What’s With Your Emergency Room, You Dog-Faced Pony Soldier?

Matt Bivens, MD
11 min readJan 22, 2022

President Joe Biden personally called a Pennsylvania hospital on Wednesday … when a friend’s wife struggled to be seen …“I was on the telephone with a person at an emergency hospital ward in Pennsylvania because a good friend had called and he had rushed his significant other to the emergency room because this one was having trouble breathing, had a high fever and could not really catch a breath,” Mr. Biden said. “And they got her into the hospital. But the waiting room was so crowded. Things were so backed up, they couldn’t even get her to be seen initially. So, because I knew this person I called. I called the desk, the receiving nurse and asked what the situation was.” — The Independent, October 8, 2021

SWEETIE PIE: Darling, what if it’s COVID?

DARLING: Oh come, we’re vaccinated!

SWEETIE PIE: But Darling, you can still catch it. Even after Moderna, which I must say is absolutely the best.

DARLING: Let’s check your temperature. Checks. It’s 99.5 °.

SWEETIE PIE: For me that is absolutely a fever! My core temperature runs low because I work out so much.

DARLING: (On phone to doctor). It’s the voicemail.

SWEETIE PIE: Ugh, what is the point of all your connections if you can’t reach my doctor?

DARLING: There’s the urgent care.

SWEETIE PIE: Urgent care! But this is an emergency!

DARLING: The ER! Sweetie Pie, are you sure —

SWEETIE PIE: Now you listen to me, if I have COVID we need treatment! Monoclonal antibodies! My sister’s lawyer says they are essential. This is an absolute emergency! I’ll just put on some makeup and we’ll go.

Sweetie Pie and Darling walk into the emergency department.

GREETER: Next.

DARLING: Good evening. We —

GREETER: Taps pencil on sign in window: “Travel, sick contacts, symptoms”?

SWEETIE PIE: Yes, I believe I could have COVID. Now my core temperature runs very low —

GREETER: Wait over there please. Next.

SWEETIE PIE: (Horrified) Do all of those people have COVID?

GREETER: No, they just might have COVID. Don’t worry, each little booth is six feet from the other. Next.

Sweetie Pie and Darling take a hard plastic seat together between plexiglas divider walls. Dozens of other citizens sit in similar booths with chairs. They all look uncomfortable, bored, sullen. A man with wild hair bursts through the double doors that lead into the ER itself, shouting. “Tonight’s the night! I’m gonna kill myself!” Voices back in the ER faintly call to him, “No you won’t!” and “Do it already!” and “Go home Larry!” Sweetie Pie and Darling cling to each other and shrink back as Larry staggers toward them. He lurches past, stops before a vending machine, starts pushing its buttons and muttering. A nurse approaches with a friendly smile.

NURSE: Evening y’all! Let’s check some vitals.

Puts blood pressure cuff on Sweetie Pie’s arm, pulse oximeter on her finger.

SWEETIE PIE: You’re not from New England.

NURSE: No ma’am, I’m from North Carolina. I’m what they call a traveler nurse. They’ve hired about a dozen of us to help out.

DARLING: So you’re on a short-term contract? Hmm, I wonder about the economics of that.

NURSE: They are as sweet as honey, ha ha!

Puts thermometer under Sweetie Pie’s tongue.

DARLING: But isn’t this hospital system negotiating over pay rates with thousands of nurses?

NURSE: Yes they are, and over nurse-to-patient ratios, vacation time, all of it.

DARLING: Ah. So travelers are like strikebreakers? Rather than increase the pay of a thousand nurses by $5 an hour, and be stuck with that cost forevermore, management brings in a few traveler nurses for $150 an hour or something?

NURSE: (crossly). Thank you! But let’s talk about y’all now. What’s our emergency tonight?

DARLING: Oh yes! So, my wife is not herself. For example, for dinner, we had a raspberry chicken dish, and she didn’t eat much of it. We also had asparagus, and some mashed potatoes. She just picked at it. Like she didn’t want it, you see? So I asked her, I said, “Do you have normal taste and smell?” Because they say that COVID-19 will take that away. And she wasn’t sure, but the more she thought about it —

Thermometer beeps and nurse takes it back.

SWEETIE PIE: I can tell it myself Darling! Rolls eyes to the nurse, “men!” So he’s right, I’m absolutely not myself. The raspberry chicken we had is my favorite dish, and do you know I didn’t really want it? There were also these mashed potatoes —

NURSE: Aren’t you two just ADORABLE? Like the only two people on the whole planet, just as cute as two peas in a roomy pod, riffing off each other and gettin’ nowhere fast! Now as things are all cattywampus here in our lil ol’ emergency department, and we do still have some emergencies to attend to, I’m going to hurry you along a bit. Sounds like you’re concerned you might have COVID-19? If all you want is a test, they have a quick in-and-out option, that opens at 8 a.m., and you could certainly come for that in the morning.

SWEETIE PIE: But what about monoclonal antibodies?

NURSE: Oh, we don’t do that here, ma’am. Nope. No ma’am. Your primary care doctor —

SWEETIE PIE: Is useless! Now my temperature at home was 99.5 ° —

NURSE: It’s 98.6 ° here —

SWEETIE PIE: — which for me is a fever because my core temperature runs low.

DARLING: She’s like a lizard that way.

SWEETIE PIE: No, I am certainly not like a lizard!

DARLING: Sorry.

SWEETIE PIE: I’m like a person who works out!

DARLING:

SWEETIE PIE: Who keeps herself in good physical shape!

DARLING: I didn’t mean.

SWEETIE PIE: Unlike some!

NURSE: Ahem. Your oxygen level is also great, it’s 100%. It doesn’t get better than that! It’s a perfect score!

SWEETIE PIE: (Getting angrier). Now something is not right! I know my body, this is not normal!

NURSE: I understand dear. I was just telling you about your vitals. Everyone by law has a right to an emergency medical evaluation. I’m sure we’ll get you back to the doctor just as soon as we can.

DARLING: When will that be?

NURSE: Hard to say. But at least a couple of hours. Remember, we take the sickest first, so if ambulances show up with heart attacks or major traumas or such, they’ll always go ahead. Also, we’re pretty short-staffed — they really oughta hire some more of us strikebreakers!

LARRY (interjecting from his post at the vending machine): They made me wait five hours. Me, a man who could kill himself at any moment — five hours! And no food either until the doctor sees you. Not that she even talks to you for very long. I told her straight up that tonight was different —

NURSE: Go home Larry.

LARRY: OK but I’m coming back in a body bag!

NURSE: Go home!

Larry staggers out the automatic doors. The nurse moves on to the next patient. Sweetie Pie and Darling confer.

DARLING: Five hours! We can’t sit here for five hours! Heck, I’ll catch COVID!

SWEETIE PIE: But my monoclonal antibodies!

DARLING: What antibodies! Sweetie Pie, you heard the nurse. We can come back in the morning for a test, and if it’s positive your primary doctor can order antibodies.

Sweetie Pie and Darling leave, headed back to their car, arguing as they go. In the parking lot, Sweetie Pie pulls out her phone and calls 911.

DARLING: (Horrified) What are you doing?

SWEETIE PIE: She said ambulances go first! Well this is —

911 DISPATCHER: Nine-one-one, what is your emergency?

SWEETIE PIE: (Gasps in fear.)

911 DISPATCHER: Hello? Can you hear me?

SWEETIE PIE: Yes!

911 DISPATCHER: What is your emergency?

SWEETIE PIE: I’m … I’m having trouble breathing!

DARLING: (Hisses angrily). You are not!

SWEETIE PIE: Sshh! And … and chest pain!

Two minutes later, an ambulance pulls up with lights flashing, no sirens. Two EMTs step out. One wearing an N95 mask and a blue plastic gown speaks with Sweetie Pie, the other unloads a stretcher from the back of the ambulance, wheels it over, lowers it to seat-height. They help Sweetie Pie sit. They buckle the stretcher seat belt, raise it to chest-height and load it and Sweetie Pie into the back of the ambulance.

DARLING: Can I ride with you?

PARAMEDIC: Unfortunately in the COVID era we can’t really take passengers. The good news is it’s a short walk.

They close the ambulance door, leaving Darling standing uncertainly in the parking lot. In the ambulance, Sweetie Pie recounts her symptoms. The medics perform an EKG.

PARAMEDIC: Your EKG looks good. Since you have chest pain, my treatment protocol requires that I put in an IV. I have to tell you that the emergency department might take it out without using it. Are you OK with me starting an IV?

SWEETIE PIE: Aren’t monoclonal antibodies given intravenous? If so I will definitely take an IV please!

PARAMEDIC: I don’t think they do monoclonal antibodies in the hospital.

SWEETIE PIE: Well they must have them. I’m sure they use them when it’s appropriate.

Driver starts ambulance. Paramedic places IV. Driver gets on radio.

DRIVER: Medic 4 to St. Jude’s.

EMERGENCY DEPARTMENT: St. Jude’s on.

DRIVER: 38-year-old female, stable vitals, chest pain. Possible COVID-19. Coming from the parking lot. ETA one minute.

EMERGENCY DEPARTMENT: Received.

Ambulance backs up to emergency department entrance. The paramedic opens back doors. Stretcher legs automatically extend as medics wheel it out of ambulance back. The medics guide the stretcher down a long hallway, past overflow beds that line all of the available walls, with people in them snoring, or sleeping with covers over head, or playing on cell phones, or moaning, or just staring. The medics stop next to a nursing station with desks, radios, ringing telephones, beeping telemetry monitors. A tired-looking senior nurse looks up from glaring at his computer screen, glances at Sweetie Pie, turns to medics for a report. Simultaneously a patient registrar approaches with a computer on wheels to take Sweetie Pie’s information and insurance.

SENIOR NURSE: She can go to the waiting room.

SWEETIE PIE: What!? But —

Radio tones loudly. Senior nurse answers it.

RADIO: Stroke alert. 64-year-old male. Last seen well 90 minutes ago. Now with facial droop, dysarthria, right arm weakness, right leg weakness. Not on blood thinners. ETA 5 minutes.

SENIOR NURSE: Received.

As Sweetie Pie tries to get senior nurse’s attention, a second EMS crew approaches with Larry in a stretcher.

LARRY: I’m going to do it Ryan! I bought a knife at the kitchen store, and a rope at the hardware store —

SENIOR NURSE: He can go to the waiting room.

LARRY: What!? No, I need a bed!

EMS crew wheels Larry down hall, with Larry calling out. Emergency department tech removes Sweetie Pie’s IV, places a gauze with tape over, and her paramedics wheel her down same hall. In the waiting room, they lower her stretcher to seat-height, unbuckle the stretcher seat belt, and help her to stand, wish her a good evening, and leave with the stretcher. Darling walks over.

DARLING: (anxiously) What happened?

SWEETIE PIE: (sobbing and furious).What happened? What happened is that I could be dying, but I can’t see a doctor! Not my primary, not even some random ER doctor! And Mister Big Shot, with all of the connections, you’ve done nothing to help me! Nothing!

Back in the emergency department itself, two ER secretaries sit side-by-side at desks. They are answering phones and coordinating requests and communications between doctors, nurses, ambulance companies, patient families, housekeeping, food service and security. They chat with each other between tasks.

ER SECRETARY: (Answers phone.) Emergency department! … Spell the name please? … No sir, we don’t have anyone by that name here … No, that person is not in the ER, not in the waiting room, and not admitted ... All I can do is read what’s in the computer, she ain’t registered under that name … Well I don’t know sir, she’s not my wife. … Well, just because she didn’t answer her phone doesn’t — OK, that’s rude. (Hangs up). These fuckin’ people. I’m all set. Did you hear that —? (Phone rings, answers phone). Emergency department! … We can’t give medical advice over the phone ma’am … People have been waiting 2 to 3 hours to be seen … No ma’am I have no idea if that cream is gonna work … Look ma’am, I’m just a secretary … No, the doctor ain’t gonna come talk to you about your cream. (Hangs up, phone rings, answers). Emergency department! … (Hangs up). Joe Biden my ass. These fuckin’ people. (Phone rings, answers phone). Emergency department! … Hold on sir, I’ll transfer you to the nurse takin’ care of your mom … OK, you have a nice evening too, sir. (Phone rings, answers phone). Emergency department! … Uh huh … No, I dunno if they’ll give you a cab voucher home. If you need an ambulance because it’s a big medical emergency then maybe you shouldn’t be decidin’ whether to come based on whether you’ll get a cab voucher home! … OK. Yeah, whatever. (Hangs up). Dumbfuck. These fuckin’ people. He wants a promise that he’s gonna get a free ride home after he takes a free ride in! (Phone rings, answers phone). Emergency department! … (Hangs up). Joe Biden. You fuckin’ wish you was. Dumbfuck. (Phone rings, answers phone). Emergency department! … Hi John, yeah, Room 6 was a COVID patient and needs a full clean. OK, I’ll tell them, thanks. (Hangs up, phone rings, answers phone). Emergency department! … Larry, you ain’t never gonna kill no one least of all your rat self … No you won’t, we ain’t that lucky. … You know what, Larry, I will buy you some rat poison at Walmart. I got your mailing address right here in the computer. I will mail you a giant fuckin’ crate of D-Con, peanut butter flavor, and a whole case of emergency department ginger ale so you can wash it down, I’ll even throw in that body bag you’re always promisin’ to show up in … (Hangs up). Ha ha, he hung up! These fuckin’ people, I’m all set with that shit. I’m here workin’ my ass off, I got doctors tellin’ me that if I don’t get an EKG fax done right then someone’s gonna die, it’s the most stressful job I ever heard of, and meanwhile my whole paycheck is going to payin’ for Larry to — (Phone rings, answers phone). Emergency department! … Spell the name please? She left without being seen. Oh wait, no, she’s back in the computer, just got here. … No, I can’t tell you how she’s doing, I can’t give out medical information … Nope, all I can share over the phone is whether someone is in the waiting room or the ER, and whether they’re gonna be admitted or discharged, all the rest is what we call privileged, private information … Uh huh … Uh huh … Well why don’t you call her yourself? … Wait, you just said you been talkin’ to her husband, and he’s with her, right? Well, just call him and have him put her on the phone … You know, sir, with respect I don’t gotta figure every little thing out for you … Don’t raise your voice with me, “Joe Biden”, that’s right, I recognized you, you gonna keep callin’ all night? … I dunno MISTER PRESIDENT, it’s like this all of the time now, maybe YOU should tell ME, don’t you got all the smart people? … OK. Yeah, whatever. (Hangs up, phone rings, answers). Emergency department! … If you don’t feel good you can come get seen. No, I can’t send the ambulance for you sir, you gotta call 911 yourself if you want an ambulance. … Uh huh … Well if they did nothing for you yesterday here, I dunno why you think today’ll be different … OK sir, goodnight. (Hangs up, phone rings, answers). Emergency department! …

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Matt Bivens, MD

Born in DC, studied at UNC-Chapel Hill, now living in Massachusetts. ER physician, EMS medical director, recovering journalist & Russia-watcher.