After a buddy of mine had the poor judgment to choose to be born on the island of Hispaniola, he compounded his ineptitude 30 years later by contracting malaria. Sensitive to my wife's unyielding policy of "no dead guys in the living room," I drove Sebastian to the county hospital where we learned that 1) a fever of 104.1 does not move you to the front of the line and 2) seven hours in the waiting room is more than enough time to tell every joke you've ever heard and 3) if there is ever a good time to become involved in healthcare in a major metropolitan area, Saturday night during a full moon is not that time.

There were a lot of people in the ER. A lot in the sense that there are "a lot" of stars in the sky. Sebastian was endeavoring to get his fever up over 105 degrees so that he could cut the line and receive medical care before the end of the Pleistocene. I was trying to determine the job descriptions and responsibilities of the various uniformed personnel scurrying about, none of whom seemed to be tasked with engaging with actual patients or providing what might have been termed "care."

One woman, whom I will refer to as "the sitter upper" appeared responsible for ensuring that none of the potential patients--either from hunger, fatigue, boredom,  or actual illness--remained face down on the tile floor.

Perhaps there were fire lanes involved as I would suggest that you have attended weddings that weren't as crowded as this cavernous emergency room. You have heard about fraternity parties with fewer supine bodies strewn about every horizontal surface. When I obsequiously responded to "the sitter upper" that Sebastian was too ill to get up off the floor, she replied, "he walked in here, didn't he?"

Point taken.

Let us leave Sebastian's inert and feverish frame slumped over a folding chair (he must have recovered at some point or I would not have been able to leave the hospital to write this newsletter) and consider a different venue. My wife experienced a minor come-apart recently in a small town out west. Dropping her off in the emergency room, I prepared myself for a waiting period equivalent to that required to adopt a child from Central America. But before I could park the car and hurry back into the clean, well-lit facility, my wife was already being attended to by an articulate and compassionate triage nurse. Within moments, eight other medical personnel had poked and prodded, tickled and tested, and provided ultrasound, MRIs, and advice to my stunned spouse.

One of the nurses even went so far as to offer me a soft drink.

The only thing the doctor did not do in one of his four lengthy conversations with my bride was to offer her a foot massage. Whether or not Patti received a mani pedi remains an open question as I dozed off in a comfy chair at one point and can not be certain what transpired during my brief snooze.

That there are differences in the quality of healthcare delivery systems in disparate cities is not news. That it would be cheaper, faster, and more efficient to fly across the country to receive adequate medical attention is worth noting. Even getting through TSA and a four-hour transcontinental flight is more attractive that flopping around on the floor and having your roasting carcass emptied into a chair in the big city waiting room.

Allowing your children to choose the right friends is similar to qualifying for boutique health care. You know those kids who live on the 47-foot boat behind the home of their absent parents, the kids who have no chores or responsibilities, the ones who smoke pot every day before school? Your kids would do well not to spend any time over there. When something bad happens--mortgage the farm, something bad invariably happens when unsupervised 17-year-olds live on a 47-foot boat--it would be well if your kids were elsewhere.

Of course, flying out west every time your buddy decides to contract malaria is as unrealistic as hopping on a flight whenever your kids want to go play. The good news is that whereas malaria befalls an unfortunate, keeping your kids safe from children making absurdly poor choices is easier.

When the kids are little, allow them to choose the friends who play imaginative games and run around outdoors rather than children who are drowning in glowing rectangles. Invite for play dates those kids who understand "we don't do that here" instead of "let's watch another fart video."

When the children are older, take them hiking and camping with peers who don't smoke pot.

Because unlike boutique health care, the good kids are just around the corner. There are families who share your values. You don't even have to travel half way across the country to find them.

3 thoughts on “ER

  1. Charo Oquet

    Fortunately, I was born in the Dominican Republic in the Island of Hispaniola. Yes, it is a small developing nation which has suffered from many of the problems caused by being the first country in the Americas to be colonization and later abandoned by Spain, later occupied and ransacked by England and occupied by the USA. I does not have very good health care for the poor which is mostly free. You don’t have to be a registered to any medical group just walk in. I, myself have used these services in an emergency and like anywhere it depends when you go. I was fortunate and they saved my life. I have horror stories of public hospitals in the USA, which I could write a lengthy article about, but we don’t want to compare these two countries. I live in the USA and I am very grateful for all of the assistance I’ve received here and love this country, but like anywhere else, its far from perfect. A lot depends on how much money you have. While you are badmouthing the DR why don’t you ask people to help this country whose health system is not only taking care of poor Dominicans but also neighboring Haitians, too. I am not saying It has a great government or that it could not be better and that the system could and should not be made to work more efficiently. Yes, the rich everywhere are privileged. What else is new? But I can tell you that I am proud to have been born to a country that gave me so much. A country where the people are kind and intelligent. It seems to be a popular time to put the Dominican Republic down. Before you judge it, go there yourself and see it with your own eyes and meet the people. Don’t listen to those who can only try and compare it to the world’s largest, most industrialized country in the world in efficiency. These people should go to the poor areas of this country and see the deal that poor people here get in the hospitals when they have no money and no insurance.

  2. Mike T

    Lighten up, Charo. I too was born in the Dominican Republic and am proud of it. But if all you secured from this enlightening and insightful blog comment was that you are being disrespected or denigrated, maybe you need a vacation. I suggest the beautiful beaches of the Dominican Republic.

  3. Martin

    It is indeed not clear why David starts the piece by saying that his friend had the “poor judgment” to be born in the DR as the rest of the piece says nothing whatever about the country, not even that he contracted malaria there. Nor is it relevant to the article where his friend was born. I think maybe David was just trying to b cute.

    That said, the contrast between the two Emergency Departments is good, and works as a way of making the point that we have choices in where we go, in who we marry, in who we allow our children to play with… and these can be very important to the outcomes we experience.

    David’s friend was born on Hispanola, but got sick and went, as I read the article, to the Emergency in the city where David lives (Miami).


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