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A perspective on Niagara Falls Memorial’s ER department

By Frank Parlato

Laura Cherry, R.N. has been with the Emergency Department for more than 25 years.

People walk in the main door or they come in through the back on a stretcher from out of an ambulance.

Always in pain.

Chest pain, stroke symptoms (their color ashen; visibly breathing too fast; a numb arm, a facial droop, slurred speech are the telltale signs). Then there are gun shot wounds, stabbing wounds. Burns. Sexual assault. Pregnancy complications. Bad coughs. Someone with tuberculosis vomiting blood. A raw sore throat that won’t go away. Abdominal pain. A child got into grandma’s medicine chest. Another one has a sprained ankle or is it broken? Someone fell off a roof. Someone was injured at work. Another hit by a car.

On a quiet night maybe 10 sufferers are here at any one time. 30 or more when it’s busy.

They are not only locals. The casino seems to send one every day. And during the tourist season people from all over the world who came to see the falls have had their trip interrupted by a medical emergency visit to Memorial. There may not be a country on earth that this community-owned hospital has not treated one of its citizens. And Memorial does it all without subsisting on city, county or state subsidies.

Almost every day there is someone brought involuntarily because police or crisis services believe he or she is presenting psychiatric episodes of anxiety or depression that suggest they could be a hazard to themselves or others. Memorial Hospital has the only psychiatric emergency room in Niagara County.

An emergency room in any hospital is one where quick decisions are always being made. When a patient come in, he is “triaged,” which is French for “sorted,” by the severity of his ailment. It is not first-come, first-served. The least serious matters like ankle sprains, toothaches, sore throats have to wait for the man who just came in clutching his chest.

Then there are those who do not have doctors, who use emergency rooms as a primary care facility. These come here frequently and Memorial has a program to help these get a primary care physician whenever possible. At Memorial, they never turn anybody away. If someone shows up, even if they cannot pay, even if it strikes some that there is really nothing wrong, they are still examined and treated.

“We never say you can’t come in,” said Laura Cherry, R.N., who has worked at this hospital’s ER since 1986 and is now its ER’s clinical coordinator. “Sometimes we get repeat people; twice a day; twice a week. Sometimes people come for attention. Sometimes it’s sad; sometimes it's annoying, but we always see them. We don't want to miss the boy who cried ‘wolf.” You don't want that to happen on your watch.”

If I counted correctly, they have 18 beds and, as I learned, about 30,000 people come to use them in a year. They have two rooms for patients that they can seal and get negative pressure to protect other patients from those who come in with communicable diseases.

These are also used for privacy for gynecological exams or for sexual assaults.

Ms. Cherry has seen hundreds of thousands come and go during her more than 25 years her and she has witnessed all kinds of days.

“I like it busy,” she said, “because it makes the day go faster. I like it slow because that means fewer people have been hurt or are in pain.”

The crash room is a specially equipped room where they have everything needed to resuscitative a patient who might have stopped breathing or whose heart stopped beating.

In the crash room, Ms. Cherry displayed the equipment on the crash cart and she recalled that from out of this room, she went to go tell a family the sad news of someone’s death.

“We have a private room where we deliver the news,’ she said somberly. “We try not to tell anyone over the phone that their loved one has died.”

Overall, the emergency room at Memorial is bright, spacious and immaculately clean. The large central working area encased by glass looks not unlike the bridge of the starship enterprise. It was quiet tonight. On staff was a physician, two physician assistants, four nurses and several aids and a security guard.

“This is a place that can go from 0 to 75 mph in seconds,” said spokesman Pat Bradley who recalled a chemical spill at a local plant that saw 75 people suddenly arrive. “It can be quiet all day and then, in the turning of a heartbeat, that can change.”
Bradley also spoke of how Memorial President and CEO Joseph Ruffolo took the lead in ensuring that the facility was well equipped for natural disasters or acts of terrorism.

“All you can do is plan for the worst, train for the worst and hope for the best,” Bradley said.

Dr. Sanford Glantz was the ER physician on duty today. He had just completed another 12 hour shift. In 30 years, he has spent more than 7,000 days of doing 12 hour shifts, more than 90,000 hours, seeing a half a million or more ailing people.

“Every single week I see something I've never seen before,” said Dr Glantz. “You have to be on your game. In emergency medicine you get to help people right at their worst, their most painful moments, at the time of most fear. Sometimes, it's not a big deal and you can relieve that fear by simply saying, ‘No, you're not having a heart attack.’

“In emergency medicine, you can do wonderful things. You can save lives. And sometimes, even if you don't save them, you can treat the patient compassionately.

“Emergency medicine is a specialty that requires a wide spectrum of knowledge. You are constantly making quick decisions. You must constantly diagnose. For instance, somebody comes in with a stroke. We must determine if this patient gets thrombolysis and gets admitted here or gets transferred to another hospital for some kind of invasive procedure. Decisions must often be made in seconds. A patient needs defibrillating. He goes out in front of you. He might still be awake and you don't have the time to give them a sedative the first time around.”

The commitment is constant.

“I have yet to walk out of any emergency department,” Glantz said, “to go get food. I am not comfortable walking out, leaving the ER uncovered for that 15 minutes.”

Dr. Glantz spoke of a study that suggests that ER physicians are interrupted for the task at hand on average 25 times per hour.
“It’s a juggling act. You start doing one thing and something more critical comes in and you move over and then something more critical comes and you go over to that. Then you go back to the medium critical. When you’re finally back to the first one, there's a phone call. If you manage that juggling act without anyone slipping through the cracks, at the end of the day, you’ve done a great job.”

What makes for a good emergency medicine physician?

“Speed. Speed saves lives. Good bedside manner. An eagerness to treat patients. The ability to handle difficult patients. The ability to handle pressure.”

I asked Dr. Glantz, “Suppose an ER doctor is eating his long-overdue lunch, a sandwich and a guy comes in with moderate pain. He is not in immediate danger. He’s been in pain for the last hour. Does he finish his sandwich or get up and take care of the guy?

“If you just sit there on your duff, you're not a good emergency doctor,” Dr. Glantz replied.

As I left in came a man doubled over in pain. Sheer pain. All the ambitions of life for that man were reduced unquestionably to one: how can I get rid of this pain?

That’s why he was here.

And there they were – our society provides this – a group of trained medical people to triage him – and if it were more than a belly ache – to get him fast treatment.

To diagnose and to treat him.

 

 

Niagara Falls Reporter www.niagarafallsreporter.com

Dec 04 , 2012