Saturday, July 26, 2008 | At Scripps Mercy Hospital’s emergency room in Hillcrest, doctors see an average of 2.2 patients an hour with everything from gunshot wounds and drug overdoses to urinary tract infections and sore throats.
Dr. Valerie Norton knows that life well. She served as medical director of emergency services at Scripps Mercy for three years until this month, when another doctor rotated into the position. A 17-year veteran of emergency medicine, she remains on duty and spoke with as happened in New York recently). …
And even here in our own waiting room, we’ve had a case where an elderly person was brought in in a wheelchair, and the family said she just wasn’t acting right. There was a line of 10 people waiting to be triaged, and she was at the back of the line. By the time she got to the front of the line, she was dead.
It’s not anybody’s fault, just inadequate resources. I don’t think the family realized how sick she was, that she wasn’t breathing.
Do patients get angry about the wait?It used to be when I first started working here that people would be really angry at the amount of time they waited, even if it was only an hour or two. Now I see people waiting for 4-5 hours, and I apologize for the wait, and they say “It’s OK, we understand.”
I wonder if that’s a nationwide phenomenon, if people are getting so used to the idea that this is a finite resource that they just expect these long waits. … Have we gotten to the point where this is the new norm?
What are you seeing more of that you didn’t see as much in the past?
We’re seeing more MRSA. It’s mostly skin abscesses. We have definitely started to see a real epidemic of that in the last five to six years,
We’re seeing more STDs because people have gotten more complacent about condoms since AIDS became a manageable disease instead of a death sentence. We’ve been seeing more syphilis.
Are there things you’re seeing less of?
It used to be we saw a lot more horrible blunt trauma from car accidents. There’s less of that because of airbags. A lot of people’s lives are being saved by airbags.
And then because the population is aging, we are seeing more elderly who have trauma, mostly from falls — falls at home, in the bathroom, over curbs or steps. Often they have very severe injuries because they’re frail, or they’re on blood thinners.
We’re also seeing fewer horrible complications of AIDS. When I first went into practice, you would typically see several patients in a shift with pneumocystis pneumonia, Kaposi’s sarcoma, thrush, weird fungal infections — really ill.
Because of the fabulous new AIDS medications, and a better network for care of AIDS patients, they’re being managed more as outpatients.
We see them for other things, their ankle sprains and back pain, but it’s unusual to see people for other complications of AIDS until they really get to the end stage when the medications aren’t working anymore.
Are there certain kinds of conditions that ER doctors have gotten better at treating since when you started?
We get EKGs in the ambulance, which we didn’t used to have 10-15 years ago, so we often know when someone is having a heart attack when they hit the ER doors.
We’ve gotten better at treating bad pneumonia and what we call sepsis, septic shock. We are doing better in taking care of people with congestive heart failure and COPD (chronic obstructive pulmonary disease).
Even though patients have to wait longer, they’ll still get the same level of care they would have gotten in the past, right?
Maybe even better because of the advances in medicine. We have better technology and our lab is faster than it used to be. We have better imaging and monitoring equipment than we used to, and better medications.
(Also), people are much more highly trained than they were 20 years ago. In general, you’re going to get excellent care.
Do you ever watch “ER”?
When people ask if “ER” is like your practice, I say it’s like all the worst things that happen in a whole month crushed into one hour.
(In real life), it’s a lot more bread-and-butter medicine — people with a toothache, a sprained ankle, they’re having spotting in the first trimester of their pregnancy, they’re having chest pain but it’s not a heart attack.
That’s 90 percent of our job. The other 10 percent is the really exciting, lights-and-sirens TV-show stuff.
— Interview by RANDY DOTINGA
This article relates to: People