Scenes from a public hospital emergency waiting room.

It’s the first day of spring break for Atlanta’s public school system. It’s a beautiful day. The city staged an amazing concert last night. Gas prices have fallen. The pollen count is climbing.

It’s a perfect recipe for disaster in Grady’s emergency ward. Where I find myself waiting again, freaked out among the freaked out and those who freak out others,  the “New Scum” of a Spider Jerusalem column, the huddled masses a-yearning.

Friends of mine watched the horror show unfold four months ago, as my mother and I explored the wonders of emergency services at a public hospital. We waited about 26 hours for care; six hours before the urgent care center moved her to Grady’s emergency triage system … for another 19 hours.

I started blogging at hour seven on Facebook. Some people found the attendant observations interesting. I was in talks to publish a long piece about it for the AJC, but things broke down after the editors found it difficult to square my background as an activist against the use of their bully pulpit, my time on their payroll be damned.

To spare my mother the exposure — and myself from weird phone calls from family wondering what the hell I’m doing — I’ll spare you the details of what brought us here again. Suffice it to say that my mother — elderly, working class and uninsured — is substantially less healthy now than when we first found ourselves here in December, and arrived in a state of near collapse. We’re not waiting in the waiting room. She’s already in a room … which should be an indication of the seriousness of the situation.

I find myself incapable of doing anything especially productive, so I’ll write instead. I need a better hobby.

14 comments

  1. George Chidi says:

    Let me start by saying that I’m a little concerned about my acute sensitivity to disorder. I fear that it is diminishing. I would like to believe that I’m not growing … well, comfortable seems to be an overstatement; let’s say tolerant … of the conditions and expectations at Grady. But things seem substantially more human in the Grady emergency ward today than they did four months ago.

    The socio-economic mix is decidedly different today. The smell of urine is faint and soft, less a malevolent force than a distant threat. No one is screaming. Two children who look like they might be extras in a Cosby Show episode are playing in the children’s area. I don’t see their parents, but given their demeanor I’m not sure I need to.

    A skinny white kid, maybe 20, with a fauxhawk and a tattoo of a game character from “Street Fighter Alpha” or something hurried in a moment ago in a state of agitation, a bundle of Shonen Knife magazines in hand. Since the front television is tuned to “The Big Bang Theory,” he seems thematically appropriate.

    About 40 people are waiting here, at 7:30 p.m. on a Monday. The waiting room is half full. People have been waiting for about eight hours at the longest — that appears to be the typical time and the target for the moment.

  2. George Chidi says:

    Still, it’s worth comparing the madness of what is considered “normal” here to what might be expected at a place that doesn’t serve the indigent population of Atlanta. I happened to be at Emory Hospital’s emergency ward on Friday.

    The differences between Grady and Emory are stark. Emory is a college campus, not a bus station.

    Emory’s emergency ward has a quiet, beige waiting room. There are 25 comfortable padded beige chairs. The room on a Friday afternoon is half full, and doesn’t really fill up until after six p.m. A pile of well-used copies of the Atlanta Journal-Constitution lay on a matching nondescript coffee table between the rows of chairs, next to a telephone — a regular, non-pay, non-time-restricted phone. There’s a potted plant in a black planter next to the papers. I think it’s a ficus. It had been watered.

    Every single one of these banal courtesies would be laughably out of place in the Grady admitting room.

    Emory sees suffering. A young woman sat across from me at Emory on Friday. She was probably about 23 or 24. Pregnant, no more than 4 months in. And in tremendous pain. She curled up, kneeling fetally on the edge of her seat while her husband consoled her. I spent some time trying to flag down a nurse to get her more immediate attention.

    This observation may seem out of place, but I note it to dismiss it properly: of the 15 people waiting for help at Emory, only five of us were black. Two of them were the couple suffering in front of me.

    The conditions surrounding me at Emory — the relative opulence, the quiet, the relative quickness with which my mother’s information has been taken and her vitals checked — lead me to believe that this couple would be attended to quickly. I recognize now that this was a completely false impression … but I was in a place where such impressions might be conveyed.

    For half an hour while I was waiting at Emory, a harpist played in the hallway. Pachabel, I think. Some Brahms. She is a musical therapist of some sort — a nurse who moonlights as a musician, moving to a different hallway at different times during the day.

    “Did you valet park? Did you park in the deck?” a nurse asked a patient behind me at Emory on Friday. “Next time you come, remember that we will valet park and that you can get validated.”

  3. George Chidi says:

    One may wonder why I’m nattering on about Grady Hospital here, on Peach Pundit of all places, making performance art of illness as though I were Pope John Paul II trying to make a point by suffering in public, or something. We argue politics here, it would be easy to say.

    Well, last time I checked, Grady Hospital — the only tier 1 trauma center serving metro Atlanta and effectively the only hospital serving Atlanta’s urban poor — is facing a multimillion dollar shortfall next year, the result of Governor Nathan Deal’s decision to refuse to expand Medicare access.

    The care my mother is receiving is in all likelihood quite expensive. She is unlikely to be able to cover these costs without help, and is unlikely to be able to adequately repay these expenses in any case. The unemployment check she’s drawing — the result of a lifetime of work foreshortened through no meaningful fault of her own — is enough to make her ineligible for Medicaid while remaining almost completely uninsurable because of her age and condition. She’s just a hair too young to qualify for Medicare. But the alternative to incurring these costs for her is … something I would rather not contemplate while I’m sitting at her bedside.

    While Deal is kowtowing to Tea Party hectoring, the legislative delegation has been pushing a proposal to strip Fulton County of much of its tax revenue, and apparently doing so without adequately describing how the $50 million that the county contributes to Grady’s budget will be replaced. The $50 million that Fulton pays each year for indigent care.

    The $50 million for this.

  4. Rick Day says:

    similar horror stories in Houston. From a friends locked post about her disappearance from Live Journal for 15 weeks Yes, sometimes, I peed in bed. I remember an incident when I was in the toilet (I was in a private room). I rang the bell for help. Since the intercom was over my bed, not in the bathroom, and since the person answering my call didn’t hear me, he decided to NOT have anyone investigate as to why I was ringing the bell and not answering. Duh, I could have been semiunconscious. So, after 45 minutes (I knew that it was 45 minutes because the TV was on Good Morning America, and the time was announced), I threw a garbage can against the door. The noise made a nurse curious to see what was happening and opened the door on me. I was crying. So this wonderful person who joined a profession of compassion and help, looked at me and said that since I was out of control, she was going to leave me there till I composed myself.

    She suffered from whooping cough and Tako-Tsubo Syndrome.

    I don’t know what I would do without the outstanding corporate insurance my spouse provides us. I just don’t know…

    • George Chidi says:

      Corporate insurance. I aspire to this. Damn it.

      I’m probably a month or two of invoices from reclaiming something akin to a middle-class existence.

  5. George Chidi says:

    A thin older man is bouncing around the waiting room. He’s wearing a blue hospital mask like one might wear a bandanna on the prairie, and his pants are slung low in a way that makes one wonder if it’s a deliberate fashion statement or not — I think he’s too old for hipster irony.

    For about 30 seconds, he stood in the corner shouting into the Avaya phone tacked to the wall, the one that is limited by software to three minute calls in exactly the same way one might use a prison phone, and apparently for the same reasons. I think he had been there for at least 10 minutes. Perhaps he made multiple short calls and the last one was irritating.

    Abruptly, he hung up and began hopping around the room. He spun, once or twice, as if to make a point about giving not even a single faint damn, and then stood in front of the nurses station, arms outstretched like a crucifixion, daring her to search him for stigmata.

    What strikes me as odd — what continues to strike me as odd — is how little mind anyone paid to the fellow. It was as though he were a two year old bumbling around the living room during Thankgiving dinner, with the parents and guests keeping him in the corner of their eye while they chat just in case he toddles within arms reach of the good china or the knife drawer. The guard conducting security theater today said nothing. I don’t think the nurse even looked up.

  6. George Chidi says:

    I’m back in the waiting room for a little while. I’m sitting next to a 28-year-old woman from Oakland City, she of the two Cosby Kids. Three, actually; a 12-year-old daughter is at home with her father. Cosby Mom manages a McDonalds at the airport. She’s here because she thinks she has a broken finger, but it may be sprained.

    We’re talking about the comparative state of dysfunction between Hartsfield-Jackson Airport and Grady. She says she sees crazy things every day, but is hard pressed at first to name any of them. “I don’t pay attention to the people. I pay attention to getting food served to people.” But with a little prodding, she submits a list of airport madness and tomfoolery. Fistfights. Thrown food. Temper tantrums from crazy people. Brazen acts of theft.

    She looked up to see someone she recognizes, an older, heavy-set black woman in an inappropriate pink t-shirt who seems out of it. “This lady is from our old neighborhood,” Cosby Mom mentioned. She lowered her voice. “She’s kind of … throwed off.”

    The older woman took to the corner phone. Nothing she said to the person on the other end of the line seemed to compile into an actual sentence.

    “I saw her walking in the Oakland City neighborhood earlier today.” Cosby Mom mentioned. How far is that, I asked? “Well, you have to go to Five Points and switch trains. It’s not walkable to walk here.”

    She does look like she needs help. I wonder in passing how much support she might be getting closer to home. I suspect it is slight. People have enough trouble there keeping their own heads above water without borrowing trouble. But even as the thought passes, it occurs to me that the result is more toleration for human disaster.

    “That’s just life,” Cosby Mom said. “If you could just fix everything, everything would just be life. It would be boring.”

  7. segafamily says:

    If it’s not too personal, care to share why you’ve not provided even a modest level of health insurance coverage to your mother? You appear to have the wherewithal. Additionally, you’ve categorized your mother as “elderly” yet she’s not even 65. You may wish to rethink the modern day definition of elderly. Finally, best wishes from Southeastern Georgia for your mother’s speedy recovery.

    • George Chidi says:

      I really don’t have the wherewithal. Not yet. There’s been a lot of personal and financial turmoil in my life over the last 12 months — more, actually, since I didn’t land one of those lovely high-paid jobs Georgia Tech likes to talk about with its MBA program. The corporate recruiting train passed my station without stopping.

      I’ve been on the financial edge, myself, for about a year. It’s the perils of entrepreneurship. I can see the horizon from here, thanks to new business coming in from a piece I wrote about my competitive intelligence practice for Inc. Magazine, but things have been hand-to-mouth since early last year and got much worse late last year.

      Believe me, I wish I could have. I’m not covered, myself, and I’m quite aware of how dangerous that is … since I wrote a piece about how bad that can be for entrepreneurs. But I just haven’t had the money.

    • George Chidi says:

      And I suppose I’m thinking of my mother as elderly because she’s far more frail now than at any time I can remember. The woman I’m sitting next to is unrecognizable to me compared to the energetic person I’ve known her to be. It’s subjective. You can draw Social Security at 62. AARP starts at 50. The equal opportunity “protected class” rules start at 40. Your call is as good as mine.

      Thank you for your well wishes.

  8. George Chidi says:

    Fulton County’s financial issues with Grady get all the press, but DeKalb County has its own flavor of catastrophe.

    DeKalb County noted in its annual budget report in December. DeKalb’s fund balance budget hit for Grady worsened from negative $1.3 million to negative $2.9 million last year. Right now, DeKalb is planning to use a bond refinancing to skate its Grady funding shortfall until next year. The accounting maneuver appears to create an $8 million shortfall in bond payments covering DeKalb’s hospital debt.

    “A major policy proposal to refinance bonds connected with Grady hospital may be a short-term gain in 2013 putting additional pressure on 2014,” notes the 2013 budget analysis presented to the DeKalb commission in January.

    “While rates are at a historic low, it is the deferral of payments for one year which may cause a short term saving with an extreme second year impact. Supporting documentation for the general obligation debt repayment funds indicates that there will be no tax revenue for Fund 41013 in 2013 and a small increase to the amount collected in real property taxes in Fund 411, despite other documentation indicating that all tax rates would stay the same except for the General Fund. These proposals seem to contradict each other.

    “These figures technically balance against the proposed spending for Funds 410 and Funds 411. However, there is no listed significant decrease in expenditures in either bond fund from 2012 to 2013. There is a proposed increase in the budgetary reserve in Fund 410 leaving $5.8 million at the end of the year. Fund 411 shows no budgetary reserve remaining at the end of 2013. There is a more drastic swing readily apparent in the fund which pays the debt for Grady. Its budget decreases from $19.1 to $11.4 million. The entire decrease is in the line item for debt payment. On the revenue side of the equation, total tax receipts go down from $20.5 to $14.3 million, despite the millage staying the same.

  9. George Chidi says:

    Unlike last time, I find myself in Grady’s “Red Zone,” designed to treat major and minor trauma patients, though any patient may be evaluated in this area. Two large trauma bays, with the capacity for four simultaneous major trauma patients, anchor this area. This area also has general care rooms, an orthopedic room, a gynecology evaluation room, and an eye, ear, nose, and throat room. All rooms are capable of cardiac monitoring.

    There are 15 people receiving treatment in the general care rooms. It’s quiet. The staff here say things have been quite typical for the weekend and a Monday. There’s some surprise among the staff, but only a little. Predictability is a problem. One might think that the Final Four, the weather and the first day of Atlanta schools’ mid-semester break would combine into something absurd in the emergency ward, but apparently not.

    Wait times for treatment have been hovering between four and eight hours — nothing like the 24 hour odyssey on a waiting room chair in December.

  10. John Konop says:

    George my family will say prayers for your mother……our healthcare system needs an overhaul…..you cannot talk free market when your health and or life is at risk……

  11. George Chidi says:

    One of the themes I’m planning to write about over the coming months will be how different people accept disorder — operational disorder, social disorder, political disorder, economic disorder — as a normal thing. Somehow in certain circumstances, we’ve allowed ourselves to believe that certain problems are intractable, or tolerable, or merely irritating and should simply be accepted … but only in certain contexts. What might be acceptable in downtown Atlanta would be cause for town hall meetings, stern sermons and Kickstarter projects in parts of Roswell or Suwanee. And vice versa.

    George W. Bush’s linguistic quirks have been much maligned over the years, but he got one phrase dead on: the soft bigotry of low expectations is a real thing.

    Two people catching a smoke on the smoking benches next to the McDonalds outside of Grady — and, boy, that image alone juxtaposed against the city’s hospital speaks to a kind of dire fatalism — said that the last time they were out there, a man was sitting at the end of the benches with binoculars, peering at people walk into and out of the hospital. He may have been looking for someone who gave a damn, but I suspect he left disappointed.

    There’s a cost to indifference to madness: it creates resistance to change. We find ourselves justifying how inured we’ve become. We justify inaction as a rational choice. We engage in a kind of consistency and confirmation bias, looking for the data that explains why, for example, no one thinks to ask the fellow who appears to be slipping in and out of a diabetic coma outside of the McDonalds if he needs immediate medical attention. “It’s Grady. This is normal. Someone must be on it already. But, ma’am, I don’t want to supersize it today. That would seem inappropriate.”

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