Last week I found myself—not for the first time—standing in the ER apologizing to a patient. Not for one of the much studied mistakes that doctors and hospitals make, such as giving the wrong medication or making the wrong diagnosis. I wasn’t even apologizing for being late to an appointment. No, I was apologizing for something much more basic: I had sent my patient to the emergency room, expecting that she would be admitted to the hospital. But the hospital was full. So my patient spent a sleepless night on a gurney in the noise and bustle of the emergency room. I’ve had it happen at every hospital I’ve worked at: As winter begins the hospital fills and the ER becomes a holding area for admitted people waiting for somewhere to rest.
“This ain’t no place for a sick person!” I remember a Korean War veteran saying to me, after a night in the ER. “It’s colder in here than it was when I was sleeping outside in the Army!” And I could not disagree with him. It seemed like an awful place to get better.
I’ve never worked at a hospital that didn’t have a winter overcrowding problem. During my internship the winter hit so hard that part of the ER was converted into a mini-ward, with patients completing their entire hospital stay without ever going to a regular room. It got even worse in the winter of 2003-2004, when virtually every hospital was stretched to capacity. The seasonal peak in hospital visits is a concern from Canada to Australia, and not just because of the discomfort of a night in the ER: Some data suggests that overcrowding is associated with higher death rates in hospitals in summer or in winter months.
What drives this increase in winter ER visits? The answer, in the Northeast at least, is a spike in influenza and respiratory illnesses. These illnesses, particularly among frail people or those with chronic lung disease, often lead to more than just feeling lousy and missing work. They lead to the ER.
The solution, it would seem, is vaccination. The Centers for Disease Control & Prevention recommends this for a substantial population at risk. And without going into a long soliloquy on the whole issue of vaccine safety, I’ll give my two cents: This is an intervention for which, in the vast majority of the population, the benefits outweigh the risks.
And if you don’t worry too much about getting the flu yourself, consider this: You could get someone else sick, someone who ends up in an ambulance, struggling for breath. And I’ll be standing in the ER next year, apologizing all over again.
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