The New York Times
February 19, 2002

Divergent Views of Surviving in the E.R. Maze

By JOHN LANGONE

Medical emergency is unquestionably a harrowing experience for the patient, and it is equally so for the physician who is suddenly called upon to give care. Judgment must be exercised to ensure that the case is indeed an emergency, the right procedures and instruments must be selected, and, above all, the physician must show unflagging confidence in handling a bewildering variety of illnesses and trauma.

These two books take strikingly different views of the emergency room. Dr. Cohen’s chillingly focuses on understaffed and overburdened hospitals and clinics, often filled with moonlighting inexperienced doctors and nurses.

Mr. Humes’s book is about hope, and the efforts, and sometimes miraculous achievements, of the extraordinary healers who work in the neonatal intensive care units, the “baby E.R.’s“

Together, the books shed light on an essential hospital service that can be terrifying and comforting, inept and exquisitely managed, and, ultimately, a place where one’s life is often literally in the doctor’s hands.

Dr. Cohen, a practitioner of emergency medicine and a former clinical instructor at the New York University School of Medicine, makes the disturbing point that though our nation’s emergency rooms save countless lives, patients place their lives and well-being in jeopardy every time they walk, or are carried through, the doors.

There are, he warns, not enough well-trained emergency room physicians to go around, especially in rural and community hospitals; burnout is rampant. Moreover, specialists on call are reluctant to come in because of overwork and underpay.

“If you were about to have dinner with your family after a 14-hour workday,” Dr. Cohen asks, “would you want to rush out the door, hungry and tired? Your desire to leave the house is even less, knowing you may get paid little, if anything, for your efforts.“

Compounding matters, says Dr. Cohen, is that the person who first screens you is often a desk clerk with no medical experience, or a rushed nurse who hurries through a 30-second screening interview.

So what does a visitor do? Dr. Cohen offers several tips: go to an emergency room where the patient’s family doctor has privileges, ask that doctor to guide the treatment either by phone or, if possible, in person; if possible, get to a teaching hospital where specialists are available 24 hours a day; ask whether the treatment can wait for the patient to choose the specialist; don’t go to an emergency room alone but with a relative or friend who can be an advocate; and consider the time of day for less serious problems — Mondays, Friday nights and Saturday nights tend to get very busy.

The author of “Baby ER” is a Pulitzer Prize-winning writer whose newborn daughter spent seven days in neonatal intensive care for a serious kidney infection, which had been caught in time. He captures the drama one may expect in a hospital where premature babies, some no bigger than a can of cola, fight for their lives against birth defects, heart conditions, lung damage and drug addiction.

Set in Southern California at the Long Beach Memorial Medical Center, home to one of the nation’s best neonatal units, Mr. Humes’s narrative follows the infant patients, their families and a remarkable cadre of medical personnel. It is riveting storytelling.

“The most impressive, rewarding, distressing, chaotic, mesmerizing aspect of the N.I.C.U.,” he writes, “is that it never stops. There is never just one story unfolding, never just one life-and-death decision to make, never just one expression of joy or sorrow or bewilderment.”

Mr. Humes introduces his readers to the attending physician who works through the night and well into the morning, surrounded by mounds of patient files.

A colleague says, “Don’t you hate all this routine work?”

The doctor shakes her head and replies: “This isn’t the routine. The babies are the routine. This is the interruption.“

There is the young mother slumped next to her daughter’s incubator and singing softly. Then she whispers fiercely, “We’re going to do it, baby, I promise you that.“

Some nurses complain of how difficult it is to get by on their salaries. “Nowhere can you work harder and longer for less money and respect than here,” says one. “That’s why we love it here.“

As Mr. Humes writes, “The most extraordinary medicine happens here, practiced upon some of the most extraordinary patients there are.”

ER: Enter at Your Own Risk, by Dr. Joel Cohen, New Horizon Press, $14.95.

Baby ER, by Edward Humes, Simon & Schuster, $25.

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