What do you mean it’s a cold? A poem…

What do you mean it’s a cold?
A poem for viral illness season.

Fever, cough and runny nose,
Muscle aches from head to toes,
Scratchy throat and stuffy ears,
Doctor, please allay my fears!

Can’t I get some Zithromax?
Lortab for my aching back?
Maybe just Amoxicillin,
For my stuffy, whiny children?

You say virus I, but I’m dying;
Surely there ain’t no denying,
What I have is devastating,
And I spent an hour waiting!

Hook me up and make me better,
Else I’ll write your boss a letter;
Don’t you tell me ‘it’s a cold,’
That tired line is getting old.

I know it must be bronchitis,
Strep throat, Zika, meningitis!
I require a strong prescription
For my horrible condition!

Cipro, Doxy, Levaquin
That’s what someone gave my friend,
After two weeks they felt well
So why should I endure this hell?

Please throw in a week off work,
Percocet’s an added perk,
My tolerance for pain is high,
But I am just about to cry!

What, I don’t get any meds?
Drink some fluid, go to bed?
Are you crazy, are you cruel?
I think you’re a quack, a fool!

I’ll go home but I may sue
Everyone, especially you.
I don’t need this here abuse…
Fine, now what about that work excuse?

Let’s Stop Bullying (Attention Adults!)

This is my latest column in the Greenville News.  Bullying is at its worse, but most acceptable, when adults use it to intimidate people who disagree with them.



Let’s Stop Bullying

I well remember being bullied on the school bus. Many cold, wet mornings (a large portion of the year in WV, by the way) I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and anger, trying to find my assailant, was pointless. ‘What are you looking at?’ they asked. It was a very long ride to school.
To this day, kids are still assaulted and treated badly by other kids. Children and adolescents are called cruel names and belittled by those who have more things or more opportunities. They’re told that if only they’ll wear these clothes, or listen to that music, engage in some sexual act or take that drug, they’ll be accepted. Bullying comes in many forms, it seems. And now we have the added joy of the Internet. No small number of young people have been mortified, emotionally traumatized, considered suicide or actually committed it in response to online slurs and cruelty, or embarrassing photos or video posted online.
These days, adults are supposed to understand, and teach their kids, that no one should be mistreated, harassed, harangued, belittled or besmirched in our hallowed school hallways for any reason at all. But something happens after we leave school. Suddenly, adults believe that bullying is OK as long as it’s about something that’s really, really important, and as long as the people they bully are different from themselves. It seems that in actuality, adults are the worst bullies around.
These days, in order to find bullying one need look no further than any discussion about politics (or frankly, culture, religion, science or almost anything else). I’m simply stunned at the way purported grown-ups with differing opinions can treat one another. Online forums and media comment sections drip with disdain. Those who believe ‘the wrong way’ are instantly labeled ignorant, or irrelevant, and often called names. Sometimes, people even wish death upon others.
In fact, that’s one of the clearest forms of adult bullying I see. ‘Well, if you weren’t so ignorant, you’d understand the truth.’ Even those with no particular knowledge of a topic consider those who disagree to be stupid, plain and simple; it’s a strange kind of ‘pseudo-intellectualism,’ in which the enlightened get to wear the mantle of truth. A truth largely determined by the crowd; not surprising in an era when truth is considered a personal choice like food on a buffet.
This sort of argument is everywhere. And not just in the Wild West of the Internet. Even noted political figures accuse their detractors, saying that they’re uneducated and backward or they’d see the truth.
Adults love to bully, no matter how much they pretend to hate the idea. We see it in its soft form in the recent video of celebrities reminding everyone else not only to vote, but who to vote for. They’re the cool kids. They may not be the smartest but they’re the richest and best; they’re sexy and sarcastic. Don’t you want to be like them? Remember, beautiful, rich, famous people are much better (and insightful) than regular poor people!
Comedians once entertained us with the universal, self-deprecating, slap-stick humor of everyday life. Now they, too, are the cool kids yelling their invective at everyone who dares to have an opinion off the mainstream. Biting and cruel towards those they don’t understand, they represent little more than a shinier, richer form of the old-school bully.
Bullies use words to great effect. Disagree with a candidate? You must be a racist, or a sexist. Disagree with a law? You must be a bigot or a fascist. Believe your God is real? You must be a fundamentalist nut! You don’t want to be a bigot or fascist or a nut, do you? Then just do like everyone else does and you’ll be so cool! There, now doesn’t it feel better to be like the crowd? (Now remember kids, you should always be yourself and follow your own heart. Until it takes you outside the bleating herd, that is.)
Robust dialogue is good for a nation. As in evolution, ideas diverge and produce more good ideas. The future of our freedom demands that we disagree. But bullying is the stuff of brutish children.
So let’s stop it, shall we?

The Overwhelmed EP in the Single Coverage ER

This was my column in Emergency Medicine News in September, 2016


I was working a 6 PM to 2 AM locums shift a few months ago and was preparing to leave. There were about 15 patients in rooms and 15 waiting to come back. I asked the lone night physician: ‘hey, do you want me to stay a while?’
Her answer, defeated, was this: ‘no, don’t worry. It’s always like this.’ I packed my bag and headed to the hotel, still feeling guilty but also exhausted. And wondering why my colleagues are treated so poorly in emergency departments all over the land.
I see it time and time again. Overwhelming numbers of patients with increasingly complex medical and social problems, versus inadequate physician coverage at all hours of the day, and especially the night. We’ve all done it. Already fatigued, we have five chest pains yet to see, as well as a trauma on the way into the department. Two more patients have fever but don’t speak English and we’re waiting to make the translation line work. And there’s a large facial laceration yet to be repaired. And that’s just the first nine patients. It’s not even three hours into the shift. (And the EMR backup is in process.)
Do we call the cardiologist and internist to take over on the chest pain, ask the surgeon to come and check the trauma and get plastics to close the face? Hardly. Furthermore, that’s just more time arguing on the phone. It’s easier to forge ahead as wait times creep from two to four to eight hours. Furthermore, on days it’s the same; with the added gift of acting as backup for all of the primary care offices.
There was a time when we actually might have asked other staff members to help. Those times are mostly gone. As a specialty, we’ve spent decades saying ‘don’t worry, we’ll take care of it!’ And our fellow physicians have obliged.
But at least, when we’re alone and overwhelmed, we don’t have to worry about lawsuits, patient satisfaction, quality measures, charting, coding, door to needle times, door to CT times, door to doctor times, door to…oh, yeah, we do have to worry about those things. As well as the sound criticism that will follow in the light of day, when all the administrators and other specialties are rested and shocked (shocked I say!) at how things went when we were alone.
The thing is, hospitals get a real bargain out of the understaffed emergency department. The physician does a heroic job of seeing every conceivable complaint and doing it with knowledge, skill, professionalism, urgency and political savvy. If you think of what they bill for that 35 patient, single coverage shift versus what they pay the exhausted physician, it’s a ‘win, win for old admin!’
In fact, emergency department physicians do the work of several people throughout their shifts, from secretary (filling out forms and entering orders), to social worker; from surgeon to psychologist, pediatrician to hospice worker. And we do it while trying our best to keep up with ever more complex charting rules, treatment pathways and admission battles.
We also do it when expectations are ridiculous. For instance, why should we, in a busy urban department, be doing the full stroke assessment when a neurologist could be at the bedside? Why are we arguing about the NSTEMI patient, or managing complex rhythms, when cardiologists (the alleged experts) are available? Why am I doing the neonatal sepsis workup in all the chaos when a pediatrician could come to see the child?
I’ll tell you why. Partly because we’re perpetually trying to prove our worth and fortitude. ‘I can handle it!’ And partly because we simply agreed. Consequently, ’call me when the workup is complete’ is a common mantra in the ED where we are indeed interns for life.
I wonder, are we training our bright eyed residents for this in the trauma center, in the simulation lab? Because when they leave the medical center for the community, this is how it looks. All the exciting, cool stuff. But ‘all by your lonesome.’
I know that lots of jobs are hard. I get that. But from what I’ve seen, all too many emergency departments over the past few years that are miserable, and dangerous, working environments. Does OSHA ever even look at our workplaces? Because when JCAHO does, they just increase the work-load in the alleged interest of patient safety (and their own job security).
We should all be proud of what we do. But we shouldn’t be abused children, or Stockholm Syndrome hostages to inadequate conditions. We should be treated as valued professionals. And if there aren’t enough other doctors to go around, every effort should be made to help and encourage those willing to work in such daunting settings.
And until you’ve come to work a shift alone, with a full waiting room and ten potentially critical patients right up front, you don’t understand what it’s like on the ground. And you have no grounds to criticize anyone facing the same tsunami of expectations and exhaustion in the noble effort to save life and limb, and ease suffering.
In the end, the weary look in the eyes of my colleagues breaks my heart. And something has to be done.
I call foul.

EPIC Go-Live Day! And a prayer for wisdom…

Some dear friends of mine, at Busy Community Hospital, are having a momentous day.  Today is the ‘Go-Live’ for their brand new, shiny EPIC EMR.

For those of you outside the hallowed, creaky halls of medicine, EPIC is one of the most widely used electronic medical records systems in America.  It’s big, it’s expensive, it captures lots of data, integrates ER’s, hospitals, clinics, labs and everything else.  (Probably your cat’s shot records too.)

EPIC is also a company highly connected to the current administration; big donors to the President.  FYI.

The problem isn’t what you get out of it, it’s the cumbersome way you have to put it in.  In my opinion, for what that’s worth, EPIC is not intuitive. It takes a long time to learn to use it well.  I have never used it in a situation where it could be fully customized, but I’m told that makes it easier.  And admittedly, some docs and nurses truly love EPIC and are at peace with it.  I suspect they have implanted brain chips or have undergone some brain-washing.


Typically EPIC instruction occurs over weeks, as it has for my friends.  The first time I used it was in a busy urgent care, which was part of a large medical system.  And I learned it over one hour. On the Go-Live day.  So I’m sympathetic.

Thus, I have a prayer for those in the belly of the beast right now:

A Go-Live Prayer for those with new EMR systems.

Lord, maker of electrons and human brains, help us as we use this computer system, which You, Sovereign over the Universe, clearly saw coming and didn’t stop.

Thank you that suffering draws us to you.

Thank you for jobs, even on bad days.

Forgive us for the unnecessarily profane things we have said, or will say, about this process.

As we go forward, we implore you:

Let our tech support fly to us on wings of eagles and know what to do.

May our passwords and logons be up to date.

Protect us from the dreaded ‘Ticket’ submitted to help us.

May our data be saved, not lost.

Let the things we order be the things we have.

Shield us from power loss, power surge, virus and idiots tinkering with the system.

Give our patients patience to understand why everything takes three hours longer.

And may our prescriptions actually go to the pharmacy.

Keep us from rage and tirades.

Protect the screens from our angry fists.

May everyone go home no more than two or three hours late.

And keep our patients, and sanity, intact.

Great physician, great programmer, heal our computers.








The Presidency Won’t Change the Division

The first presidential debate is over, and all I can say is that these are interesting times.

The fact remains that whichever candidate wins the presidency, the nation’s polarity will not be suddenly reversed. We are spinning further and further from one another all the time, divided by many issues, by race, gender, religion, accusation and insult. Are we one nation anymore? Hardly. We’re many nations trying to control all the others.

The election itself cannot change that. Whether Donald Trump or Hillary Clinton wins, they are unlikely to do so by a wide margin. And they will make policies that nearly half of the country will find objectionable. Maybe both parties need to strive to bring unity more passionately than they strive for electoral, legal and legislative victory.


Wasps and other heartless minions of nature

We live in South Carolina.  Thus, we live in what amounts to a tropical rain forest.  Starting about April and ending about, say, November, you can almost hear the trees, bushes, brambles and vines growing.  The many layers of green can be overwhelming.  Trails we cut in the winter, fields we mow down, erupt as soon as the weather is right; verdant invaders who overtake all.  I have fought the battle of the weeds; and recently, I have surrendered. We had a huge DR brand brush cutter.  It was great at cutting thick stuff until it ran into Mountain Laurel.  The bushes simply forced the great 17 HP machine to climb the front and try to run vertically.

We have been through an assortment of weed-trimmers and lawn-mowers, most of which appear to be in league with the lawns and weeds, given their tendency to early obsolescence within one season of battle.

Our porch and utility building are the resting place of all too many devices.  The electric ones are anemic and raised the white flag early after their first uses.  (Even small weeds and grass scoffed.)  The gas powered devices are systematically destroyed by ethanol in the gasoline, which dissolves the plastic fuel lines and priming pumps.  I have used some herbicide, but from what I can see it’s more like a vitamin cocktail for my green attackers. I suspect that for our needs, a plane-full of Agent Orange might come close.  But I wouldn’t count on it.

We have chain-sawed and machete’d and axed our way through many trees and larger bushes.  I had a beautiful European brush scythe (bought by my wife as a Christmas gift), which the weeds found laughable and ultimately broke in two pieces.

This yearly war with nature is something that those in more urban settings may not get.  I’m speaking of those who love the manicured beauty of their local parks, or the well-maintained paths of national forests and mountain-biking trails.  Those things, my dear reader, are false advertising.  They’re ‘nature porn.’  Because nature is ‘in it to win it.’   And so far, may be winning despite our national obsession with the belief that humanity is destroying the environment.  Sure, we can harm the natural world with oil spills and air pollution, with deforestation and other grave errors.  And we should be good stewards.  But nature is still, well, nature.  And often as not, Mother nature laughs at us dismissively.

Around our place, she wins all the time.  I now have a hayfield where a yard used to stand. Why have I ceded the yard, you may ask?  Because nature has stinging insects on her side.  After a long summer of assorted attacks, with resulting pain, itching and swelling, I admit it.  The bugs can have the yard until the first freeze.   We have been stung by wasps in our bed, wasps on our carpet, wasps on the porch and in the utility building.  My son was stung mowing. So the last assault, when his mother was mowing and sustained seven yellow-jacket stings at once, well that was it.  ‘I give,’ I told my swollen, itchy bride.  ‘They can have it until it gets cold.’  I sounded retreat and never looked back.  Quitters may never win, but they do avoid painful stings and potential allergic reactions.

The weeds and wasps are an annual reminder that nature has a way.  Whether by freezing or melting, by stinging or biting, by erosion or earthquake, by lightning, flood or hurricane, she will have her way.  It’s a charming human affectation, the belief that we can ultimately deal her a serious body-blow.  Nature may fall down, but she’ll be right back up in no time, erasing careless humans from the surface of the world they thought they ruled.

So don’t judge me please.  I’m biding my time.  I’ll take the yard back, I really will; even if it means a grass-fire.  But I’m not ashamed to say that for now, the Green Flag of nature waves in victory, fluttering in the breeze around my house.

But once that flying, stinging, irascible security detail is dying or sleeping off the winter, I’ll be back.  And then we’ll see who’s more evolved!

Until October of course; we have an understanding.




Everyone is a treasure (The Gospel in a Lost Bracelet)

Here is my column in today’s Greenville News


The Gospel in a Lost Bracelet
My wife lost a charm bracelet about a month ago. She was shopping in Easley, and she thinks it came unhooked and fell to the ground. We haven’t found it, despite her asking at the stores and restaurant she visited.
If someone picked it up, they would have seen charms of various sizes and shapes. Some from distant places, some representing times in the lives of our children. It’s a lovely bracelet that she has had for decades. However, it’s a bit worn with time. It hasn’t been polished in a while. It’s still precious to my bride, but for reasons a stranger could never fully appreciate in what appears a trinket.
I was thinking about this at work one day; about how easily we miss the value of others. I have seen this demonstrated as I have watched married couples, late in life, come to the hospital. They attend as closely as they can to their cherished partners. They hold hands, they stroke hair, they speak in sweet tones and say things like, ‘there’s my beautiful girl!’ Or ‘hey handsome!’ Even in the midst of their mate’s profound dementia, they are gentle and loving. Even though the ravages of time and illness have left their spouse with babbling speech, or a body twisted from stroke.
It may not even be the aged, but the young; with scars, burns, amputations, infections. The families of wounded service-members understand this well. When we come to them, as strangers, we sometimes fail to see the truth. What we see as shattered and unlovely is only a dim reflection. Who they are, their value, is perceived through the loving eyes of those who ‘see them as they are.’ We strangers certainly have no concept of the treasure trove of stories and wisdom, memory and meaning in the people we often see only in terms of illness and injury.
I have also seen this in the adult parents of addicts. Worried fathers and mothers who come to the hospital from across the town, or across the country. They hover over their children despite the emotional pain, the fortunes spent on rehab and legal fees. They are so happy to see that wayward, prodigal child that they ignore the lies, the violence, the profanity and derision hurled at them as they try to help. Many times I’ve wanted these patients to simply go to jail and stay there. Their manipulation and narcissism being more than I can tolerate.
Ah, but I cannot see them as they are seen by those who love. I cannot know them before the drugs and alcohol, when they had joy, when they were charming or kind. Even if they were always hard to handle, I cannot know the innate, irrevocable love, the hopes and dreams their parents (spouses, siblings) have carried for decades, through trial after trial. The remembrance of school days, vacations, triumphs, romance and dreams.
My vision is sometimes clouded because these people appear worn. They have cirrhosis, hepatitis, HIV, chronic wounds. They have handcuffs and warrants; they have lived hard lives. But that’s not how they look to those who continually lose them, and find them again, hoping at last to see the cycle broken. They are precious gems, covered in dust and dirt, lying in life’s sediment, as families try to find them and polish them. It’s easy to ask ‘why do their parents keep helping?’ To which they answer, ‘how could I stop? This is my child.’
And in considering all of this, from bracelets to drug abuse, I understand better than ever what this kind of love actually is. This kind of profound worth and care of the beloved, do you know what it is? This is the Gospel of Jesus. It’s a love that will live and die for the objects of its affection. It knows the value of everyone, for it created them, and imbued them with it. It’s a love that knows all of their stories of sorrow and pain. And never, ever, stops pursuing them until the end of time.
If we want to stop struggling with ‘isms’ and ‘phobias’ and all the rest, if we want to stop the endless, exhausting arguments of political parties, all the attempts to assert control, all of the ‘othering’ based on ideology, science, faith, race, education, geography or anything else, this Gospel is the best place to start.
Because everyone is a treasure. If only to God. May He open our eyes.

PS Reward for the bracelet!

Driving Country Roads to the ER

These days, I work most of my shifts about 45 minutes from my ‘house on the hill.’ At one of those jobs, the day shift starts at 06:30. Which means I’m rising from my bed at 04:30 in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.

I lay out my clothes the night before, so as not to awake my darling wife in her sleep. Sometimes I am able slip out without her knowledge. Others she wakes to kiss me goodbye. Then I go downstairs and put together some lunch, get the backpack and make my way out the door. I know that my wife and children are safe upstairs, as I lock the door behind me.

The door creeks a little, or did until my son Elijah oiled it. (One always wonders why a teenage boy oils a front door…) Occasionally I lock it as I realize I left my keys inside, and poor, tired Jan opens the door for me patiently. On the front porch, by the soft yellow of porch-light or the shock of flashlight, I step over dogs freshly awakened from sleep, who look at me with gentle annoyance. The sharp-eyed cats sleep in more secret places, so are seldom seen in the morning. Other dogs (we have five), sleep on the gravel drive in the summer and seem confused as to how to react when my Tundra rolls towards them, slowly, and I roll down the window. ‘Get up, you silly dog!’ Heads and tails down they amble away.


Up the long drive and down the road, I am suddenly all but alone on the two lane roads that lead me to Tiny Memorial Hospital. Despite the early hour, I am ‘awake, alert and oriented.’ The sky is dark, and in winter stars shine down when clouds don’t lay low against the earth. I scan the roadside for deer, their eyes reflecting the truck’s headlamps. Opossums sometimes shuffle across, along with squirrels and rabbits. (One day I saw a big, black bear on a hill by the road. He ran away as I stopped for a photo.)
I drive through forests, past sleeping houses and across a dark, still lake where sometimes, the light from a bass-boat shines across the emptiness where someone has fished all night…or started very early. Or a campfire on the shore still burns as their line rests untroubled in the water.


It is so early that I drive past gas-stations and convenience stores still dark and locked, the ‘closed’ sign reminding me to keep on moving. The air, even in summer, is cooler and in winter, positively cold. Winter is my favorite, I think, with the heat of the truck turned out, and the chill wind blowing past.

I think as I drive. And I pray. And I listen to the news, a recorded sermon, a pod-cast. Many mornings I turn on an oldies station from the North Carolina mountains; in the loneliness of the drive the music of Sinatra, Johnny Cash and others, make me feel I’ve gone back in time.

I cannot talk on the phone (hands free or otherwise). I pass through places where cell-signals are only a dream, and often even radio reception is poor. Remote areas, mountainous places, lonely and beautiful places defy cell signals and seem to say ‘look around! What else do you need!’ Even at 5 am, I agree.
Eventually I am near, and I find a fast-food joint for the obligatory chicken biscuit and tea, because, well, the South and all. And then I roll into the ER parking lot, lock things up and head to work.
Because this is no urban trauma center, the early morning is sometimes very slow and relaxed. A few patients may be waiting for turnover, but often none. I can sit and think, I can ask about the previous night. I can ease into work. My drive has already prepared me, but it’s nice to have a few minutes peace in the department before the chaos of the day begins. I text Jan. ‘Here safe, love you,’ and she answers. ‘Love you back, have a great day.’
There are those who don’t have to drive long distances. For most of my career it was about 15 minutes to work. And there are those who have long commutes through traffic, and through the waking body of a large city, people and cars just starting to fill its veins and arteries. Sometimes I am jealous. It can be lonely where I am.
But I think I’ll keep it for now. There is a solemnity, a serenity to my mountain and lake commute, with animals heading to bed and people not yet rising, with my own thoughts and prayers to myself.

And I suppose that if there were a better way to prepare for the madness, badness and sadness of the ER, I don’t know what it is.

A dark union: EMR meets EMTALA

Ah, EMTALA! The revered ‘Emergency Medical Treatment and Active Labor Act!’ It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training.  ‘And then the bad doctor sent the poor lady to another hospital because she couldn’t pay!  And the King came and crucified him for doing it!’  The end.

EMTALA, for the uninitiated, is a federal law which ensures that we don’t turn people away from the ER because of finances, and also keeps us from transferring people to other hospitals without that hospital’s agreement.  It also exists to guarantee that we stabilize them as much as possible before they go.

I’ve said before, and always will, it was a good idea.  But like many laws, it was subject to the law of unintended consequences.  For instance, being forced to see lots and lots of people (who may not really be that sick), and do it for free, has huffed, and puffed and blown the hospital and trauma center down on too many occasions.  But that’s not my point here.

My point is that when EMTALA forms meet electronic medical records, chaos can ensue.

Allow me to illustrate:  This is a standard EMTALA form.  Check, check, check, sign.  It takes a busy physician less than a minute, and the nurses a few more since they have to call the other hospital and record times, etc.  This has worked well for a very, very long time.


Enter EMR.  This is the procedure for doing an EMTALA form at Tiny Memorial Hospital, which has been enchanted by the dark Lord Cerner.  Mind you, I’m sure the ‘powers that be’ feel that this is a perfectly wonderful way to do the form.  Indeed, it captures lots of information and stores it in the system.  But two facts remain:  first, the people who designed the system generally work at Large Urban Hospital, which owns Tiny Memorial.  They don’t transfer things out very often.  They receive things.  Second, most of the patients being transferred are going within the system.  All the data is on the EMR, and it isn’t as if they’re going to some strange facility far, far away.

This, children, is the EMR based procedure (on a cheat sheet developed by a frustrated and confused provider):


Not long ago my team worked a cardiac arrest at Tiny Memorial, with a successful return of cardiac activity.  Given our size and staffing, it took pretty much all of the staff available and nothing moved for a while.  A helicopter whisked our patient away.

Of all the things we did; drag her out of the car, do CPR, start IV’s, intubate, talk with family, chart, arrange transfer, nothing was as complicated or frustrating as this process to complete the EMTALA form.  In the end, I still got it wrong somehow.

Mind you, I never violated the spirit of the law in any way. She was treated, stabilized (to the extent of our ability) and sent away to a receiving hospital with the capacity to care for her.

I don’t want to impugn the motives of those who developed this.  I’m sure they were trying their best.  But if you don’t use it, you can’t see how hard it is. And you also can’t see how much time it takes in a place with limited resources and staff.

So please, folks, let’s use technology to simplify, not make things more complicated!  And let’s remember that charting isn’t the same as doing the right thing. And sometimes, doing the right thing isn’t perfectly reflected in the chart.

But paper or electrons, it’s still the right thing.  And that’s what EMTALA is about.



Ed Leap