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.