By Cotton Delo
It was shaping up to be a sleepy afternoon last Thursday in St. Luke’s Hospital’s emergency room on the Upper West Side. Doctors in blue scrubs were tracking their inventory of patients on computer screens and flipping through charts until paramedics called to advise that a patient who’d been impaled in the pelvic area was on the way.
An attractive gaggle of youthful attending physicians, residents, interns and nurses with scarcely a gray hair among them thronged to the trauma room. They slipped on green smocks, set up the gurney and spoke excitedly among themselves like a group of teenagers waiting for a roller coaster ride to start. One nurse cracked a joke about Steve Irwin, the Australian wildlife expert and TV personality who was killed after being impaled by a sting ray.
A few minutes later, EMTs rolled in a stretcher bearing the moaning patient – a man they said was high on crack and had impaled himself on a fence while running from police. The green-smocked ER personnel left off chatting and descended on him with the hierarchical discipline of a military organization.
Public perceptions of emergency rooms have been shaped by NBC’s “ER”, which portrays adrenaline-fueled doctors gamely performing life-saving intubations and eliciting heartbeats from lifeless bodies with hardly a moment in between to flirt with each other. But the reality can be mundane, filled with paperwork and examinations of non-emergency patients who visit the ER when they get sick because they’re uninsured.
Some ER doctors feed off the adrenaline rush of working Friday and Saturday night shifts, when trauma patients are plentiful. But to veteran physicians, treating a gunshot wound may seem like business as usual, while the diagnostic dilemma of figuring out what set of circumstances produced an unusual drug reaction is the part of their work that’s intellectually sustaining.
There’s an ER superstition that warns against uttering the word “quiet” when patients trickle in slowly out of respect for the hell that might break loose at any moment. But prior to the mobilization for the impaled man – who didn’t appear to be seriously injured – the day had been slow.
Department chair Dr. Dan Wiener – a jolly, bearded 50-year-old tennis enthusiast, sat at a computer station shared by attendings, residents and interns. They checked on patients behind curtained partitions and pored over print-outs of lab results while intermittently discussing the World Series champion Red Sox and their Halloween escapades the night before.
“It’s just Stomach Pain Day today,” said one intern with her long, dark hair pulled back in a ponytail, referring to the volume of patients complaining of constipation and diarrhea who’d been admitted.
Among her cases was a man whose skin turned bright yellow and was complaining of sharp abdominal pains. Doctors thought it might be caused by acute pancreatitis, though it was impossible to say definitely until his labs came back. Though Wiener – besieged by entreaties for his directives or his signature on forms from all sides of the room – felt the patient should have been hospitalized, the man insisted on returning home to his invalid mother who was only eligible for a few hours of home health care a day. The only recourse was to write him a prescription for Percocet for his pain.
Decisions like these have to be made quickly since St. Luke’s-Roosevelt’s emergency department is flooded with patients. The ER will serve about 105,000 people this year – up from 59,000 in 1999. In 2005, there were 3.6 million ER visits citywide, according to the Greater New York Hospital Association. Wiener attributes the nationwide surge in ER visits to two familiar culprits: a lack of treatment options for the uninsured and hospital closures – including, most recently, St. Vincent’s in New York.
For all the inaccuracies of hour-long medical dramas, which blithely cram the potential events of a month into a single episode, emergency medicine’s surge in popularity may owe something to them. According to Wiener, “ER” produced a bump in the number of med students interested in emergency medicine and raised the field’s profile for observers who once figured ER doctors were just biding their time to open a private practice.
“People didn’t understand it as a field, and the show definitely changed that,” said Wiener. “All my relatives wanted to know when I was going to become a real doctor.”