if at first you don't succeed, skydiving is not for you

I should really have a frequent buyer punch card at the ER. Last night I spent another in a long line of memorable evenings in that bastion of universal healthcare. Fortunately this was Charlotte's first trip, and so the topic of CPS was not broached. I fear the next time Jude needs stitches I'll be sewing on the kitchen table to avoid his relocation to a safer family. Charlotte and I arrived at the cleanest and least busy ER in San Francisco around 5 pm on a Friday and settled in for what I knew would be a long night.

Forget what you may have heard about education; the ER is the great equalizer. An older woman, whose clothing and bags of possessions led me to believe she was homeless, arrived by ambulance as a trauma case.  An SFFD trainee whose finger had been smashed in some sort of work related accident sat to our right. A very well dressed older woman with an infection that would not subside after her escalator fall accompanied by her equally elegant looking husband sat to our left. At one point, a blind man with a cane came in requesting follow-up care after he'd been mugged and stitched up Frankenstein style at SF General the day before. His list of symptoms ranged from vomiting to dizziness to insomnia. I suspected he might be casting a wide net in the hopes of acquiring a place to stay that night, and was grateful that for us the ER was an inconvenient pit stop rather than a comparative mecca of comfort. We were a motley crew of people who would not otherwise mix, bound in a strange kinship by our emergent need for care.

Much maligned, I find that the doctors and nurses in the ER are usually far superior to many I've encountered in civilized offices. Having learned to relate to all walks of life, they seem a kinder, more compassionate group. Many doctors specialize once they begin their careers and lose touch with developments in other fields of medicine, but not those who labor in the grab bag of afflictions. During any given shift one might be called upon to treat a gunshot wound, diagnose a heart murmur or stitch the laceration incurred by a little girl who fell from her bar stool while eating at Pig + Pie. In addition to possessing the skill to treat these varied maladies, ER docs must also deal with frightened people's anxieties, irate people who have waited hours to be seen, and disoriented patients plucked from daily life and thrown spontaneously into the emergency room subculture, all the while prioritizing by severity of injury. How's that for magical medical multi-tasking?

Last night I was presented with the gift of time unencumbered by any expectation or ability to accomplish work. I used it wisely. My daughter and I were together for hours without television, computer or siblings to distract us. We analyzed a bizarre coffee table book of photographs left behind by some previous patient we chose to believe had been cured and released. The aspiring tome created a collective snapshot of life in post-9/11 America for the stated purpose of edifying future generations, a pictorial time capsule of sorts. It's not often that a parent has the opportunity, complete with photographic illustration, to explain wide-ranging topics from botox to the devastation left by tornadoes in one sitting. After perusing the book, we brushed up on our Spanish by eavesdropping on the family behind curtain number three. We laughed, we cried, we braided each others' hair. We hypothesized possible causes for the strange screaming emitted from behind the trauma patient's curtain and applauded the doctor who graciously accepted the gift of the shirt literally taken off a patient's husband's back. The lemonade we created from the lemons handed to us on the floor of that hipster food joint in the Mission was oh so sweet.

In addition to mother-daughter bonding time, the ER bestowed another gem: the chance to reconsider Mitt Romney's revelation that universal health care already exists in the form of the Emergency Room. Initially I was incensed by his idea that those without insurance or resources should be relegated to the infamous and largely avoided ER. Though there is good to be found in emergency rooms, I can't quite imagine them being my primary source of healthcare. Seeking treatment in the ER is terribly time consuming, exorbitantly expensive and exposes one to the dangers of unidentified diseases and potential gunshot wound revenge seekers. I explained to Charlotte that we might be spending our entire evening in the ER to get two stitches requiring, in the end, a mere 20 minutes of our time because emergencies are unplanned, thus treatment cannot be effectively scheduled.  Additionally, while the ER is venue of last resort for insured patients and the wealthy, it is often the only option for the medically underprivileged masses. By the time an uninsured person makes it to the ER, many complications preventable by regular health maintenance have likely occurred, necessitating more costly and time consuming intervention with less probability of success.

Yet upon closer examination there is a nugget of genius to be mined from this proposal, surely unintended by Mitt. We need health care professionals with the multidimensional medical and relational training earned in the ER, care givers who can treat the whole health of a patient in a time and cost effective manner. I'm no doctor, despite the many hours I've logged watching McDreamy, McSteamy, and their far steamier predecessors Kovac and Pratt. Yet even I can think of three ways this might be accomplished off the top of my head. First, require all doctors to return periodically to an ER rotation as Continuing Medical Education. Second, compensate ER service appropriately given the stress of the job and the almost encyclopedic knowledge necessary to successfully diagnose and treat the wide range of maladies presented in this setting. Third, remedy the issue of long wait times in the ER while simultaneously reducing the amount and severity of actual illness by providing those with non-emergent problems effective care sources other than the ER. In other words, back to you, Obamacare.


This same reasoning applies to other unappreciated and undervalued jobs. The two examples that immediately come to mind are parenting and public school teaching, though I'm sure there are more. The world would run more smoothly and with more compassion if everyone were required to take a rotation in the ER of life, prioritizing and solving the widely varied problems of dependent, irate and often anxious people while simultaneously managing the workflow of an institution. Furthermore, those institutions would be more productive if the parents and teachers who labor in them were given the respect, support and compensation they deserve.

Paid for by The Committee to Elect Somebody's Mother and Somebody's Teacher