The emergency room

I went to the emergency room recently. The head of a tick was embedded in my arm, and I couldn’t get it out. My arm was swollen, red and sore. My GP’s practice—taken over by a conglomerate—doesn’t take “walk-ins.” Heading for the ER, I was aware that this wasn’t an emergency, but what was I to do?

In 2022 there were 155 million visits to emergency rooms, up from 130 million in 2018. With Trump’s cuts to Medicaid, that number is expected to increase. A third of Americans have no primary care physician, up from a quarter ten years ago. In the past, the ER was used for last-resort care. Now it’s become the doctor’s office for millions of people (like me!). Some patients sit in the ER for days—a situation called “boarding”—while they wait for hospital admission.

I read an article about a Columbia University student who fell ill with headaches and chills and went to the ER. The best diagnosis they could come up with was “acute viral syndrome.” They sent him home. He returned to the ER the next day, and after careful examination, they stuck with that diagnosis and sent him home again. Two days later he died in his dorm room. (The cause of his death, according to the autopsy, was “pulmonary hemorrhage of unknown etiology.”) The father sued Mount Sinai Morningside hospital for medical malpractice.

I’ve read lots of books by ER physicians. They work hard. They’re conscientious. They do their best. As one ER doc said, “The spectrum of disease is just unbelievable.” The first job of an ER physician is to treat patients in need of resuscitation. More difficult is determining which patients are in imminent danger, neither obviously dying nor obviously well.

In their high-volume, fast turnover environments, should doctors be expected to follow mysterious blood results over days or phone patients after discharge to check up on them? As one doc said, “Our job is kind of perilous…bad things can happen. It’s on you to be extremely vigilant, and to some extent, lucky.”

Maybe I should buy some lidocaine and instruments and take care of future tick heads myself.

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