As I arrived to work I saw that the parking lot and the waiting room were packed. This is not supposed to happen at this place. “I’m getting too old for this,” I mumbled to myself as I dropped my 2am lunch in the frig and grabbed a handful of charts. I’d raced through an hour of charts before it dawned on me that they were filling the rack as fast as I could empty it.

Barry, the senior paramedic, was at the head of the gurney as they wheeled into the trauma bay of our ER. “This guy shot himself,” Barry said. “It’s a mess.” One of the other paramedics pumped on the guy’s chest while a firefighter fumbled to undo the yellow straps securing him to their gurney.

With less access to primary care and multiple gatekeepers adding to the expense of health care, perhaps EPs should be the final stop for many ED patients.

Last spring a group of physicians and medical societies filed suit in federal court to overturn a state law that bans healthcare professionals from asking patients about whether they own a gun. On first blush, it seems like the reasonable and responsible thing to do. The government has no place in telling doctors what they may or may not ask a patient, right? Maybe.

“Did you know that sleep walking will get you disqualified from the Navy?” I asked my wife in response to her usual “What did you do today?” interrogatory. It was drill weekend and I had just finished one of my rare day shifts serving at the Naval Academy clinic.

Over the years I’ve gotten many calls like this one. “Will you look at this case? Something very bad happened and I think someone screwed up.” They seldom say it quite that bluntly, but that’s what they mean.

altOne day, many years ago, I was sitting in front of the television when an emergency news bulletin broke in. There was a major water leak on Broadway and 34th Street in New York City, not far from where our family lived. The camera faded to a big hole in the street with water gushing out of it. There was the usual crew of nine men looking idly on, but in the hole, there was one man digging frantically. His head bobbed up and down, shovels of mud flew through the air.

It was my first night at a new emergency department, so I was just getting used to the system and the people. Everything seemed to be going along smoothly. The staff was great and very welcoming. The patients were pleasant and generally not so sick as to create a stressful first shift.

“Hey sweetheart,” my wife said cheerily as I stared into my coffee. “Today’s your day.”

“Huh?” I said blankly. It had been a long night and all I wanted was to eat my breakfast in peace and go to bed.

“It’s your birthday, silly.

Have you ever arrived at the hospital for your shift with the sinking feeling that the odds were stacked against you? Sometimes it’s a quick look at the ambulances lined up waiting to drop off patients. If I walk by the waiting room I can sometimes get the feeling of whether people are waiting patiently or whether there is a sense of anger and frustration.

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