Trying to find relief in the emergency room — especially on or approaching a holiday — is like stumbling into a scene jointly written by Joseph Heller and Franz Kafka. As in “Catch 22” and “The Castle,” there’s no way out.
The horror began in mid-afternoon with a hurried call for help. The 74-year-old woman had fallen and feared she was badly hurt. Her daughter arrived within minutes and found her on the floor, unable to get on her feet. They called 911. The response was quick, and with some effort she was placed on a gurney and rushed to the hospital two miles away.
After the daughter had dealt with the admittance bureaucracy in what has become Northern Virginia’s major hospital center, she found her mother in an ER treatment room in major discomfort. Nurses and doctors filed in and out, with long intervals in between. X-rays showed that she has broken her right arm near the shoulder (she’s right-handed). The final diagnosis was that, while she did not need surgery, she would need a sling for more than a month. Her right knee, while not broken, could not support her.
An orthopedic resident showed up six hours later and declined to admit the woman, despite her age, her lack of mobility, her diabetes and a history of congestive heart failure. The patient lives alone in a house full of stairs, and her daughter’s house was no better suited to dealing with her injuries.
“We can’t admit her for a broken arm,” he said.
“But it is more than that,” the daughter protested.
The patient was released. After a heroic struggle, she was somehow loaded into the back of the daughter’s car, driven home and ultimately installed in a recliner on the house’s first floor, not far from a powder room. There she stayed for four days as relatives took turns attending. Throughout the process, numerous calls for nursing care or admittance to a rehab center ended with “you need to call these people.” It became clear no outside help was available on a holiday weekend. More importantly, the patient was told, in a classic Heller turn: “You have to be admitted to the hospital for three nights before Medicare or anyone else will come to the rescue.”
Guess what? That would mean going back through the ER process, a totally unacceptable solution. By the fifth day, the woman was running a fever, had developed a severe cough, and was listless and refusing food. The daughter again called the ambulance and the mother went to the ER. Seven hours later, the patient was moved again — this time to a room in the hospital’s heart center. She had developed pneumonia from being unable to move, and there were signs of other severe problems. A week later, she was assigned to rehab.
All this could have been avoided with the proper response to the first emergency.
The ER staff is a hassled, overworked lot that moves at a snail’s pace and the ER specialists seem oblivious to ailments except with the most urgent trauma. (In 13 hours, the patient had spent less than five minutes in the presence of an actual doctor.) Much of this clearly stems from the fact that Americans with no insurance use the ERs as their only access to medicine. They have no doctor, just the ER, and they naturally clog the system. They have no other recourse.
Medical care in America is a learning experience. One of the things learned is that it frequently doesn’t work very well.
Dan K. Thomasson is former editor of the Scripps Howard News Service.