Volume 76, Number 30 | December 20 - 26, 2006


My fast track to E.R. purgatory at St. Vincent’s

By Michele Herman

I went away recently for a few days — far, far away. When I came back, Abingdon Square was bright with mums, the monarchs were flying through, and the bus shelters wore brand-new billboards. It was the billboards and the matching full-page newspaper ads that riveted me. They are not the sexiest billboards you’ve ever seen, showing as they do a happy woman in a blazer and pumps, hoisting her pocketbook over her shoulder like someone with places to go. She’s marching away from a hospital emergency room, or at least the barest, blurred, happy suggestion of one. The ads are for the new Fast Track Emergency Department at St. Vincent’s Hospital. “Get in, get out, get better,” they promise.

It just so happens that the far-away place I went to for a few days was St. Vincent’s. I can assure you that at my St. Vincent’s, where I arrived on a Monday afternoon doubled over in abdominal pain, there was no such track. It’s not for nothing that my family, which has endured more than its share of long visits to the emergency room, likes to call St. Vincent’s “the hospital that must not be named.”

Emergency-room waiting is a passive but highly competitive activity, and one perverse hope brightened the Monday evening I spent there. With my nausea, cramps and a tender, distended stomach, there was the very real possibility that I was the sickest person in the room and therefore likely to be called in first. But then he staggered in like Captain Jack Sparrow, a walking page-one story about a healthcare system in permanent crisis mode. He was a tall, gangly, fairly young man with a loose, desperate way of speaking. You’ve heard the line about how you have to be spitting up blood to get seen at the emergency room? Well, I’m here to tell you that if you want to get the attention of the hard-hearted triage nurses in the germ-proof booth, you have to come up with something much better than that. With blood pouring from his mouth, he wove around the room begging for help for a full half-hour — quite coherently, considering.

The emergency room is a through-route for hospital staff, and various men in deep blue St. Vincent’s shirts strode past purposefully, trying to ignore the lot of us — the old woman with the swollen legs, the young Australian traveler with fatigue and joint pain, the little girl with the hurt finger. When accosted they would put up their hands and say: “I’m not a doctor.” Meanwhile, the triage nurses were pissed off about something and kept storming out of their booth. Eventually one of the blue shirts, on his third or fourth pass through the room, pressed a business card in the bleeding man’s shaking hand, saying, “I agree with you that this wait is unconscionable. When you get out, give me a call.” The sad thing was that it wasn’t clear that the man was going to get in, let alone back out.

I didn’t keep track of the hours, but I do remember that on the wall-mounted TV the Final Jeopardy question was Beowulf and then thickheaded “Wheel of Fortune” contestants were buying vowels, which would mean I sat there for two and a half hours. When you’re sick, you drop your loftier life goals one by one. What did it matter that I was scheduled to begin teaching a class at 8 that night? I wanted only one thing out of this life: to lie down.

They did call the bleeding man, and I never saw him again. Eventually they called my name and put me on a gurney in a crowded back room. A couple of hours later, after siphoning some fluids out of me and putting others in, they wheeled me away for a two-hour X-ray process, or should I say, the standard 10-minute X-ray process with the really wide, unexplained cushion of time on either end. The X-ray showed nothing amiss, so I was bumped up to a C.T. scan. “Here,” a nurse said, “drink this down,” handing me a 48-ounce bottle of thin red liquid, a bland and yet repulsive cocktail of contrast fluid mixed with diet cherry Crystal Lite.

By now it was the wee hours. They wheeled me to the C.T. scan hall, where most of the lights were out, as if it had been abandoned some years before. St. Vincent’s is a pretty Catholic place, but this floor was downright sepulchral. Medieval-looking pictures of saints on the walls peered down dolefully at me. I rode past a door behind which I swear I saw a cathedral. I began to fear the staff knew something about my condition that they weren’t telling me. More unexplained waiting, since no one seemed to be there ahead of me.

At 3:30 Tuesday morning, 10 hours after my arrival (breaking my acute-appendicitis record of seven) they gave me a diagnosis of diverticulitis and admitted me. I entered a new, more settled, stage of hell. Because my colon needed to rest, I was on no diet at all, not even water. The pain gradually eased, replaced by nausea from the two intravenous antibiotics. I lay as quiet as I could, concentrating on getting well so I could go home to my family.

My first roommate, a blind soap-opera-obsessed woman who passed the time discussing plot developments with a very loud visiting friend, was discharged after my first day. I had a blissful night alone, moaning with abandon at every fresh wave of nausea. Then on day two, I heard, from way down the hall, a cough that rumbled like lava. I had a bad feeling about that cough and, sure enough, it grew louder and closer and became my new roommate.

The curtain between us remained closed, so I came to know her through sounds and an occasional stolen glimpse on the way to the bathroom. She was large, downright Vesuvian. She had asthma, and diabetes, and congestive heart failure, but was admitted for acute pneumonia. It wasn’t the first time. Just a week or two earlier she had apparently signed herself out of a different hospital A.D.A., or against doctor’s orders.

Every day they shot her full of albuterol, prednazone, oxygen, nitroglycerine and who knows what else to approximate the conditions inside a functional body. She reminded me of Manhattan Island — such a complex, patched-together mess that you had to give it credit for functioning at all. Every morning they discussed her “sugar” as if it were as remote and beyond her control as the outside temperature. Day and night she crinkled snack bags, although I never heard her brush her teeth.

Sometimes I wondered what my roommate made of me but I think I was too small to register. The first afternoon she had yelled to no one in particular, “How do you work this damn bed?” I know she wasn’t thinking of me at 1:40 the first night, when she finally found the bed controls and worked the jackhammer-like motor for 20 minutes, until I had to say, “Please, there’s someone here trying to get some sleep.”

Some of her 13 siblings would visit and deliver boilerplate lectures: “This is a wakeup call, sis. This is a blessing in disguise.” She would agree and then, after he left, she’d tell the endlessly patient nurses, “I’m going home. I’m a big woman. I weigh 300 pounds, and this bed is killing me.” All week she remained desperate to talk to a man named Glenn. One afternoon while I tried to nap, she called him a dozen times: “Glenn, pick up.”…. “Why don’t you pick up?”…. “Glenn, pick up the damn phone already.” Later I understood why: He was her ride home.

I heard her explain her previous A.D.A to one of the young doctors: “I’ll tell you why I went home. I’d put a chicken in my CorningWare slow cooker that morning. That sucker cooks eight hours, but not the whole weekend, and that’s the truth about why I went home; I went home to my bird.”

“Oh, you’re good, you’re killing me,” the young doctor laughed, shaking his head as he signed her new A.D.A. But the sad truth was it was herself she was killing, while I tried my best under the circumstances to get in, get out and get better.

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