Liveblogging a Visit to the St. James Emergency Room

I was bit by a stray dog last night; it was one of those things. I was walking my dog down the alley between our house and the building next door, and there he was: a big, red lug of a mastiff mutt, about 100 lbs and suddenly interested in us.
I spun my dog — who is unfriendly to most other dogs — right around, but the stray followed us to the back yard. Long story short, I found myself trying to separate the two. My wife, a dog trainer, came out and helped me get the dogs under control, but not before I was bitten by the stray.

She waited for Animal Control while I walked a few blocks to St. James. When I arrived, the waiting room was nearly empty; one person was seated among the 30 seats, all facing an old color TV blaring America’s Next Top Model.

I waited at the triage window for two or three minutes before the woman waiting gestured me towards Registration. Two women in their twenties were there chatting, saw me, and asked me to wait as they called the triage nurse. It was about 7:45 PM.

Ten minutes went by before the triage nurse called me into the office, glanced at my wounds (which weren’t superficial) and filled out a stack of paperwork. I was sent back out to wait for registration.

After another few minutes, I was offering my ID and insurance card to one of the twenty-somethings who was now peppering me with questions. I waited for an opening while she typed.

“Is it usually this quiet?” I had only seen one other family enter the waiting room.

“Yeah. Lately.”

“You mean since the hospital was sold?” She nods.

Back to the waiting room. It’s now 8:30 PM, and it would be another hour before I would see the doctor. No one else has entered the hospital. Whitney, however, is thrilled to be America’s Next Top Model.

“Mr. Walker?” I’m called and escorted into the emergency room. The nurse asks someone with a white coat, “Did you know the dog bite was waiting?” and I’m sent to bed six. I regret not eating dinner.

“No dinero? None?” At the bed next to mine, two staff struggled with discussing travel plans in Spanish with a patient, who apparently was on her way to visit a friend in Kearny. They were astonished that the friend had no phone and no car. They call for the help of a translator and suggest that the patient take a cab out to her friend’s place and ask the friend to pay. After some discussion, they relent, agreeing to charge the hospital for the cab ride.

Staff are moving with a purpose, but are not in a hurry. Somewhere behind the nursing station, a couple discusses gas prices.

The doctor introduces herself at 9:42 PM and asks about my penicillin allergy. She’s not quite sure what antibiotic to give me and has to look it up. My tetanus isn’t up-to-date, either — whose is? — so she tells me I’m in for a long night.

The RN comes back to clean the wounds, so I ask how things have been since the hospital was sold.

“Like this,” and gestures over her shoulder. Work is steady, she says, but manageable.

“Well, sure, you’re still an emergency room here, right?”

“Yeah, but some things we don’t do anymore.” Major trauma, CAT scans, ultrasounds — they all go to St. Michael’s now. “The hospital’s closed: the only thing we’ve got here is the Psych cases, drug addicts and such. But it’s all empty on the upper floors. It’s kind of creepy.”

She finishes and tells me it will be a while before I can get the rabies shots. “They’re sending it from St. Michael’s.”

10:44PM. A boy is carried into the room after having taken a baseball to the temple. He’s been vomiting. The same doctor inspects him and says he looks okay, but is concerned about the vomiting. She walks away announcing, “I have to call the other hospital.”

The nurse comes by to ask some questions and tells me that she called ten minutes ago about my antibiotics and shots. “They said it would be another half-hour.”

I see the triage nurse passing by and ask if there’s coffee around (the coffee at the suburban hospital where my daughter was born was good and free). He shakes his head, “No, nothing like that here.”

11:10 PM, I’m told the meds are here, but the nurse needs to tend to an emergency.

Ten minutes later, the triage nurse does me a solid and comes back with a cup of coffee. Another nurse gives me my second shot, then comes back to do the third, which, she warns, has to be done in the wound. That hurts — a lot — and draws an “ouch!” from the doc walking past looking at my grimace. That shot is followed by a fourth and a fifth.

Returning to my senses, I ask this nurse if things have been slow.

“Yeah,” she makes a face, “we don’t get many ambulances any more. They have a list of things we can’t do and take those cases to St. Michael’s.”

My antibiotics hadn’t come with my shots, so I’m still waiting at 12:17 AM. With iPod Touch in hand, I take a few minutes to reflect on how the sale of St. James affected my care today, and how my experience translates to the community at large.

Before tonight, I had only been to this hospital once before. This was in no way a controlled study, but the day-to-day operations at St. James seem to have taken a turn for the worse, and many of the staff seemed to feel that way, too.

The staff was professional, courteous, and good at their jobs, but it was clear that the process of waiting for supplies and calling for advice from St. Michael’s has taken its toll on their ability to deliver quality care. It wouldn’t be difficult to overwhelm the skeleton crew left to run the emergency room. In the dead of night, the hospital felt like a remote outpost rather than a community service surrounded by thousands of residents.

When the hospital was sold, I thought the worst impact would be some slightly longer ambulance rides for a small group of cases. It’s clear now that what was lost was actually much more dear: that Ironbound residents no longer have a neighborhood hospital they can trust. If they walk in the door here, they’ll wonder whether they’ll be packed up in an ambulance and sent off to someplace else.

It’s an under-reported story that’s not likely to change without some drastic reform — perhaps like another private investor. As residents who are seriously considering a longer stay in the Ironbound, we can only hope that change will come soon.

At 1:44 AM, the nurse wakes me (I had dozed off while waiting): my meds finally showed up from St. Michael’s. She gave me the two pills.

“That’s it?” She seems surprised, and explains that I would need to fill the prescription to get the remaining doses.

I had waited two more hours for two pills when I could have been filling my prescription at Walgreens up on Ferry Street. No one had bothered to explain this to me.

I left my community hospital and walked home.

Author: Ken Walker

Husband, Father, Analyst. In a glass case of emotion since 1978.

4 thoughts on “Liveblogging a Visit to the St. James Emergency Room”

  1. This is a small but vivid account that reveals the state of health care in the U.S. today. Emergency rooms in the “inner city” are not equipped to deal efficiently with problems like Ken’s, which should be able to be dispatched within the hour. In France, for example, a doctor would actually come to your home during regular hours; after hours, you would walk a few blocks to the nearest emergency clinic. Routine. Expected. A right.
    It will take a Democratic President to usher in a single-payer system that all other industrialized nations enjoy but ours.


  2. Zemin-
    When something is free, it makes sense to think that more people will want more of that free thing. Expect wait times to increase.
    Is it even worth keeping St. James open in this case? It obviously is quite convenient; it would be ridiculous to take an ambulance ride to another hospital for something like a dog bite. However, as your experience shows, the wait time is horrendous given under staffing and under supply. This is an issue which is very community based: Ironbound needs some sort of urgent care, however, I think given the state of things, the care they provided was far from urgent. It just is hard to weigh the pros of keeping it open (local care) with the cons being very poor service and capabilities.


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