Jewish World Review Feb. 12, 2003/ 10 Adar I, 5763
An interminable night in the ER as seen through the eyes of a terminal optimist
http://www.NewsAndOpinion.com | I have met the patron saint of the half-full glass. Actually, I've known her most of my life as she became my mother when I was 5. In a world defined by narcissism, victims, whiners and crybabies, SJ is beacon of selflessness, independence, patience and optimism.
Even at age 76, which she turns today, dealing with cancer and recently shed of one breast as well as miscellaneous lymph nodes. Even, too, with a painful, chronic, post-operative infection that sent her to a hospital emergency room two weeks ago for the sort of experience that would have sent less saintly sorts into a homicidal rage - and possibly a "Today" show appearance - and which sheds light on the catastrophe that is our nation's health-care system.
It was late Friday afternoon of course, when all infections seem to perk up and doctors vanish into weekend twilight. The doctor on call promised to see her right away at the hospital emergency room, saying he probably would admit her.
Arrival time: 3:45 p.m. By 7 p.m., the waiting room had filled with a smorgasbord of humanity. A large extended family seemed to be holding a reunion while the family patriarch lay dying beyond a curtain in the next room. Next to SJ sat a woman who also seemed to be dying. Outside, a car zoomed up, someone pushed a body out of the passenger seat, and the car sped away.
SJ realized she wasn't dying, though, as a doctor's wife and stepmother to two doctors, she also understood that her infection could become life threatening if untreated. Her concerns were elsewhere, however, as she worried mostly about the children tumbling around the room missing their bedtime. It was now past 9.
Sometime around 10 p.m., after waiting almost six hours, SJ was escorted to a gurney, where she was treated to an I.V. During the next two hours, her infection got inspected, swabbed, considered and discussed. Yes, it was a whopper of an infection all right, the sort of thing one might want to keep an eye on overnight. Alas, she was told at midnight, there were no empty beds.
SJ was sent home. The doctor who had promised to meet her never materialized.
Two weeks later, the infection is still making life miserable for SJ. She's trying a new, stronger antibiotic this week. She tells the story of her visit to ER Hell as though it were not such a big thing. Except for those children staying up too late. And the woman next to her who seemed to be dying. The woman finally gave up and went home - a better place to die after all.
"I figured I was supposed to learn something from it so I've focused on that," says SJ. "I learned a little more patience and humility. And I also learned that if you ever have surgery, make sure you ask your doctor for an antibiotic to start immediately."
The half-full glass.
Here's the half-empty glass: No one should have to wait eight hours for a doctor, but thousands do every day. The crisis in our emergency rooms isn't new, but it's getting worse. A new study released Monday by the Center for Studying Health System Change (www.hschange.org) found that emergency-room overflow owing to increased demand and fewer hospital beds is putting patients at risk.
"Serious threats to patient care are emerging," said Paul B. Ginsburg, president of HSC, a nonpartisan policy research group.
The biggest problem is that more than 40 million Americans have no medical insurance and turn to the emergency room for their health care. As ER visits increase - as much as 25 percent between 1988 and 1998, according to the National Center for Health Statistics - emergency rooms are dwindling. Between 1994 and 1999, U.S. hospitals lost 500 emergency rooms. In some strained urban areas, ambulances are being diverted to other facilities because of overcrowding.
Meanwhile, the cost of keeping emergency rooms equipped, staffed and ready to roll 24/7 is astronomical. The fixed expense of treating someone with a non-emergency such as flu and a true emergency, the definition of which includes infection, is the same. Combine these high costs with increased demand aggravated by a nursing shortage and fewer beds, and you get long waits and medical care so stretched that gravely ill or injured patients are at risk.
Ginsburg suggests that the emergency room logjam needs triage and possibly "policy intervention." As an interim measure, we might try to identify and bottle whatever it is that makes SJ tick. It may not be the cure for cancer, but it might help the medicine go down.
Enjoy this writer's work? Why not sign-up for the daily JWR update. It's free. Just click here.