A Visit to a Queen's Emergency Room

EmergencyNet News Service
09/22/96 - 14:00CDT - Vol. 2, No. 266

A VISIT TO A QUEENS EMERGENCY ROOM
By Steve Macko, ENN Editor

The future of cash-strapped public hospitals such as Elmhurst Hospital in Queens, New York, are under siege. Many public hospitals in the United States are beset by budget cuts and layoff of staff.

New York Mayor Rudolph Giuliani would like to turn Elmhurst Hospital over to private hands. What would happen after that nobody really knows. But until, and if, that happens the doctors in the emergency room at Elmhurst at committed to treating all who need care at anytime.

Doctor Stuart Kessler, the director of Elmhurst's Emergency Room says that saying the emergency room is "quiet" is bad luck. He said, "You'll jinx yourself. Apparently as soon as you say that, six patients come in -- two with gunshots, two with heart attacks, two in cardiac arrest."

The Emergency Room at Elmhurst Hospital sees about 120,000 patients a year. That averages out to about 329 people a day. Kessler explained, "Emergency room physicians never really know what's going to happen. We could see only a few patients in an hour or two, but then ten or twelve come within the next ten or fifteen minutes." The medical emergencies can range from multiple trauma to heart attacks to strokes to broken bones, allergic reactions and births.

Kessler said that emergency room doctors have to make "life-and- death decisions quickly with less information than the average physician would have."

As we will see, a typical night at the Elmhurst Emergency Room is full of confrontations, bleeding people and even death.

A middle-aged man is brought into the emergency room. The end of one of his fingers has been chopped off. He lies on the gurney with his eyes clamped shut and his teeth clenched. A pool of blood can be seen at the ragged end of right index finger as he points it up into the air. A doctor leans over it with black thread. It will take about twenty stitches to close the wound. A nurse explains that the man said that he was closing his shop for the night when he slammed the sliding door on his finger. Unfortunately, the finger was cut off near the tip. That's where the blood vessels are very small -- replacement of the tip is impossible. The doctor says that if more of the finger had been cut off, it may have been possible to sew it back on.

An unresponsive elderly woman is wheeled into the emergency room. Within seconds, a team of eight medical personnel descend upon her. The team is guided by Doctor Neill Oster, who stands at the base of the stretcher. He calls out his orders urgently and steadily. A rubber strip is twisted around the woman's bicep, a nurse attempts to find a vein in her forearm. On her other arm, a blood pressure cuff is affixed. Six wire leads are attached to her chest that go to a heart monitor.

One nurse says, "A lot of resistance, a lot of resistance." The nurse is trying to squeeze air into the woman's lungs. A doctor comes to begin to work an intubator tube into her.

Another doctor says, "She's about as sick as they come. Her lungs are full of junk and her bloodstream is infected." The woman's eyes are watery and stern and beginning to fade.

Blood is drawn with a needle. The woman's hands begin to shake. A nurse pierces the side of her throat to start an IV line. The intubator tube is too deep. The doctors attempt to pull it above the bifurcation of her bronchi. The woman's feet shudder, her shoulders lunge ipward and she begins to gasp as though she was retching.

At the side of the room, the doctors look an X-ray of the woman's chest. She has a pacemaker located near her shoulder. There's not much more the doctors can do for the woman. Doctor Oster prepares to call the woman's brother. On a table is a letter from the woman, that reads, "I do not want to be put on any life-preserving equipment." The note is properly signed by the woman and two witnesses. Should she go into cardiac arrest, no extraordinary methods will be used to keep her alive. And that's what happened to her less than 24 hours later.

A white-haired man walks into the emergency room and stands beside the stretcher where his brother lies. His brother has a gash on his face. The man on the stretcher notices who is standing next to him and yells, "Get him out of here!" Doctors rush over to the two men. One doctor tries to calm the patient and another escorts the visitor to the waiting room.

The man on the stretcher has blood running along his eye and on his cheek. He says that his four brothers punched him because he was cursing. In the waiting room, two of his brothers are awaiting word about their sibling. They tell the doctor that their brother is on psychiatric medicine and when he doesn't take his medication, he turns wild. he was injured as his brothers tried to subdue him.

Doctor Ralph Finger sits beside a man on a stretcher and lifts the man's bloody head up. Finger feels around the bloody gash at the back of the man's head. The human scalp is more rugged than most people think. This man's head looks like he's working a hole in a pair jeans. Finger declares, "He's got a hole in his head, basically."

The brother of the injured patient says that the man was drunk, tripped and fell. Blood has drenched the victim's hair and the gauze that was placed on his head. Blood drips to the floor. There is blood on the man's shoulders, chest and elbows. Finger asks the patient what happened. The man replies, "Nada."

Finally, an elderly Korean woman who appears to be quite angry is brought into the emergency room. Fire is coming from her eyes. Next to her is a friend who is leaning on a cane and listening with some unease. The elderly Korean woman points at a Korean doctor and speaks in her native tongue. The woman is not happy.

It is explained that the woman called an ambulance because her friend was complaining of knee pain. Since it was not considered to be a very serious medical emergency, the two woman had to wair four hours to see a doctor. After the doctor examined the woman's knees, she was told that she needed to see a rhematologist. That's when the Korean woman lost her temper.

Later, the doctor explained, "Some people use the ER as a clinic." Many people, mostly new immigrants use the emergency room as a means of access to the medical system. They often complain of non-emergency problems, such as coughs, low-grade fevers and other irritations. The problems occur when too many people show up to be treated for colds at the same time as five patients from an auto accident, the doctor concluded.

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