Notes From a Weekend in the ER

05/25/2011 11:45 am ET

If you're not a migrainer, you probably wouldn't think of migraine headache as the kind of condition which sends you to the chaos of the emergency room on a July 4 weekend. But in fifteen years of living with a migrainer, I've learned that they live in a different and often terrifying world, one in which every sudden shadow or flashing light can incite the fear that indescribably excruciating pain is just a few minutes away. The panic alone might be enought to elicit, for the rest of us, at least a small headache. For migrainers, that moment of fear is often the first step into a three-day abyss of thudding torment and unwanted psychedelia.

That's a common experience. What isn't common is the eventual six-day term and the constantly escalating pain profile that prompted me to take Bree to the ER at three o'clock Saturday morning. Even less common would be the followup visit to another ER within twelve hours, as the pain regimens which seemed to have worked overnight suddenly exploded in chemical rebound, causing even greater pain than before.

Much of what you see in that setting on a weekend like this confirms in detail what you already know: that the trauma room is inherently intense and challenging, that triaging emergency cases into some logical order of priority is a nightmarishly inexact and unsatisfying science, that people are sometimes at their worst when they are hurting and the people who deal with them have to steel themselves to accommodate that.

Still there were some fascinating insights to be gained. In both cases, these were upscale, supposedly high quality hospitals, the kinds of places you hope to be going to under emergency circumstances. In both cases, the overall feel of the waiting room was entropy. Were it not for the presence of visible security, it wouldn't have been difficult to imagine a riot breaking out. There's a war on between administrators, who have adopted a necessary veneer, and patients and their companions who want to be treated NOW. By the time patients are actually summoned to a treatment area, it is damned near impossible for them not to feel a certain alienation, even antagonism toward their surroundings.

One of the two hospitals was tony Cedars Sinai, hospital to the stars in Beverly Hills. It won't surprise you that they treated four gunshot wounds there in the wee hours of Saturday morning. The second was in suburban North San Diego County, the kind of place you live in to avoid chaos. The average patient in that ER waited about four hours to be treated Saturday night.

But what happens once you are actually escorted into the care system is a cosmic transformation. To witness the ability of doctors, nurses and medical technicians to rapidly reorient patients into a cooperative and willing, even supplicative state is beyond impressive, it's breathtaking. To think they can function coolly in that environment day after day, night after night, boggles the mind.
It impresses upon you that these professionals deserve a system which works better and more humanely, a system that doesn't require them all to earn medals for bravery and serenity every time they go to work.

We have too many people in this country for the number of trauma care facilities and beds available and it's been this way for a long time. It's one thing to read that in the newspaper or on the web and nod our heads, it's something else to go the hospital twice on a holiday weekend and see it close up. We can look at the possibility of improving this and other infrastructures in our society, or we can continue to do otherwise.