Soundings

Emergency room medicine: 2

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7009.881 (Published 30 September 1995) Cite this as: BMJ 1995;311:881
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

    The nurse was pleasant and anxious to help.

    “I am from Thailand,” she said; “but I have a Canadian husband,” she added.

    “Yes, I know Bangkok,” I replied, “I was there several years ago.”

    When I suggested I was tired of waiting, she explained that they had closed nine hospitals in Montreal.

    “Yet 70% of Canadians are satisfied,” she said. “Everybody is equal and all receive the same care.”

    “In your public hospitals in America patients sometimes wait for 12 hours,” interjected another nurse.

    Nevertheless, we were ready to give up. The trouble had started that morning when my wife's knee suddenly gave out. She developed excruciating pain and could no longer bear weight, so I hailed a taxi.

    “To the hotel,” I said, but the Ukrainian driver suggested we should go to the hospital--a good idea, at least in theory.

    Elevators, wheelchairs, old peeling walls. The crowd in the waiting hall cosmopolitan. A veiled oriental woman with a patch over one eye. A couple from Philadelphia, probably tourists. A lady in a sari staring at me fixedly with dark eyes. A very fat woman. A thin black man in a multicoloured striped outfit a la Pagliacci. I registered. It will be $190 for non-Canadians; and I gratefully tendered my American Express card.

    Then we waited. One hour, two. Tennis on one TV set, a rugby union match between South Africa and Canada on the other. At three hours the triage nurse calls us. Takes the blood pressure. Writes things down. “Does the pain radiate? It must be sciatica.” No, I thought, but why argue? Blood pressure 150/66--clearly a badly calibrated automatic machine, but who cares?

    “How long will it be?”

    “Very soon, perhaps another hour,” she says.

    Another hour goes by. My wife wheels herself to the triage nurse.

    “Will it be long? I need to go to the bathroom and cannot get out of this wheelchair.”

    “Get someone to help you,” replies the nurse gatekeeper.

    Four hours have gone by. We are called in. The nurse puts us in a room. There is a dirty crumpled sheet on the examining table and still no doctor.

    Emergencies roll in. A woman with convulsions in childbirth. A man with chest pain.

    “If you had chest pain you would be seen right away,” says the Thai nurse.

    “What if you had a sprained knee yourself?” I ask. “Would you come here or would your doctor see you right away?”

    “Yes, he might talk to me, but if it is not urgent he might not see me for two weeks.”

    By now I have done an examination myself and think it is a sprained hamstring. The nurse brings some acetaminophen. “Could you let me have an elastic bandage?” I wrap the leg, then ask for some crutches.

    The nurse calls the pharmacy. A man from St Vincent brings crutches and adjusts them. “It will be $25 and you can send a cheque later.” I push my wife in a wheelchair to a taxi. I shall be forever grateful to the Thai nurse and to the man from St Vincent. We never saw a doctor, but then there were only two residents on call for the entire emergency room of this famous hospital. Had I had chest pain they would have seen me right away. And for all I know the lady with the patch over her eye and the man in the multicoloured coat might still be waiting in that emergency room.

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