Dispatches From The Emergency Room

I spent my early childhood in a trailer park in Texas so, until I became an emergency physician in Oakland, I thought I knew something about barriers to healthcare access, and maybe even something about poverty. The Emergency Department at the Oakland county hospital has around 75,000 visits a year — say, 200 a day. It has 43 beds; because of overcrowding, there are ‘extra’ patient beds in the hallways, which have ended up being designated as official patient-care areas: first came Hallway 1, then, a year later, Hallway 2, and now Hallway 3 as well. At night the ED usually has one supervising physician with a couple of housestaff — trainee doctors — a student or two, and around ten nurses; there is double supervising cover­age from the late morning through to about 2 AM, the hours of heaviest traffic.