Over at Quora, someone wondered why it is that when you show up at an emergency room, none of the staff seems to understand that “emergency” means “urgent.”
A number of medical workers were quick to explain that the “emergency” in “emergency room” does not mean “urgent,” and that if you don’t have a life-threatening condition, you have to wait until they get done dealing with people who do. And that certainly is true: who would want their stubbed toe or their broken arm treated ahead of some soul with a heart attack, a stroke, or a gunshot wound?
All of us can understand that ER workers are stressed to the max and that they have to make quick decisions about who needs care and when. But…
Back in the day before ACA, poor people here used the ERs for medical care whenever their kids had a bad cold or flu and for conditions adults and children should have had treated in their GP’s office. Phoenix has a large population of working poor and unemployed, many of whom live, shall we say, very close to the bone. And in those days, if you didn’t have insurance, you couldn’t even get in to see most doctors. Many people did not have a GP and never saw doctors for routine care.
An ER, on the other hand, is not allowed to turn you away. So, when someone without insurance or cash needed to see a doctor for a minor ailment, they would go to the ER and sit there until they could finally get in. This meant waits for everyone that extended for many hours.
It was Christmas time. A flu epidemic was raging. And conveniently, my body chose that moment to develop appendicitis.
In terrible pain and throwing up, I persuaded my ex-husband to take me to the ER at St Joseph’s, a large regional medical center in the central part of the city. It was late at night.
The ER was packed. The receptionist, overworked and miserable, was rude to me and gave me a dirty look when I threw up into the bucket I’d brought.
There was no place to sit down. The floor was truly filthy, so I didn’t feel I could sit or lay down on the floor. Three hours later, I found myself sitting outside on a concrete bench, in the cold, next to a woman who was miscarrying and who had been waiting over four hours. We waited another couple of hours without anyone caring whether we lived or died.
Finally, I gave up. I figured if I was going to die, I’d rather die at home in my bed than in that place. I called a friend, waking her out of a sound sleep, and persuaded her to come get me.
At dawn I was in agony. I called the Mayo Clinic, where my old doctor was practicing. They told me to call 911 and have them bring me there. I said I thought they would take me back to St. Joe’s and I couldn’t withstand another fruitless, endless wait. She said no, they have to take you where you ask them to take you.
That, as it developed, was wrong. They would not take me to the Mayo — the twenty-minute drive would take them out of their area. I sent them away and called another friend, who kindly drove me to the Mayo.
The Mayo, being in a more upscale part of town, was not crowded with people who couldn’t afford to see a doctor. Within minutes after I walked in, they were rolling me into surgery. In the elderly, appendicitis may be life-threatening, especially if it goes untreated. Afterwards, the surgeons said the appendix was “a mess,” one of the worst they’d seen.
On the one hand, my feeling is that you wouldn’t go to the ER if you didn’t have an emergency. Obviously, I needed to be seen in less than four hours, and obviously the young woman I took up with on the bench in the winter cold needed to be seen. Obviously, we needed to be seen when I came in.
On the other, I surely understand that when everybody and his little brother and sister use the ER for routine medical care and show up when they have a bad cold or flu, the staff is overwhelmed and the likelihood that they will fail to recognize a true emergency is high. I also understand that an inner-city ER staff sees not only the routine heart attacks, strokes, accident, and appendicitis cases, but a steady flow of knifings, gunshot wounds, car wreck victims, and drug overdoses, and so of course they do not have time to deal with people’s colds and tummyaches.
With the ACA, this problem was somewhat relieved because more poor people could get insured. Once that goes away, though, we can expect to see those conditions to return. When people can’t get insurance and doctors turn the poor away because they’re uninsured and can’t pay, then ERs will fill up again with folks who need routine medical care. And the next time you have a serious condition that really does need immediate attention, you may not be able to get it.
Section of acutely inflamed appendix: By Ed Uthman from Houston, TX, USA – Acute Appendicitis, CC BY 2.0
Banner image of the day: DepositPhotos, © sepavone