All have to wait. As is normal with all the busy ER, the ambient sounds of machines, alarms ringing, debilitating moaning, and loudly drunken outbursts permeate the section. It is a controlled insanity.
But, a girl’s scream pierced my spirit. Her baby eight-month-old boy put back in her arms. He is already pale, lips his torso not climbing as it must with breathing — that he is not reacting at all. We wasted no more time. Nothing brings help quicker to a room than a dead kid. We rapidly put a breathing tube, then started pushing on his small chest with our hands to help keep his heart beating, then drilled an IV to his bones, and pushed into all the drugs we could. Ten minutes passed. Nothing. Twenty minutes passed. Still nothing. For every other patient, we might assess heart motion and if it’s not moving, pronounce the time of passing. Not for children. Never for Kids. We spent 45 minutes for this baby. Helpless, the time had finally arrived. We were in agreement. Time of departure: 0205.
The heartbreak isn’t over though. Next is the mother. What would you say? Not much. I could just sit and try to absorb her despair, her skepticism — her remorse.
What’s next? We move on. It’s a hectic night… the damage had ripped into me, but I had more hours to operate; patients are awaiting. The next patient was waiting for two hours. I took a pause, massaging sanitizer involving my cold hands a couple of seconds longer than normal to compose myself. What occurred following etched into my head as far as the tragedy that happened minutes ago.
The patient berated me. Yelled at me personally. “I’ve been waiting for hours to see the doctor! What type of place is that!? You are supposed to treat me, not leave me waiting! I knew I should I’ve gone someplace else!”
Never have I felt this way.
“I’m sorry for your wait. It’s been busy,” was all that I could muster.
Maybe, if this person knew what had happened, there could be some comprehension — when the doctor has not talked to you yet, there is somebody sicker needing attention.
But we can’t say . I can’t say a kid has just expired. I can’t tell you that a seven-year-old girl’s figure, was ripped by a stray bullet. I can not mention that we just consoled a weeping family. I can not.
Our fast-paced culture needs convenience — click on a button to arrange clothes, instantaneous posts on Twitter, receive a hamburger by means of a car window. That which we’ve lost, however, is a tiny comprehension of the human condition — compassion for others. Sometimes we are so excruciating, we can’t see past our own hospital gurney. Nowhere is that more evident than the ER.
Triage must occur. With limited, exhaustible resources we must do what emergency departments are made for: take care of the sickest first. There’s a saying in medicine:”Vitals signs are essential.” That is where we begin.
By way of example, two patients require evaluation.
One is really a 30-year-old man with stomach pain with normal vitals — waiting hours.
The next is a 60-year-old lady with chest pain, quick heartbeat, low blood pressure — waiting ten minutes.
Who’s first? The choice is obvious. Without emergent therapy, patient 2 will perish quickly. Patients #1 might need to wait longer, but patient #2 doesn’t have this luxury. ER physicians will make this choice every single time without hesitation.
We are responsible for the whole ER, its people, and its finite resources. It does not matter who you are, the ER is the excellent equalizer.
For all our patients, we recognize this is among the worst days of their life. We try to deal with it like that. Regrettably, at the ER, somebody else is constantly sicker than you personally.
Admittedly, there are more factors beyond doctor management. The flow of this ER is much like this a five-lane freeway. When everybody goes the exact same rate, traffic flows nicely. When rush hour hits, more automobiles merge in the on-ramps and visitors slows. The ER also slows only by sheer volume. In case a semi-truck crashes, automobiles come to a stop before that truck is cared for. Likewise, we must tend to that gunshot wound to the chest before focusing on the others. The truck must be cleared to permit others to pass. When the destination is outside of parking areas, individuals are left unattended around the freeway. After the hospital is complete, the ER becomes crowded. The patients which need to stay in the clinic? We keep them at the ER, there is nowhere else.
No one likes excuses. If it was possible, we’d evaluate everybody instantaneously. Waiting kills. We know this. That’s why we are constantly developing methods to improve wait times. We’ve placed doctors in the waiting room, acquired blood work and X-rays straight away, streamlined workflow with different specialties and generated different areas to view less critical complaints.
Yet, it is insufficient. Folks will wait. People have emergencies. Doctors fill up. It’s sometimes tough to wear a different patient’s gown and step into their slippers, particularly when we are hurting ourselves. But that is what makes us human — why we appreciate society. As soon as we view a fiery crash on the freeway we expect that nobody is hurt and there are survivors. We understand why we need to stop our automobiles. Our basic instinct would be to wish the best for people.
The ER is an overwhelming place — especially for patients. Several factors contribute to the wait time — many supporting the ER doors, beyond our control and beyond our patients’ sight. We might be in pain and we all might be in need, but our empathy for our humanity can make it more tolerable.