We’re on our way back from the hospital when we get sent non-priority to a motor vehicle accident for shoulder pain. The accident happened awhile ago, but one of the patients has decided they want to go to the hospital now so we are being sent.

The police direct us to our patient — a man in his early sixties who is taking a small briefcase out of the back seat of his SUV. He is well-dressed in casual clothes, his thinning hair neatly combed. “Yes, my shoulder feels a bit stiff,” he says when I ask him what is wrong. “I banged it against the door. I’d like to get it X-rayed as quickly as possible, so I’d like to go down to the emergency room, if I could.” I glance at his car. The front wheel is pushed in so it is undriveable. There isn’t much other damage.

“Can you do this?” I ask. I raise my arm above my head.

He raises his arm above his shoulder without problem. I press again his shoulder, but don’t elicit much of a response. He denies any neck or back pain. I follow the selective immobilization protocol. “I’m fine,” he says. “Its just my shoulder is a little stiff. Better to get it checked out now, then wait.”

“All right,” I say. “What hospital do you want to go to?”

“Who’ll ever see me quickest.”

I name the closest hospital, and he agrees.

“This way,” I say and we walk back to our ambulance. I open the side door and he climbs in carrying his briefcase.

I’m supposed to put him on the stretcher, but instead, I sit him in the captain’s chair and get him buckled in. I don’t really view him as a patient; its more like he is just a passenger. I try not to show irritation with him. I take his vitals and as we start to the hospital, he asks if it is okay if he uses his cell phone. He explains he delivers meals for meal-on-wheels and with his car out of commission, they will need to find someone to cover his route tomorrow. After he is done with his call, out of curiousity I ask him about his route. He delivers meals to the elderly housing apartments where we so often respond. We probably share many of the same clientel. He delivers one hot and one cold meal. He volunteers one day a week and has for several years now. Its the least he can do to help, he says. The deliveries are made five days a week and on holidays. The people pay five dollars a day for the meals. The meals are cooked in the cafeteria of a large local business.

He asks me about my job. I say I’ve been busy lately — lots of calls, almost non-stop — the hospitals are crowded too. Too many sick people, not enough resources.

“I hope I won’t have to wait to long,” he says. “An x-ray shouldn’t take too long?”

I don’t say anything.

We get to the hospital, we put him in a wheel chair and take him out to the waiting room triage. The room is overflowing. Two security guards wrestle with a ten year old boy who is screaming. No one seems to be paying them any mind. I hand the secrtetary my patient’s information (name, social, date of birth) so she can log him into the computer, and then I wait with him until the nurse can take my report. Just ahead of us the nurse is talking to a woman in a wheelchair who already wears a hospital gown and is recieving IV fluid.

“I’m sorry,” the nurse says. “There are seven people ahead of you for beds. It’s going to be awhile longer.”

“So, you telling me, I can’t get a bed,” the woman says. “You telling me my baby dead then.

“No, it’s just that we don’t have a bed.”

“I’m sitting here in blood and you telling me my baby dead.”

“No, we don’t know that. You’re only ten weeks along. It may be nothing. Whatever is happening is a natural process that we really can’t control. You’re vitals are good. You’re stable. We just don’t have a room yet.”

“I’m sitting in blood and you’re telling me my baby dead. I can’t believe you don’t have a bed for me and my baby. My dead baby. I’m sitting in blood. And you can’t find me a bed.”

My patient, watches this scene silently. For the first time I can see pain in his eyes.


  • born_yesterday says:

    Wow…that is quite a job you have.

  • Pseudo_Doctor says:

    wow talk about a broken health care system….it so need massive overhaul….thanks for sharing I’m a first time commenter long time reader though

  • Anonymous says:

    I’m tired of folks treating the ED as if it was the place for ‘well baby checks’, prenatal care and a place to get free refills for Rx. When someone has a true emergency, they cannot get a bed for four to six hours.How many times have I been told that our ED is on divert or past saturation???

  • Rocky Mountain Medic says:

    Hey,I wanted to let you know that I nominated your blog for an award. I really like it and think you deserve it.More info:

  • Anonymous says:

    We have a lot of regulars that call anywhere from once a week, to as often as 5 times a week. They always want to go. We always take them. They always go to the waiting room at the hospital, and always leave AMA when they find out the wait is a few hours. Most walk out of the hospital, down the street a block or two to the payphone, and call back again. We arrive at the payphone, find their hospital bracelet on, and ask, “Well, which hospital do you want to go to THIS TIME?” It’s another place where they go to the waiting room, sit down, and leave AMA again. Usually by now, they’ve gotten enough money for some booze or drugs, and we don’t hear from them for a few days until they have no food, no money for the bus, and most importantly, no booze or drugs. Repeat the process.I once heard an ER doc telling a story to a new resident. “When I started in emergency medicine, back in med school, I remember my classmates going into family practice saying, ‘Man, why do you want to do that? Don’t you want to have a good relationship and actually get to know your patients?’ Now that I’ve been doing this for almost a decade now, they don’t realize that I see the same patients every week for the same things, year after year. We have more regulars in the ED than they have in their entire practice.”As a paramedic, I never thought I’d see so many regulars either. Driving down the street, I often see patients I’ve run in the past. Their names escape me, but I run them about once every few weeks, which is impressive considering we run thousands of 911 calls a year.Sometimes I wonder, How long can we sustain this insane method of health care in this country? How many patients have racked up $10k, $30k, $50k in unpaid ambulance bills? How many years can we do this? It can’t be many more. There’s just not enough money in the world to continue this insanity.

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