Irrational Triage

The McDonaldization of the ER Process.

Who has time to stand outside in the Manhattan cold in January?  People like me, I suppose.  People who need answers, need them but are afraid to look for them.  A cough wracks my body, and I can feel what seems like each particle of oxygen scraping up my throat before I gasp, sending the icy chill of the air back down.  Surprisingly, the cold invigorates me, braces me up, feeds the hope that is growing inside me that something might be different this time.  The doors swich open with the sound of pressurized air leaving the compartment that has been out local emergency department for as long as I can remember.  I look up while the closest of the people milling about begin to funnel in, and I fall in step behind them, one step closer to an answer that I need.

The waiting room is the most sterile looking place that I have ever encountered.  Even with my eyes closed I could have told you where I was.  That is one of the problems with places like these, the reason so many people avoid them.  It tastes and smells like sickness and death, healing and life.  The walls are white, spotless and shiny, with and ugly stripe around the top of some muted Granny Smith apple green that time forgot and was probably all the happier for it.  The chairs look like they came from one of the exhibits of what was considered "modern" a century ago.  All edges and corner, no stuffing nor padding to ease the pain of those who come here; yet another tactic to get us out the door as quickly as possible.  The floors are an homage to a time long ago, smooth tiles the size of my hand white as lilies fitted together with those as black as the pit.  It looks like every other hospital that I have ever been to, every hospital in the country if that could be believed.  I am bumped from behind as someone pushes through the doorway behind me.  I walk forward quickly to catch up with the group that I entered the lobby with.  

There are computers against the far wall, each in its own booth with its own line waiting desperately to get to it.  These are the machines that may very well tell me what I have been waiting for.  My head is swimming in the warm air of the waiting area, such a change from the oiutside as I gulp in air that is not quite as refreshing as before.  Pain sears through my ribs bringing tears to my eyes as I do my best to fill my lungs.  The elderly man in front of me wobbles to the computer the way that only the anciently old can.  I cross my arms, grasping the bicep of the opposite, to remind myself not to breathe so deeply again.  I try to focus on the area around me, the other lines that are filled with those who waited outside with me: a middle-aged woman in a business suit tapping her foot and typing away on the virtual keyboard she has open under her hands, the hologram screen separating her from the teenager standing in front of her; that teen boy, twitching his hands impatiently, his back bowed and his expression sullen; a mother in line to my left holding a toddler who desperately wants to explore this new place.  "Congestive heart failure," the machine in front of me spouts to the elderly man, "retrieve your prescriptions below, there is no need for you to be seen today."  He shuffles away and it's my turn to step up and see what is in store for me. 

I remember my first trip to this very emergency department a year and a half ago. "Brain cancer, stage 2, inoperable, there is no need for you to be seen today," had rattled out of the machine's speakers and I had to bite back a scream.  The computer had to ask me to leave quite a few times before I could give up the stability of the cubicle wall, give the insistent machine a kick and make my way out the doors.  I step up to the machine again, my hands trembling as I reach my forearm into the hole in the front of the machine.  A whir sounds and a beep lets me know that my implant has registered.  A picture of me pops up on the screen along with the lines of type which I have come to know so well.  Adrienne Leray, age: 19, history of brain cancer, glioblastoma type, stage 2, inoperable.  Every time I see these words, it's a blow to my confidence.  I'll be dead before I can ever really live.  I shake myself as the machine beeps impatiently, the hand pad having extended from the hole that previously read my implant.  I align my hand just right on the pad of the machine, and a sharp pain shoots through it.  The slide retracts and the screen reads, "analyzing."  After a moment the machine pronounces, "brain cancer, stage 2, inoperable, your number is 12.  Please have a seat in the waiting area and you will be triaged by severity; there is a need for you to be seen today."

"What else?" I insist, placing my hands on either side of the screen.  "What else, what else, what else you stupid machine," I manage to scream before I crumple to the floor, fighting for every breathing ripping in and out of my lungs.  "Brain cancer, stage 2, inoperable, your number is 12.  Please have a seat in the waiting area and you will be triaged by severity; there is a need for you to be seen today," the machine blandly replies, "Please vacate the booth for the next visitor."  I brace myself on my hands and knees, still clutching the paper slip emblazoned with the number 12.  I look up and the next person in line, a middle-aged man looking particularly harassed by my outburst, is turning and ungodly shade of puce as I struggle to my feet and stagger to the waiting area.  I collapse into one of the waiting chairs, unable to feel disdain for its lack of comfort in my preoccupation with breathing.  That is what I came here to uncover, that was the answer I sought, the root of my problem.  I can't breathe.  I stare at the computer booths in amazement, has this ever happened before?  Has anyone else ever come here to be told they have what they already know that they have as I have so many times?  From a loudspeaker, a mechanical voice rings out, "Number 12, there is need for you to be seen now."

A door whooshes open, with the same sound of pressurized air, in the corner of the waiting area.  Everyone else in the area looks up at me: two people with notably broken bones; someone bleeding from a gash to hes head, a woman staring blankly at the opposite wall and seven other people in various stages of distress.  Triaged by severity, isn't that what the computer said?  Why am I first?

I walk down the hall as aseptic as the waiting area.  There is a metal archway built into the walls and ceilings, and as I walk through, a peal of mechanical voice addresses me, "Adrienne Leray, age: 19, history of brain cancer, glioblastoma type, stage 2, inoperable, doorway two."  I look down the hall to the seemingly endless hallway of doors and pick the second on the left, a digital 2 displayed on the board set into the metal.  The door slides away to prodouce a room done entirely of white and steel.  The walls are white, the floor and ceiling as well in a sort of solidarity that can only lead me to assume that there had been one heck of a sale on white paint.  The table gleams under a white sheet of paper, the sink a basin so spotless that I could see my reflection in it, and immediately wished that I couldn't.  I walk across the room, shoes clunking on the floor with an eerie lack of echo.  Perching on the side of the table triggers a series of whirs and clicks as the ceiling passes a red beam across my body like a barcode scanner at the supermarket.  "Adrienne Leray, age: 19, history of brain cancer, glioblastoma type, stage 2, inoperable, mental instability suspected.  There is a need for you to be seen today."  Mental instability?  I scarcely have a moment to mull over that pronouncement before there is a tap on the door.  "Miss Leray, I assure you that I am not here to harm you, remain calm if you would please."

The words precede a man into the room.  A real, live, human man.  He is tall in a dress shirt and slacks with small reading glasses and salt and pepper hair.  He looks every bit the polished gentleman and there is not a trace of mechanics about him.  He extends his hand to mine, his handshake warm and firm.  "My name is Dr. Wolfarht, it's nice to meet you Miss Leray."  I stare in amazement, there is a person here, an actual real person that can see, he can understand that I can't breathe, he can listen.  "Hello Dr. Wolfarht, the computer said that I needed to be seen, I think it knew that it wasn't getting the whole diagnosis from the one drop of blood that it took and I was just..." I trail off, he is looking at me like he has never seen someone speak before.  "I see, I see, very peculiar yes," he mumbles looking from me to a read-out screen on the wall.  "Miss Leray this scan says that you have brain cancer, glioblastoma to be exact."  I blink slowly at him," yes I am aware of that," I say, trying to keep my voice from cracking.  "You were asking the triage computer 'what else," were you expecting medication from the machine?"  I take a moment to measure him, to make sure he isn't joking.  "Of course not, there is nothing that you can give me."  His eyes narrow skeptically, "then to what were you referring?"  My heart skips a beat, he's going to listen to me, he knows that the machine isn't omnipotent, "I'm having trouble breathing, sometimes I think that I can't breathe at all."  He refers to the wall chart once again and taps the screen a few times.  A mask appears in the room.  "I want you to place this over your nose and mouth, breathe normally, and tell me if it makes it any better."  I excitedly take the mask from his hands and resist the urge to gulp down the air pouring through the mask, this is...

I awake in a room, a single matress on the floor with a pillow and a blanket.  I am in a stiff gown in a room with a single window.  I hear the soft swish of a door opening and closing.  I stand and hobble to the door, even that exertion leaving me with little breath.  When I touch the door, a mechanized voice informs me that this is, "Ward I, Adrienne Leray, age: 19, history of brain cancer, glioblastoma type, stage 2, inoperable, current delusions and psychosis not otherwise specified, there is no need for her to be seen today."  As my vision begins to darken with my shallow breaths, I hear Dr. Wolfarht exclaim to someone, "And she thought the computers missed something!"

Epilogue

Autopsy #1058, Adrienne Leray, age: 19, dictated by Lester Gideon, M.D.

"Patient is a well-nourished, appropriately sized, teenage girl.  Slight drooping of the left side of the face due to a history of glioblastoma.  At the time of autopsy it is stage 2, inoperable but not immediately fatal.  Patient has no physiologic indicators of psychological disease nor any evidence of any types of self-harm.  Patient has a pulmonary embolism as well as a good amount of fluid in the lung cavity.  There is also evidence of severe pneumonia.  It is likely that this girl felt like she was drowning for some time before her death.  Cause of death is asphyxiation due to fluid accumulation secondary to pneumonia.........It's a shame that they only trust the machines now.  End Report."