A Trip to the ER

Two weeks ago, Madam X was eating in a local restaurant when the fillet of flounder turned out not to be: Well. Filleted. 

Madam ended up with a fish bone stuck in her throat. 

The bone refused to be dislodged by a hush puppy, so Madam retreated to the ladies room to try to retrieve it with a finger. No luck. So with nothing else to do, Doctor X took Madam X to the Emergency Room.  

The following is a faithful account of Madam X's adventure as told to me, Growltiger, Madam X's faithful housecat -- and sometimes personal scribe.

A very nice woman at the desk by the Emergency Room door greeted Madam X.
ER Employee Encounter #1.  "What is the problem?" she asks pleasantly.  

Madam X: "I have a fish bone in my throat."

The woman at the desk instructs Madam X to check in with the nurse who was standing at the computer about five feet away who most assuredly could have heard Madam X. The nurse is pleasant and cordial. "What is the problem?" she asks. ER Employee encounter #2.   

Madam X explains she has a fish bone in her throat.

The nurse points Madam X to the admitting clerk sitting behind the same counter at which the nurse is standing.  ER Employee Enounter #3. 

Like the other two employees, the admitting clerk is pleasant, cordial and competent. The admission goes quickly, and Madam X is instructed to take a seat in the waiting area.  

A short time later, an EMT appears and calls Madam X's name. ER Employee Encounter #4.  

The EMT takes Madam X to the treatment area and hooks Madam X up to a monitor that records oxygen saturation in the blood, heart rate, respirations and blood pressure which is naturally slightly elevated since Madam X has a fish bone stuck in her throat. 

The EMT leaves, and a few minutes later, an RN with a pleasant, professional demeanor arrives.  This is the fifth ER employee Madam X has encountered.  "Is everything all right?" the RN asks.

"No," Madam X replies, "I have a fish bone stuck in my throat."

The RN takes a peek, doesn't see the fish bone and leaves. 

After a short, reasonable wait, the ER physician appears (ER employee encounter #6); a tall, striking woman who happens to know Dr. X. who is sitting patiently in a chair hoping he won't have to be sitting patiently most of the night while Madam X is in the OR or waiting to go to the OR to have the fish bone (by now labeled a foreign body) removed from her throat.

The ER physician takes a peek and says, "I see it!" 

Dr. X perks up knowing if the ER physican can extract the fish bone in the ER, there won't be a visit to the OR complicated by a full stomach from the madam having consumed most of a flounder fillet before finding out the flounder wasn't filleted.  

Having spotted the fish bone, now renamed a "foreign body", the ER physician  -- the most expensive employee in the Emergency Department -- disappears to collect the tools and instruments she needed to extract the bone. She returns with a headlamp, an alligator clamp and a tongue depressor. After assembling the instruments on the tray beside the bed, she asks Madam X to tilt back her head and open her mouth at which time she inserts the tongue depressor, depresses the tongue, grabs the alligator and deftly extracts a fish bone about an inch and a half long.

Operation Fish Bone having reached the best possible conclusion, Madam X is discharged...relieved and grateful for the excellent care she received and the quality and pleasantness of every employee she encountered in the state-of-the-art modern American Emergency Department.

Still the experience, happy outcome that it had, illustrates why health care costs have soared. Each ER employee (six in all) required a salary and benefits including social security, Medicare payment to the federal government, employee health insurance and retirement. 

Wouldn't it have been more cost efficient for the employee at the door to have been a triage nurse who either sent the patient straight back to the treatment area or to the admitting desk? And rather than have the EMT attach Madam X to the monitors, could that not have been done by a LPN who having ascertained the patient had a fish bone stuck in her throat then assembled the necessary instruments to extract same once the physician got there? Four employees rather than six? A savings of two salaries and benefits while at the same time saving the physician the time she spent having to gather her own instruments?

Growltiger is no hospital administrator, but perhaps that is the problem. Few administrators have ever worked the Emergency Room when a patient arrived with a fish bone in his/her throat. Administrators work in offices, not on wards, in Emergency or Operating Rooms. Their job is to administrate. And what do they administrate? Employees. Departments. Things, not people. Thus the more employees there are, the more the need for administrators to administrate. Come to think of it, isn't that the problem. Isn't administrative costs what drove up the cost of government, university education, primary, elementary and secondary education, too? And, increasingly, health care?  

Welcome to the United States of Administrators.