[Ann Emerg Med. 2008;52:570-571.]
What is the most dangerous pastime in the United States? Of course, it's “minding your own business.” And that is exactly what I was doing one recent Sunday. I am a firm believer in keeping the Sabbath, but not for religious reasons. It gives me an excuse to lie around and “veg out.” Be a couch potato. (Off the subject, but are there any metaphors for laziness with meat in them?)
In any case, on this particular Sunday I was lying on the couch reading a good book and my plans were to stay there for pretty much the rest of the day, except for bathroom breaks. My wife was reading the paper and she casually mentioned that there was a good recipe in the paper.
“Hmm,” I answered carefully.
“It's fish stew,” she said.
“Hmm,” I answered carefully.
There was a pause in this conversation and I thought I had dodged a bullet. But I should have known better.
“I need to have you go to the store,” she said.
Now here was a delicate situation. Should I agree? Should I delay, making her finally go herself in frustration? Should I protest? None of these would be good either in the short or the long run for me. I chose a tentative delay. “What do you need?”
“Roma tomatoes,” she said.
I barely kept myself from asking, “What the hell are Roma tomatoes?” So I thought about asking her nicely what Roma tomatoes were. Maybe we could get into a discussion about the relative merits of various tomatoes, none of which I have the vaguest notion about. Or maybe I could suggest that some of the canned tomatoes in the pantry would be good enough. Again, I knew this would lead to an argument even if I were calm and rational. The best piece of advice I ever received before I was married came from a fellow resident who said, “Never argue about anything unless you are willing to die for it.” I haven't always paid heed, and when I didn't, I suffered. So now I felt boxed in. I could get into an argument or I could just go get the damn tomatoes. That would take less time.
“Okay, let me just finish this chapter,” I answered. Maybe I could sneak in another 2 or 3. Maybe in the meantime she would decide she didn't want Roma tomatoes or fish stew. Maybe pigs would fly. But there was at least the issue of my manhood. So I put my foot down and made a stand. Well, actually, I kept my feet up and stayed down. I tried to finish the chapter. But I couldn't concentrate because I was fuming over why we suddenly needed Roma tomatoes on a Sunday afternoon.
And then it hit me. I have for some time been angry about the ED crowding issue. Angry at the hospital for not having enough beds. Angry at the Feds for the constant pressures they put on the system. Angry that profit often seems to take precedence over care. Angry because it is a complex, seemingly insoluble problem. And it's just a microcosm of the whole system, which seems to be going down the tubes.
But here was something else to be angry about—in addition to having to get up and go to the store, I mean. Another part of the crowding problem is our culture's 24-7 mentality. We expect to be able to get Roma tomatoes, not only on a Sunday afternoon but also at midnight. We also expect to get health care 24-7 too. Even for relatively minor things. I'm old enough to remember that my parents would wait and watch a lot of the time. “His temperature is 106. Let's give him some aspirin and see how he is in the morning [I probably had Reyes' syndrome about 8 times, which explains a lot].” Or, “His ankle looks like a basketball and he can't walk. But there's no bone showing so maybe, after soaking it in warm Epsom salts, it will be OK [probably why I can't jump].” Or, “He just coughed up a lung. Maybe his other one is good enough until morning. Let's put on a mustard plaster [which, by the way, was like having a bonfire set on your chest].” This was a generation who had lived through the Great Depression and World War II. It was fine then because there weren't really any EDs, in the modern sense. There were emergency rooms and that was literally true: one room where a physician on call would see you. Truthfully, there wasn't a lot they could do anyway.
Unfortunately, that waiting and watching was often a bad idea. Times have changed for the better. The real problem is that the ED is the only place that is truly up and running 24-7. After daytime hours the rest of the hospital is less so. Sure we have access to most radiology tests and some specialties on call, but the brunt of the system is on the ED. People show up sometimes for the strangest things. Problems that have been going on for months, or even years, but need attention at 8 o'clock on a Saturday night. People with complex issues who want a second opinion at 6 o'clock on a Friday evening and they don't have their records, scans, or MRIs. Try to get a neurosurgeon or a gastroenterologist to buy into that.
So, now I was really upset. Going to the store would just further this whole entitlement thing. The right thing to do was to refuse. We did not need Roma tomatoes or fish stew on short notice on a Sunday afternoon!
Okay, the culture of entitlement is really only a small part of the problem. But lying on the couch with Roma tomatoes in my immediate future, it assumed some magnitude. And it is a part of the problem.
I looked over at my wife. She smiled at me. I went to the store. The stew was delicious.
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