I must be a rock-star…look at the crowd!

Outside the ER yesterday

Did someone finally hear my incredible vocalizations on ‘Come Sail Away,’ performed by my band ‘Starcraft,’  when I was in 7th grade?  I mean, I wasn’t that impressed, but maybe word got out at last.  Hallelujah!  Goodbye ER!

Oh wait, that’s not the crowd to see me; well, it is.  It’s the crowd to see Dr. Leap. The crowd with chest pain and shortness of breath, the weak and dizzy elderly (the first one third of the image), the folks subjected to sudden increased in mysterious gravitational forces pulling them to the center of the earth, and into the orthopedic surgeon’s waiting arms. 

It’s the crowd of people with vague complaints, among whom one or two, ten or twenty are actually dying of something, even as we in the ever mundane emergency department try to get lab results, X-rays, beds for admissions and pages answered by specialists. 

Yesterday was difficult.  I wonder, frequently, about how well we work when we are overwhelmed.  If any group of physicians can do it, emergency physicians can usually pull it off.  We learn, in residency and in practice, how to streamline and be as efficient as possible.  But we’re often short-circuited.  Other medical staff members often seem to view us as the holding ground, the place where chaos can simply be endured.  Though chaos is dangerous all around. 

They want  patients held so they can see them after their office, or they want us to do test after test to confirm that the sick deserve for another physician to see them in person.  (Witness the modern surgeon’s trend to order serial CT scans!)

The modern emergency department is a place where the staff is constantly at someone else’s mercy, whether the admitting floor nurse who is ‘too busy’ to take report on the admission, the floor too busy to have patients in the hall (whereas the ED is fine for such an arrangement), the ICU nurse who says, ‘your patient is too unstable for ICU.’  (Too unstable for ICU?  What?)

We’re at the mercy of every cash-only urgent care that wants to send anything our way.  We’re at the mercy of every office receptionist who can simply say, ‘we’re busy; better go to the ER.’ 

ER overcrowding is a complex issue, much addressed.  It isn’t as simple as the patients who abuse our care (though in many instances that’s a genuine reality).  It isn’t as simple as uncompensated care (though surprisingly, you can’t hire new staff or build new rooms without that archaic symbol of waning capitalism, money).  It is a complex problem.  It involves things like the unrealistic expectations of patients.  It has to do with government price-controls and mandated free care.  It’s worsened by the fact that physicians and mid-level providers abdicate everything from surgical follow-up to office visits by referring any and everything to the ER.  And it’s made more difficult when primary care docs turn all admissions over to hospitalists, who don’t know the patients as well as their primary docs do.  (When someone knew them from the office, it was easier.)

We’re overwhelmed, people.  My department is a medium-sized one.  But I don’t know how to move any faster, or make decisions any better, when every bed is full, when beds line the hallways, the waiting room volume climbing and the rattle of wheels from EMS stretchers echoes in and out the back door, over and over again. 

Do we think health-care reform will help?  Among my many fears is the fear that what people perceive as ‘reform’ will mean I see more people in the emergency department (who have ‘insurance’ but can’t find doctors available, or willing to take it), and so my ability to find the truly sick ‘needle in the haystack’ is compromised by more and more numbers, and more and more potential for misses.

I don’t know the answer.  I only know that I prayed about it last night and this morning.  I cannot do this alone.  Only God can guide me in the morass of the emergency department.  Only His wisdom can show me what is right and wrong, when it really matters.  And only His spirit and love in me can stoke the cooling fires of compassion when I’m tired and everyone seems to be weak, having chest pain or out of Lortab.  ‘What is impossible with men is possible with God.’

And only God (are you listening Lord?) can turn down the gravity just a smidge so that less people seem to hit the floor today.

So, crowd, here I am.  ‘We thought that they were angels, but to our surprise, we climbed aboard their starship and headed for the skies!’  What’s that?  Oh, you’re short of breath.  Fine.  I’ll stop singing.  Step across the patients lined up here, and go into room ten.  We’ll try to figure this out together.

It may be chaos, but I promise to do  my best.

Edwin