Up All Night

Sitting in a red plastic chair. Hard on the back, hard on the bottom. No sleep is hard on everywhere. The Emergency Room.

We were advised to head there at ten on Monday evening, assured we would get priority care for our genuine emergency. Six hours later we were still waiting.

We had the relative comfort of an isolation room, but on all sides were the cubicles, separated only by curtains, and there were three additional rooms full of patients as well. Not sure which circle Dante would have labeled it, but to me it clearly looked like a scene from hell.

One patient was surrounded by doctors most of the night. He was the real emergency as judged by triage, a gunshot victim. Invaded by tubes, breathing from a mask, he apparently complained as parts of him were being sewn back together. I could see the doctor pulling up the thread, and heard the reply “We’re just trying to save your life here.” By morning he was gone, taken upstairs to another room, I was told. I hope that isn’t some euphemism.

I caught one or two programs of “ER” on TV, but their ER was a tighty whitey version of mine. In the cubicles people moaned, coughed, slept, and displayed body parts better kept private. The aisles between the rows of cubicles were clogged with EMTs, incoming patients on gurneys and police officers and their charges.

The staff and patients were the New York Rainbow Coalition of diversity in race, age, gender and ability. A night on duty must give a fledgling doc an education worth weeks of textbook learning. At one point the announcement came over the loudspeaker,”Area C, prepare for a stroke.” And they did.

The staff remained calm and moved in a pattern that appeared random throughout the night, but which I assume was ordained by a triage algorithm. When we did interact, I was impressed by the humanity and even warmth we were shown.

The aide who wanted to bring me a more comfortable chair (which I foolishly refused, thinking I would be leaving shortly), said that a major problem was people using the ER as their primary care physician, and coming in with a cold. Makes me wonder if the efforts of the ACA (I prefer Obamacare) to remedy this will reduce that load.

Finally after six on Tuesday morning, attention was paid, and the wheels of care and medical support started to turn. But it wasn’t until Tuesday night after ten that a room came free in the hospital. I won’t speculate on how, at that hour. I had left by then to subway home and sleep prone. Care continues.

I’m OK, You’re OK. Or are you?

One New Year’s Eve when we were living in Canada, Phil and I were out with friends. When my phone rang, I assumed it was our daughter Yael with New Year wishes. Instead, it was our daughter seeking advice. Her boyfriend and she were cooking a festive dinner, and when a dish exploded from heat, he had slashed his big toe on a shard. It was bleeding profusely, you could see the bone, what should they do? We insisted that a visit to the ER was called for. He was resisting, because, an aspiring musician, he had no medical insurance. Our Canadian friends sat there dumbfounded. To them it was inconceivable that someone needing medical care could be calculating whether to seek it, based on the lack of insurance. Because all Canadians have medical insurance, paid for through taxes.

In the end he went. The toe required numerous stitches. And he got a bill for $2000. Good luck with that.

I won’t even mention the bill Jon got a few years later for $30,000 for a five day stay when he awoke paralyzed and the cause could not be found. Because he was still a striving musician on a low income, he qualified eventually for Medicaid, and was relieved of that one.

Most notable for us that first night was the reaction of our Canadian friends. They literally could not comprehend the discussion over whether to go to the ER for a serious injury. In their lives they had never had to worry about whether medical care would be available or how much it would cost or who would pay for it. Like the air or the sun, it was always there for the taking, with no discussion needed. It was a right, not a privilege.

We had our own brush with medical disaster with Yael. After her first year of college, she decided she wanted to change schools and go part time, working part time as well. Of course by then, being 19, she was no longer covered by our health insurance and couldn’t afford her own on her minimum wage salary. I think I held my breath for that entire year.

She returned to college full time the next year and was again covered by insurance. That year she had an emergency appendectomy, and the following one an allergic reaction to an antibiotic that landed her in the hospital for five days. I refuse to think what would have happened to all of us if either of these had hit her during her Year Without Medical Insurance.

If you have insurance in this country, you are at least partially safe, so long as the insurance company agrees to pay the bills. Of course if you have a pre-existing condition, you could be turned down. If your employer wasn’t picking up part of the tab, the monthly cost for the premium could be crippling. And if you are a woman, you are charged more.

Obamacare will not be a panacea. There will be plenty of bumps, and it is not a single payer system such as Canada, Australia and England have. But it will smooth out some of those inequities. And if we had it 13 years ago, Yael would have been covered, and I would have been breathing in deep relief that whole year long.