How you can help the ER.

Without wasting your life in medical school.

(Air being spliced, four people per tank)

This letter is mostly cribbed from an OpEd I wrote in Canada’s national newspaper, the Globe and Mail about how to show up for your local ER instead of in it (though there are some tips for that too, if’n you do). I added a bit more for you substack peeps though, because I got you like that.

If you want to jump to the original article, paywall and all, it’s here. Paying for journalism is the coolest.

Essay in sec, but I also want to give at least a one-word followup from my last post, preparing as I was for an upcoming operation on my neck: ouch.

Today they scanned me head to toe, again, and I’m waiting on the results to roll in. So far, just the neck imaging. Nothing new. That’s a big relief; it’s already pretty packed in there.

I’ll drop a more fulsome excursion, including how I finessed the post-operative pain (opiate → nsaids → thc → nothing) and what headway I made on the intractable riddle at the centre of our culture, disbelief and fear at aging and mortality.

Hardly any. I would settle for denial, but never got the gift of that, which my psychiatrist and I agree is among God’s greatest.

What else. The ER is swell. A person, hands blue and cold, sits in a chair nodding on fentanyl or xylazine, both. A fat toddler runs around the nursing station, charms us all before his mom scoops him back into her arms, sets him beside his feverish brother. It is nothing but life, beautiful and hard.

Speaking of that, my interminable third book is nearing the end of a first draft. My next step is to print it off, lay the chapters on the floor, and take out the ones that don’t count, quick as can be. Soon I’ll know what I have.

Re: music. Listening hard. It’s the best time of year to do that, so many ‘best of’ lists to be had, including my own. Will pass it mine after New Year’s, as always, via substack. In the meantime, especially if you are a techno fan: got you somethin, a mix from a party I played in Toronto a few weeks back. It’s nice to have two hours to let the energy move up and down a bit.

Where were we…oh yeah, being packed and saving one’s own neck. Here’s how you can help the emergency room by avoiding it if you can, and if not, what to do about the wait. xx.

Emergency rooms are arguably modern society’s greatest invention, though most people who visit would rather not be there. They arrived only decades ago, born of technology too heavy for a doctor’s bag, mass synthesis of adrenalin, and science that proved early attention saved lives. By design, they are available 24 hours a day, all year, because calamity knows no clock.

If, as Dostoevsky suggested of prisons, ERs reflect our collective heart, then ours is overburdened. Many are crowded, with long wait times, the demands within them outpacing a timely response. True emergency cases are surrounded by people accessing other forms of basic care – not just medical, but food, clothing, shelter, even safety.

The effect of a crowded ER is clear: harm. Falling blood pressures fall further with long waits, medical errors rise and attrition of qualified staff accelerates. Respiratory and hospital-acquired infections pass between people, and studies link both crowding and wait times to preventable deaths. These issues constitute emergencies of their own.

This is a “wicked” problem – a challenge with interconnected, dynamic causes and no clear consensus on solutions. If you ask an ER doctor or nurse what contributes most to the stress, you might hear about the shrinking number of beds available to see new patients, because admitted patients are spending days in the ER before there is room for them in another unit. A person in the waiting room might cite the lack of a family doctor.

While an ultimate answer to this wicked problem requires radical health care reform, there are immediate ways the public can help. First, lest it go without saying, we love people and the work we do, so if you need us, we are there. If it’s an emergency, it’s best to come right away or call 9-1-1. If you’re not sure, dial 8-1-1. That number can put you in contact with a professional who can help with the decision. Contrary to rumour, most people are not sent to the ER by 8-1-1. If your problem is not an emergency but still timely, consider your family physician but also walk-in clinics, urgent-care centres or the increasing number of virtual options. Some pharmacists are also trained to prescribe for straightforward conditions.

Should you come to the ER, know that you will be triaged quite quickly, but after that there is often an interminable wait. For the sickest we make space right away. Otherwise, the time of day matters more than most realize. Hospitals, and consequently ERs, run at their highest staffing capacity on weekdays, during business hours. Best to come at 8 a.m. rather than 8 p.m. Mondays are almost always the busiest.

Most jurisdictions estimate ER wait times near you – if you are not urgently sick, consult this info online and choose the shortest wait. When another doctor suggests visiting us, get a note or even have them call in advance. This is especially true if they are sending you to see another specialist; a call may save a visit completely. If none of that happens, it’s okay, we’ll figure it out together.

If you find yourself in the ER, waiting, let it be some solace you are not being rushed in, which is much more concerning. Similarly, if you queue for hours to be told you don’t need antibiotics for a cough or an X-ray of a sprained ankle, please accept it as a rare instance where waiting for nothing was good. Overall, we discharge 80 per cent of people who visit us. Only one or two per cent need resuscitation, but when you see hundreds of cases per day, that can be several people, and they take up much of our time. We get to everyone else eventually.¹

Some colleagues might see a diversion of people from the ER as affecting the bottom line. People are, after all, where the money is, even in a public system. What a day that would be, an empty ER, but we will never see it. Look at the people bunched on the streets or at the borders, waiting for a safe space.

If we did the work for “thank yous,” we’d have left a while back. Still, they matter. ER staff are just people, after all, in thrall to these rooms where anyone can come at any time to ask for help and find it. Maybe one day the medicine will come to you and we won’t need the rooms. Until then, if you find yourself in an ER this holiday season (or anytime), consider writing a note to its staff after you’ve left and just let them how much it mattered, having a place to go.

1. Here’s a template for that letter, taken from one I wrote for my father’s retiring family physician. Feel free to copy-and-paste it, make it your own, get CHAT-GPT to do a pirate-version, just google the ER address and send it!
*
Dr.X/NurseX/Emergency Staff

Address

DATE,

Dear Dr./Nurse/Emergency Staff

I had on my ‘to-do’ list, for ages, a thank-you letter, one that let you know the attention you paid to me/my friend/my family didn’t escape our notice. It was a difficult time but you made it easier. Thank you.

I am particularly reminded of how (PARTICULAR EXAMPLE eg “how you spent time with him, saw him as a human, and something even more rare: examined him” etc )

If you could pass along my best to everyone there, from the people at the front desk, to triage, and the cleaners, the people who make the food, the guards, the engineers who keep the light on, it matters so much having a place to go when your hurt and or afraid.

It seems like hard work, and I bet there are times you wonder if it’s worth it. I won’t comment on that, except to say, the day ended more kindly than it started. Thanks again. It won’t be forgotten.

Sincerely,

NAME

CITY

COUNTRY