Vital Signs

THE LUNG X-RAY on the vertical two-foot-by-three-foot monitor, like all lung X-rays, looked like a pair of black wings. But when the physician’s assistant called the doctor over to examine the image, she halted between the syllables of his name. “Gar,” she said, "cia.” The patient had checked in complaining of a cough. “She’s been a smoker for 20 years,” the PA explained, pointing at the screen. In the middle of the left lung appeared 
a white mass the size of a fingertip, an ethereal shape with uneven edges, brighter in some spots than in others, like in purported photographs of ghosts.

“Yeah,” Dr. Gregory Garcia said. The word hung in the room. Highline Medical Center’s chief of emergency services is not one to employ a pregnant pause to convey meaning. No, Garcia is all speech and motion, filling the air with anecdotes and acronyms, arms gesticulating madly. But staring at what could be a lung tumor, yeah was all the doctor had. Only when someone finally asked, “Will you guys mention the C-word to her?” did Garcia speak. “I think we have to. If we don’t at least mention the possibility of cancer, she might ignore the symptoms.”

And with that he grabbed his computer on wheels, his partner in vanquishing all that ails the human body, and rolled it down the hall. Before him lay Highline’s new $28 million emergency unit and four more hours of an eight-hour night shift.

The COW, as ER staff surreptitiously refers to the device (Garcia says they’re actually supposed to call them WOWs—workstation on wheels—“to avoid offending anyone who might think we’re saying they’re a cow”), displays a grid listing every patient in the unit, their name, age, room number, and chief complaint. Garcia no longer chases a maddening stack of papers around a cluttered office; he consults the mobile computer—connected to the hospital’s server—to retrieve patients’ medical records, and review X-ray, CT scan, and blood test results.

Chances are, five months ago, had life thrown an emergency your way—broken limb, heart attack, or mystery cough—Highline in Burien, 10 miles southwest of Seattle, would have been at the bottom of your list, even if you lived in the neighborhood.

The ER, built in 1958, had gone without an update for decades. Designed to accommodate 12,000 patients a year, the 19-bed unit served 50,000 annually, nearly all of whom languished in the waiting area for an hour or more only to be crammed into tiny exam rooms or, worse, a larger room shared with five other patients, just a thin curtain to separate them. An arcane traffic system ruled the cramped hallways, where staff members would flatten themselves against the sickly pink and green walls to yield to rolling hunks of medical equipment.

And the noise. The groans of arthritic octogenarians mixed with the wailing of flu-stricken toddlers. If someone vomited, you heard it. If an embarrassed patient proffered an explanation as to why he might have a rash there, you heard it. Meanwhile, nurses and physicians shouted their alphabet soup of industry acronyms over the whole nauseating din.

The ER was also the bane of ambulance crews. Only two vehicles could fit in the ambulance bay at a time, and drivers had to back down a curved ramp to reach it. Given the option, paramedics often took patients elsewhere.

Plans were in motion to upgrade the ER in the late ’90s, but the economy flatlined. As Seattle-area residents lost their jobs in the 2000s, Highline saw a decline in insured patients and an uptick in uninsured patients, which often meant that the hospital had to put bill collectors to work, stalling its cash flow. In 2009, money became so tight that the hospital laid off 85 employees.

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Published: August 2010