I am a trained observer in remission, that is a retired officer of the law years removed from my former vocation. This past Tuesday evening, I was able polish my observational skills in an eye opening experience in one of our large area hospital’s emergency room. I thought I might share our experience with an eye toward one of the many problems with our medical care system in America.
Sharon, my wife, doesn’t fall well. She suffers from a form of neuropathy that results in poor feeling in her lower legs. This affliction, in turn, results in her body occasionally getting ahead of her legs, not a good thing. We were enjoying a Netflix movie Tuesday evening when she suddenly decided to hop up and thaw a pound of shrimp for dinner. As you might guess, her legs were not in sinc and down she went striking the corner of the coffee table and bending her ankle in a direction that ankles cannot go. This graceless tumble was accompanied by a distinct cracking sound and a great deal of pain. (We later determined the cracking sound was the sound of my laptop slamming shut when she hit the table it was on.) Putting my observational skills to good use, I suspected we had a major issue on our hands and I elevated her leg and began preparing for a trip to urgent care. The swelling was instantaneous and significant as was immediate bruising. Her last fall resulted in a titanium plate in her wrist, which only served to increase my sense of urgency. I was able to get her into the car and off we went. This is the beginning of the train wreck.
A quick perusal of the urgent care centers seemed to indicate that most had closed at 4:30 or so, and given the nature of the injury I made the command decision to head to the local hospital ER as I suspected a fracture was likely, necessitating a care level above an urgent care shop. After all, it was Tuesday and the ER surely would not be that busy. I parked, grabbed a wheelchair and rolled up to the triage nurse who was polite but unimpressed. We checked in and began the wait for a room and examination. The next two hours constituted a college level course in the observation of human behavior. Immediately to our left sat a portly young woman engaged in a FaceTime call with a male during which she laughed and joked with the gentleman over the course of a full hour. They were on the speaker phone and he could be heard encouraging her to not smile when the vitals nurse made her rounds so as to appear really sick. When asked by the nurse what her pain level was she somberly replied 7, and suggested the pain was located in her abdomen. She kept the gentleman on the speaker phone during the course of her discussion with the nurse and immediately resumed her animated discussion with him when the nurse departed. A quick survey of the triage area and waiting room revealed two obviously homeless folks (their bicycles, laden with trash bags of clothing and such were parked in the entryway) and a surprising number of folks who had turned the trip into a family get together, laughing and visiting as they awaited the vitals nurse. To be sure, there were some very sick people in the waiting area, including a young girl who was absolutely miserable and nearly unconscious. I felt very badly for them. There are a number of ambulance bays outside this ER, all full, resulting in a steady stream of ambulances discharging their patients outside the ambulatory doors. Some of these folks were able to get off the gurney and walk in to the triage desk. Interesting.
In the middle of the waiting area there is a counter with an automatic coffee brewing machine, operated by pushing buttons to select your preference and to add cream and such. People who were very sick were following people who were presumably very sick to this machine sharing whatever pestilence they were afflicted with through the manipulation of the machine. Sharon was taken back for an X-ray, about halfway through this ordeal, thus precluding our walking out which was exactly what we wanted to do. I sensed a monumental miscalculation on my part in deciding to use this facility. My fears were confirmed when Sharon was whisked back and confronted by a nurse practitioner who said there was no fracture and told her to see a doctor tomorrow for the possibility of a tear or other soft tissue damage. The nurse said she had no idea how much soft tissue damage there might be.
At this point a very nice gentleman walked in and demanded 627.85 be paid immediately for the services rendered. He had already checked our insurance status and noted that she had not exhausted her deductible, accounting for the charge. Our insurance had negotiated a ER rate of 671.00 as opposed to the normal rate of 802.00. I paid, tendering my MasterCard while standing under a sign that said if you cannot pay the hospital will treat you free. The guidance provided by this sign undoubtedly accounted for many of the folks waiting for care in this ER, as I can guarantee that few of them were prepared to lay 802.00 on the barrelhead.
This event underscores one of the many weaknesses in the delivery of health care. To be sure, my amateur diagnosis and suspicion as to the extent of injury led to our not exhausting the possibility of care at any number of urgent care facilities that we later learned were open. An expensive lesson. A conversation with one of the staff in the hospital resulted in my learning the ER begins to fill immediately after the dinner hour as folks stroll in for their medical needs that most of us handle through a relationship with a primary care doctor. The sign says it all. They will treat you for free if you do not have the money or insurance to cover your care. As I understand it, ER’s are losing propositions for hospitals, irrespective of those of us who chip in to cover the expenses of those who cannot pay.
As a last point. It is interesting that I have endured two surgeries and Sharon one, as well as both of us relying on a PCP and various specialists within the Mercy system. We have never carried a balance for the services provided, immediately remitting all copays and after insurance balances. Our loyalty and track record was of absolutely no interest to the fellow with his hand out Tuesday night.
That is how they roll in the ER!