Yelp, the company that publishes crowd-sourced reviews on everything from restaurants to car mechanics, has added emergency room waiting times to its review pages. Upon reading that, my mind drifted back to one night more than 35 years ago when I tended to Ms. Washington in an emergency room. It's too bad Yelp wasn't around for Ms. Washington back then.
It was a slow, lazy winter evening and the waiting room was completely empty. I enjoyed working the ER as a physician on the overnight shift. It had a different vibe than the other shifts - less administrative hassle, greater staff bonhomie, and the people working nights were more of a team in their approach to caring for whoever came in. The day shift was rap music, the evening shift was easy listening and the overnight shift was jazz.
I passed the hours reading a medical journal in the main trauma bay, listening to the FM radio disc jockeys. About 4 a.m., a triage nurse informed me that a patient had come in but that it was not an emergency. Figuring there was no hurry, I stopped to get a cup of vending-machine coffee before seeing her.
Ms. Washington was an African-American woman in her late 70s. She had come in alone, in no distress, and was sitting calmly in the examining room when I walked in. I looked her over, took her vitals and made a mental note that it was not an emergency - the kind of case they never talk about on the ER television shows. Taking a history - asking the right questions of the patient and listening to his or her answers - is an art, and given the lack of urgency, I was not focused.
"Ms. Washington, what brought you to the hospital?" "My thumb hurts." "Did you bang it or mash it?" Mash is an all-purpose term for any kind of trauma.
"No, I didn't do anything to it. It just hurts." I looked at her thumb. It looked OK. I was puzzled. Why would someone come into the emergency room at 4 in the morning with a sore thumb? I decided to ask her, a definite impertinence on my part.
"Ms. Washington, I don't understand. Why did you come to the emergency room at 4 a.m. with pain in your thumb?" She immediately took the question as an affront.
"Listen, sonny." She was not pleased and called me "sonny" to show her displeasure. She paused for dramatic effect, sighed deeply and said, "Because if I came at 4 in the afternoon that waiting room would be full and I would have to sit and wait. And then you wouldn't see me until it was 4 in the morning. So I just decided to come at 4 in the morning because I knew I wouldn't have to wait. That's why." There was no denying she was right.
My question was insulting. To Ms. Washington, her sore thumb was as important as any other patient's problem. I made a mental note never to be so presumptuous with a patient again.
Duly chastened, I sat back, relaxed, and took a sip of coffee.
"Ms. Washington. I have all night. I want you to tell me all about your thumb. Take your time, and tell me if there is anything else bothering you." Her demeanor softened and she opened up. I evaluated her thumb - nothing serious - and I decided to use the next several hours to talk about whatever else she wanted to talk about. She told me all about her health problems, her family and her pets.
Maybe she only came to the emergency room to talk in the first place. Some people do that. By 7 a.m. the sun was coming up, and I discharged her as my shift ended. She was satisfied and, albeit humbled, so was I.
As I was leaving, a younger resident approached me and remarked, "You spent nearly three hours with the old lady with the thumb. Why did you waste so much time with her?" To him, Ms. Washington was the old lady with the thumb. It's not unusual for doctors, especially younger ones, to refer to patients by their presenting problems. Depersonalizing, but unfortunately it happens.
"Long story. Tell you about it when we have some time." To this day, in my mind's eye I see Ms. Washington and hear the echo of her words, "Listen, sonny." I wonder what she would have put on Yelp.
Cory Franklin, a doctor, lives in suburban Chicago.