HMOs? Put 'em out of business

I had to take my two-yearold son to the emergency room at 9:30 the other night. A couple of hours after he fell asleep, he suddenly started gagging and struggling for air. He could not talk, his face was drawn in desperation and there were a few moments when it looked as if he was not going to be able pull another breath. His throat was badly constricted from croup.

Experienced parents-my wife and I have four children-may know this syndrome often sounds worse than it is. But it sounds like the child is going to die, and sometimes children do die from croup. Any parents in their right minds, seeing their child in such a crisis, would do whatever it takes to save his life.

As our little boy heaved frantically, almost vomiting in his effort to get air into his lungs, my wife put him over her shoulder and scrambled into the bathroom where she turned on hot water to generate steam. I picked up the phone and punched in the number of our pediatricians.

It rang and rang and rang and rang. Did I get the wrong number? Did their answering service pick up only after the tenth ring?

Who Do You Call?

I finally hung up and dialed again. It rang and rang and rang and rang.

I hung up again and ran into bathroom. Thankfully, the boy had already calmed a bit. His heaving no longer verged on vomiting. Some steamy air was getting into his lungs. "Didn't I tell you," said my wife, "that our pediatricians do not take night calls anymore."

"Well, who are you supposed to talk to then when this happens?"

"They tell you to phone a nurse at the emergency room." By now the little boy's three older sisters were in the bathroom, too. They had been awakened by the sound of their baby brother gagging. "What's happening to Danny?" "Is he going to be okay?" "Is he going to die, Daddy?"

"He'll be okay," I said, not entirely convinced myself.

By now there was a strong rasp in his throat, but he was breathing steadily, no longer heaving.

This was the calculation my wife and I had to make: In a few minutes the hot water would run out, the steam would start to dissipate, and the bathroom would convert to a cold, wet chamber. Maybe that would be no big deal. Maybe Danny was over his crisis and would spend the rest of the night sleeping peacefully. Then again, maybe he would have another attack---only this time there would be no more hot water to create steam in the bathroom. In that case, where would be the smartest place to have him: at home, at the emergency room, or somewhere in between in the back of a car or an ambulance?

It would have been nice to consult with one of our five pediatricians about this. But wherever they were at that moment, one thing was clear: They did not want to talk to me about my sick child. That is why they had contrived to make it impossible for me to reach them.

I would have gladly read the doctor my credit card number over the phone so he could charge me on the spot whatever fee he demanded simply to consult on the best course of care at that moment for my son. I would have paid him more than the going rate for a malpractice attorney.

But this was not an option. Nor was calling an ambulance or 911. If the little boy had another, more severe crisis, one that actually blocked his breathing, what help would it be if paramedics arrived 15 minutes later?

We live only ten minutes from a large hospital. Without a physician to consult, the most prudent course appeared to be to take him there. So we packed Danny and his three sisters in the minivan and drove off.

Wheezing and Whooping

If you walked your kids through the door of a burger joint where the floor was as crusty as the floor in this hospital's emergency room you would immediately turn and leave. Here, where you had no choice, a triage nurse and a clerk hunkered behind a thick glass wall, where they instructed you to sign in on a tablet. Stacked on the counter in front of this wall, handout sheets warned of the five-step admissions-- and-treatment process, of which my wife had just completed Step 1: signing in. The hospital wanted us to know our child was about to spend a considerable time waiting with other wheezing, whooping and oozing people.

Fortunately, Danny's breathing had settled into a consistent rasp, and the girls were so tired they eventually started to fall asleep on lounge chairs that were as crusty as the floor. After about 50 minutes, we were briefly permitted behind the glass wall for Step 2: The triage nurse took Danny's pulse and blood pressure, weighed him and asked us to return to the waiting room.

Step 3 soon followed: We were led into a little office where we proved we had health insurance and forked over $40 in "copay."

While the clerk punched our financial information into a computer we had time to read a poster on the wall. It listed the "Core Values" of the emergency room-aimed at providing the best care in America. Paid up and computerized, we returned to the realm of the injured and the ill to await the illusive Step 4: treatment.

Forty minutes later we were still waiting. I don't think they've brought a single person back for treatment the whole time we've been here," said my wife. I had seen no evidence to contradict her. A few moments later a man whose two- or three-year-old daughter was holding a tissue-paper compress over either her eye or her mouth caught the attention of an emergency room physician who had appeared at a door in the glass wall. I overheard the physician say, "It's going to be a long time."