One Long Monday Night in the Greatest Healthcare System on Earth

[frazzled]

6. Spot on: we really can't afford NOT to

Each of us probably has a story like this one, gained from painful hours in an emergency-room waiting room, surveying a sea of humanity suffering from everything from gas to gunshot wounds, the shortage of staff, the waste of resources and money.

My story was a few years ago, and took place at a prestigious big-city hospital associated with a storied university. It was several months after a bicycle accident my husband had had, sustaining a fractured shoulder, four broken ribs, a punctured lung, etc. (At that time, the police had taken him to a sleepy suburban hospital near his accident site, early on a Sunday morning, where bagel-slicing accidents were the norm for that time of the week, so he was seen promptly; their efficiency was to send him home with me several hours after doing CT-scans and X-rays, to seek out care with orthopedic and thoracic surgeons in the city. Fun!).

At any rate, he'd weathered those injuries well and seemed to be on the mend. One day he felt ill and feverish, however, and we thought he perhaps had a flu. By next morning, I noticed that the hematoma on his hip (the one thing from the accident none of the doctors had worried about initially: it would heal itself over maybe a year's time, they said) had spread all the way down his leg, which was fiery red and had grown to an enormous size. It was a Friday, and neither his primary care doctor nor orthopedic surgeon was in the office. The two conferred, however, and told him to get over to the hospital ER right away. So we did, and checked in on their new marvy computerized system, which brought up all his records and insurance info in no time; we described the injury and sat down to wait. And wait. For five hours. It was a busy place, and I'm sure our place on the triage list wasn't number one (we saw police bring in what was probably a gunshot victim, plus some other people in obvious distress), so we didn't push it. However, after seeing a later-arriving young woman who had what looked to be a paper cut from the office, who was gabbing on her phone the whole time, go in before us, we decided we better check.

This time we were a little more emphatic, and offered to pull down his pants in the crowded space to show them if they needed. That got a bit of attention, and within a half hour or so we were in. When the attending physician and nurse opened his gown to have a look, I watched as the nurse turned her face away and made a gagging sound and the doctor exclaimed: "Holy sh_t!" I was at least relieved we hadn't waited 5 1/2 hours to be told it was nothing. It was a staph infection, which of course could have killed him had it spread to his organs. They removed blood and fluid for testing and started the hospital admission procedure right away. This, of course, took more time ... on a gurney in the hallway with other very sick people on gurneys waiting for admission (the examining rooms were needed for the hordes of other people still waiting to be seen). But after seven hours total, we were finally up in a swell room in this otherwise swell hospital, hooked up to IV antibiotics, and under good nursing care. I can't even tell you what this whole episode cost: it had to have been a small fortune, but we have good insurance and had to pay next to nothing.

We've got to find a way to make sure that people—all people—have access to good medical care so that emergency rooms can operate as, well, emergency rooms, for real emergencies. Even at this, a big urban hospital will always be overstressed. But getting people access to care for chronic or low-level conditions (at lower cost) so that emergency care can operate more efficiently is not just something nice to wish for—it's a necessity, both healthwise and economically.