An ER Miracle

If you are expecting a heart warming tale of a miraculous recovery from a serious illness, sorry.  That sort of thing is actually pretty common.  Oh, sure, the first few times you see an apparently comatose patient wake up and look around after you give them a dose of Narcan (reverses opioid overdose) or glucose ( 'cause having a blood sugar near zero ain't healthy),  its pretty impressive.  But this story is about something far, far less probable.

It was a night about this time of year.  There is usually a cold, dark, unhopeful stretch right after the holidays.  It was snowing.  And I was the only doctor working a small ER in Northern Wisconsin.

The ambulance brought in a man suffering from severe depression.  This is of the "no hope, suicidal" variety and as such not something that a pep talk and a prescription for anti depressants that will start working next week is in order.  No, this man needed inpatient psych care.

But there was a problem.  He was a VA patient.

Things have gotten better in recent years but for a long time the Veteran's Administration health care system was legendary for its callous, inefficient, slow nature.  Patients could not get in the door, and if they did they could expect to sit on gurneys in the hallways for a very long time.  Probably it started with the attitude that "You GIs are used to waiting in lines and obeying orders, so just keep waiting around and do what we say".  This of course is not being fair to the many VA employees who cared a lot, nor is it unreasonable to note that some segments of their clientele are patients of the most challenging sort.  For a long time, if you had "better" health care options you used them.  Those who did not, had much higher rates of homelessness, mental health and substance issues.

But that's not relevant to our story.  

The patient was a nice guy.  He was trying to do his best in a situation where he had little support.  He was not one of our "regulars", that challenging cohort whose creativity and tenacity in seeking narcotics was as impressive as it was aggravating.

What I'm about to say next will not be believed by anyone who has ever worked in an ER, or who has had extensive contact with the VA healthcare system.  I understand your disbelief.

Within 90 minutes I had spoken to the nearest VA hospital that had inpatient psychiatric services.  It was in Minneapolis, probably three hours away in good weather, longer under current conditions.  I had him approved for admission, the receiving resident briefed on the details, the records faxed and the ambulance putting wheels to slick pavement.

How is this possible?  That would be a longer story.  But it is always important to know who makes the decisions in any system and what motivates them.  It never hurts to be relaxed and pleasant in your conversations....none of which should be delegated to others.  Most inefficient systems are actually staffed by good people, you just have to appeal to that goodness and encourage them to do the little bit of extra work that their protocols don't strictly require.  

I hope the old soldier did OK.  I never saw him back in my ER, so most likely things worked out.  As a victory over bureaucratic inertia this was way up there in the difficulty level.  But I don't gloat over this one as I have on a few other occasions*.  A simple and sincere thank you from the patient, which I duly passed along to the VA, was sufficient reward on a cold, bleak night.                            ---------------------------------------------

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