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Slumdog New York

February 23, 2009
by daphne
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I watched the Oscars so I have that movie on my mind. But as I write this, my mom’s lying on a gurney in a hallway of an ED, and all I can think of is that she may as well be in the slums of Bombay. I don’t mean the nice hospitals there—I mean the ones that you might have seen in Slumdog Millionaire.

And this is New York.

They are piled up 10 deep in the hallways, to the point where the orderlies can’t get any carts through. I’ve never seen such an overcrowded ED in my life, and I’ve seen plenty. Even diverting ambulances can’t help, because so many of the patients are being brought in by friends and relatives, like my mom. I guess so many people losing their jobs and insurance is one explanation. February is another. But the bigger reason is that two Level I trauma hospitals in the area closed in the last few months. The ED doctor explaining this to me just shook his head. "We're practicing field medicine now," he said.

Another doctor just walked by to take her H&P and God help me, he scribbled it on a scrap of paper. That may wind up in his pocket, in the garbage, or in someone else’s chart. Her name wasn't even on it. If, and I mean if, it even ever gets transcribed to a chart, who knows if it’s even right?
They finally, after many hours, hooked her up to a heart monitor (she was in heart failure). It was an ancient machine that looked like an old TV set. They propped the monitor on a chair next to the bed. They told me they had run out of heart monitors. I guess we were the lucky ones because they went and dug this one up for us and found a chair to put it on--I think the chair was even scarcer than the monitors. Of course, they had to keep moving it every few minutes when an orderly moved a patient. that's how deep the patients were stacked, there was not even room to move a gurney through. The patients went all the way out to the front door, and the lobby was packed with gurneys. Every time someone came in or out of the emergency room, the patients there got a nice blast of cold air.
How did we wind up like this? My sister is a nurse, my brother is an attorney and I know hospitals inside and out. And yet, between the three of us, with all our best laid plans, my mom decided to go, on her own, to a hospital where her ancient doctor admits. A hospital no one, unless they had no choice, would ever go. Technology? Forget it. More importantl, there are just too many patients. And now mom won’t let her children transfer her to a “good” hospital” because they don’t have her record. That record. That record. That’s all she keeps talking about.

There’s a whole story in here about the importance of that record, and access to it. But I can’t write it now, because I’m running back to the hospital to pull an overnight in the hallway. She’s not getting a bed, no way no how. And I want to make sure, if she arrests in the middle of the night, that I’m there to make sure they let her go in peace instead of intubating her. That’s what she wants, what she always wanted. And I know they’d never find her DNR orders floating around on a scrap of paper.

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Wow thanks guys. I did some checking and found out that the two area hospitals that are closing imminently just stopped accepting patients into their EDs a few days ago. We got caught smack in the middle of that the other night. Who knew? Mom's hospital can't relly be faulted, they are doing a yeoman's job under the cicumstances. The hospital was given no notice or support to help with the overflow. Of course, her doctors and nurses have been extrordinary under circumstances that would have sent me screaming. As always, caregivers WANT to provide good care.

Daphne:
It is good that you are there to advocate for your mom. Stay strong, and we will keep you both in our thoughts and prayers!

Perfectly said, Anthony.

Daphne, our best wishes and prayers are with you. I can relate to your point about your mother being tethered to her doctor, and the doctor tethered to a particular hospital, thus ... . My father is in the same position: very happy with the cardiologist he's had for almost 20 years, but that doctor is affiliated with what we consider a substandard hospital. My father, however, will not change doctors, so we're stuck with the hospital. Moving the record around, as you note, is another hassle. Physicians still treat those document, often, as if they are the owners, rather than the stewards.

Your beautifully written post also makes me reflect on how much family matters. We all get irritated from time to time with our loved ones (ironically, this is often proportional to the amount of time we spend with them), but who else is willing to spend the night in a hospital corridor by our side? A child's vigil over an ailing parent is the repayment of a loan made long ago when that parent cared for their vulnerable child, it's the beautiful unspoken agreement decent people make with their loved ones: care for me now and I'll repay you in kind.

Daphne, your sense of duty to your mother is, of course, expected, but that doesn't make it any less touching. The amazing thing is that I doubt your concern would be much diminished if she were in a "better" hospital, because we all know that even good hospitals can have a bad apple in the bunch, and if that bad apple is your love one's overnight nurse, you've got no reason to sleep well at home.

Its no wonder that the EDs are in the state they are in. They must accept every one regardless of their ability to pay and no hope of getting reimbursement from the government. It is an unfunded mandate and a very screwy form of socialized medicine.
We should bite the bullet and bring on some true healthcare reform that will benefit all and not waste money on special interest groups.

Daphne: This is an unbelievable story and one that is probably being replayed in ED's across the U.S.
It sounds like you are the primary caregiver for your Mom!
I do hope your Mom is somewhat comfortable even in the conditions you mentioned in your blog. Thank God you are there to check on her while she is waiting for further care. I wish her and your family my very best.

I still can't believe the state that NYC's EDs are in, and I can't believe the ordeal your family has had to go through. It really makes the whole problem of overcrowded EDs hit home. Hang in there - you and your family are in my thoughts.

It's amazing that in a city where you can get almost anything you want 24-7, you can't necessarily get good care. I'm so, so sorry.

Thanks guys, advocate is the word. So far so good but she's still in the ED! I'm in such awe that these amazing caregivers have to work under these conditions that I've been surrepticiously taking pictures, and will try and post them later.

daphne

Twitter @Daphne Lsawrence

Daphne Lawrence is senior associate editor at Healthcare Informatics magazine, covering the...