The Real Reason You Wait: 6 ER Realities Not Seen On TV
It has been more than 15 years since Clooney starred on ER, and we're still lost in his dreamy eyes (somebody, please, send help; it's so lonely in here). But, real emergency rooms aren't nearly as sexy. If you visit one, it might be the worst day of your life. And that trip might just start by seeing Gabe. Gabe manned the front desk at a Texas ER, making him the first person to assess your condition and the first person to come asking your healthy self for some cash. Here's what he told us:
The First Person You Meet In The ER May Have No Medical Training
Walk into my hospital, and I'll probably be the first person you meet -- a guy whose only qualifications are devastatingly good looks and a high school diploma. I have no medical education, aside from some totally irrelevant training in CPR and the Heimlich maneuver. When you enter the emergency room, frantically asking for help, I'll merely reciprocate with a frantic call of my own into the phone on the desk. And then you and I will just stand there. Waiting.
Even if I know exactly what you need to do, I couldn't tell you. It is illegal for me to advise you (by phone or in person) on anything medical. If someone called the ER asking for advice about the 6-foot metal rod embedded in his skull, I couldn't even say, "Dear God! Get in here at once!" Instead, I would have to say, "I'm sorry, but, legally, I cannot advise you on medical matters. If you think you're having a medical emergency, you can certainly come in. We're here."
One time, a patient came in after having "accidentally" swallowed half a bottle of Ibuprofen. Here is, essentially, what I had to tell him. "You're welcome to sign in if you would like, and we'll see you. You can sit here and wait to see how you feel, and then sign in if you feel ill and we'll see you. You can decide to come back later if you would like to wait at home, then come back and we'll see you. However, legally, we can't advise you one way or another."
We Don't Have To Treat You
Back when we were all debating exactly how many reapers Obamacare's death panels employed, a popular argument was, "We already have universal health care in this country. Anyone can go to any ER and be treated for their illness!" That's not true at all. In short: The ER has to evaluate you. Treatment is a different story.
The Emergency Medical Treatment and Active Labor Act (EMTALA) states that any Medicare-participating emergency center must allow access to its services to anyone, regardless of ability to pay. However, "services" is a relative term. If you are in active labor or one of your arms just fell off, we'll treat you. But, if you aren't in immediate danger of losing life and limb, you get "screened."
You'll be taken to a room and seen by a doctor. He or she will decide whether to treat you, and the decision is based on your condition, sure, but also on our budget. The doctor is making a medical call while trying to limit investment into you. Blood work, X-rays, and the like cost money, and the doctor doesn't want to unnecessarily burden you (or uh ... us) with a huge, impossible debt. When the hospital I worked at started having serious revenue issues, we screened people like mad.
And I was the one who got to give the rejection speech.
"Hello," I would say. "You've been evaluated by our ER physician, as is your right, and she has determined that your condition does not require emergency treatment. If you would like to continue treatment with us, I will have to collect a deposit. Otherwise, I can provide you a small list of free and discounted clinics that can help you."
I once had an uninsured friend who came into our ER for breathing issues. He had pneumonia fairly recently and felt it coming back. Well, the doctor didn't agree. I had to screen him and send him home. Seeing him later, I found out he went to a different ER the very next night and was admitted. What for? You guessed it: pneumonia. The system works!
There's No Escaping Our Bills ... But, You Can Sure Stretch Them Out
I once had a parent who wouldn't sign any consent forms for treating her baby because she had no insurance. She figured if she didn't sign the forms and consent to treatment, she could not be billed. Mind you, she still expected treatment for her baby, which we absolutely provided. The hospital treated the baby even without the form (this is common; consent forms are about as necessary as a smartwatch). A week or so later, she got a bill in the mail. Obviously.
Really, the only way to avoid receiving a bill might be to give us a fake address and fake identity. However, if you don't want to risk committing a crime, and you land with a ridiculous bill (often the result of ridiculously priced items), our hospital would likely be willing to either settle for less money or let you pay stupidly low payments at no interest.
I once had a patient who, every month, sent $20 to a different hospital after visiting the ER for a heart attack. God knows how long she had been paying, and God knows how long it will take her to finish, but hospitals take any payment as a sign of good faith. Something is better than nothing, and if you're a nonprofit (we were), then you ain't kicking $20 out of bed for eating crackers.
This also applied to how I performed the financial screenings, in which we had to determine whether to extend treatment once starting it. Give us something, I would say, sometimes anything, and we'll continue treatment. The minimum payment ranged anywhere from $100 to about $300, but I personally would go as low as possible. "Give me $20 or $10 -- hell, you got a chicken? Maybe they'll go for the barter system -- and I'll tell them you're clear. I just need to show you paid something to your account."
In a weird way, it started to feel like I was trying to extort them for money, only instead of paying me to not break their legs, they were paying me to help them fix their already broken legs.
There's A Reason You're Stuck Waiting For Hours
An ER is bound by a long list of completely finite resources. Whether it's rooms, medicines, equipment, or just staffing, an ER has limitations to what it can handle and the speed at which we can operate. The ER I worked usually had about 12 rooms open overnight, which might dwindle down to eight if nurses got cut early. So, imagine you have 13 identical patients walk into the ER simultaneously with severe heart attacks. Right from the start, someone's not getting a room, no matter how much he or she needs it.
"Fine" you say, "then put them in the hallway or shove 'em in a bathroom or whatever. Just start helping them!" Sure. But then, there's the issue of staff. You don't keep 12 nurses to cover 12 rooms. If we have a full staff, that's one nurse to two to three rooms at best. Then, we have two doctors on staff overnight, maybe only one after 2 or 3 a.m. So, each of those 13 heart attack patients isn't seeing a doctor at the same time, even if their lives depend on it.
So, if you're in an ER waiting room, do try to stagger your heart attacks with the other patients appropriately.
We Have To Examine Patients We Know Are Fine
Maybe you see an emergency room trip as a terrible conclusion to a pretty bitchin' weekend, but a certain type of person comes again and again by choice. An ER's a lot of fun for a hypochondriac who can afford it. Pop in complaining of chest pain, and you'll get an EKG within minutes. Instant gratification!
We had a handful of "frequent fliers" who kept coming in, clutching their chests, but the hospital can't just dismiss a patient outright, even if we know they're full of shit -- because this might be the time they're not. We're like the villagers in The Boy Who Cried Wolf, except we have to roll our eyes and just pretend to believe the boy every single time.
Speaking of ulterior motives for heading to the ER, we once had a patient come in for something pain-related, and we hooked him up with an IV. The nurse set the needle into the vein, set up the drip, and stepped out of the room to attend to other things. This was what the patient had been waiting for. I saw him leave through our lobby entrance, not noticing that he had the needle still in. The guy got away, not just with pain meds like so many drug seekers but with a free port straight into his veins for whatever chemical he had in mind. Letting him run off with hospital equipment was majorly illegal on our part, and this living liability on the streets could be a big-time issue if something happened and it was tied to us. And if he did score himself the easiest fatal overdose ever, it would hardly be the first death to come out of our ER ...
You Might Die Here
You've just arrived at the ER after hearing a loved one has come in. You rush to the front desk, I glance at my computer screen, and I make a phone call. "OK," I say. "Come with me." I walk you all of 10 steps to the "family room," a small waiting area measuring maybe 8 by 10 feet. The doctor enters, tells you your loved one has passed, and leads you to the next room to see his body on a slab.
I knew your loved one was dead from the moment you came to my desk -- my computer listed him as "expired" -- but, I couldn't say anything. I could only follow protocol. And back at my desk, I know the exact moment you hear the news. The family room wall is thick, to block the sound of your crying, but I'm super close on the other side, and I hear every sob.
To some people, the hospital is a magical place. If you survive your issue long enough to get there, you're good -- down a few potions and get those HP back up. But, no. Sometimes, you're just fucked. We had one patient who strolled in, presumably heaved a sigh of relief, and then died before making it to the front desk. Steps away from checking in, he just fell down dead in the lobby. The family was furious that we didn't give him faster treatment, but how could we have? He died literally moments after arriving. When you get sick or injured, you're gambling with cards no one can see. If Death wants dat ass, he'll get it.
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