We sat and waited, all eyes glued to the shiny swinging double doors that seemed to be where help lay. Everyone turned whenever anyone new came through the sliding doors, watching the confusion on each new face as they wondered how to sign in. We directed a few of these newcomers ourselves, showing them the nondescript sign and pointing out the black bin. The room slowly filled up, as very few people were being taken back to that unknown territory behind the swinging double doors. Chairs lined the walls on three sides and soon there were only single seats available here and there. There were no tables and not a scrap of reading material available anywhere in the room, only a mute television that few watched.

As my dad sat anxiously among the crowd, I was concerned that he was getting worse. I warily approached the one computer terminal that had a person at work behind it. My father is 83, has had bypass surgery already and is experiencing chest and arm pain, I explain. Maybe this is the description of a situation that is worthy of some speedy treatment? Sure enough, his white form is dug out of the pile where it has lain since we arrived and he is seen quickly. An EKG is administered and blood drawn for testing. Then, back we’re sent to that waiting room where all the same people sit, along with more new faces. No one seems to have disappeared behind the doors while we were gone.

Forty minutes later another call for my father, and we breathe a sigh of relief. Then we’re told to stay behind, he’s just going for a chest X-ray, no need to follow. He returns. More people wander in and are helped through the check-in procedure by the other patients. People sleep, trying to find a place to rest through the long afternoon. Children fuss and mothers comfort. The pay phone rings and is ignored.

The hours crawl by as I keep an eye on my father. He seems to be OK, but what do I know? His pain is lessening, he reports when we ask. One of the people behind the other computer terminal becomes extremely agitated that patients are moving “her” chairs to sit in, even though none of them have been needed for her purposes all afternoon. Nearly all the chairs designated in the waiting area for patients are taken, and people who are ill clutch the loved one who brought them. It’s understandable that they need to have them nearby, a hand to hold, a shoulder to lean on. But “her” chairs keep being confiscated for sick people, so she takes valuable time to make hand-lettered signs: "Pls. don’t move pt. ck-in chairs!”

And the hours crawl by. Twice during the long afternoon of waiting a nurse enters the fray in the waiting room to announce that they are doing the best they can. Please be patient. Nurses are also out ill, so they are short-staffed. Everyone listens, sighs, and goes back to waiting and staring at the swinging doors, hoping against hope that their name will be called the next time the doors swing. We all knew that was the path to help, the golden arches of the emergency room. Not often enough a nurse pushes the door open just enough to call a name, a lucky soul who had finally risen to the top of the list.

Finally, five and a half hours after we arrived, it was our turn. Within the hour he was admitted to the hospital on the basis of his symptoms, a night of observation and tests ahead. Help had finally arrived.

The debate about the health care system in this country rages on, with the topics of the uninsured and those who use the emergency room as their source of health care at the top of the list of those conversations. We all have our perspective and our opinions. But until we spend a day amidst the pain ourselves, the debate has no face, no soul. These people were all ill, some in extreme pain, and I saw none who were there for a cold or other minor ailment. All I know as I sat with them is that the system appears to be overwhelmed and quite broken, all humanity sucked out of the process. I have no answers but I can still see those faces in pain waiting for medical care just to take an easy breath again.

3 Responses »

  1. I experienced a very similar episode this summer with my 91 yr old mother who had fallen and had a large lump on her forehead and had obviously dislocated or broken her thumb. In addition to her age she has a pacemaker and numerous other medical problems. We waited 6 hours to be seen with no offer even of ice for her injuries. In the end the medical staff were unable to re-locate her thumb due to the amount of swelling and she required surgery and insertion of a pin a week later to take care of this. The end result was thousands of dollars charged to medicare and her insurance and a great deal of pain for herself. This doesn't even account the numerous trips to Dr offices over an hour away for her care.

  2. "Obama Care" is all about "fixing" the payment side of healthcare, not the delivery side. It doesn't matter if you have a 'plastic card" promising payment, if there is not someone willing accept it, or able to provide care. Nothing has been advanced - just some vague attempts at cost shifting, and cost (reduction)management by mandate. Nothing is better, some things are made worse.

  3. As an Emergency Department healthcare provider, it is my opinion that some abuse of the ED is taking place. Much of our country's healthcare costs are related to drug seeking behaviour as well. However, MOST of the problem is that people have no where to turn. THEY ARE SICK and need care, but do not have a provider because they don't have the money up front so they come to the ED where they are not required to pay up front. Thousands, yes, thousands of dollars in testing is completed in the ED related to the MD's concern about future lawsuits. People sometimes have illness for months, but suddenly they want to know the answer now. Of course there are serious conditions such as the one noted above that are true emergencies and require immediate attention. Many in our communities have also learned to manipulate the system by calling an ambulance or saying they have chest pain or shortness of breath to get back before others. An ED can get easily overwhelmed.
    As an ED nurse for over 20 years, I am considering changing jobs or professions. We work long hours, continue our education faithfully, and serve with dedication, many times without lunch and even putting off our personal needs to provide our patients with the highest quality of care. Granted there are "bad apples", but for the most part healthcare workers do what they do because they care!