There has been a mistake. I was not meant to live in a cold, dark place where the sun sets at 4pm and one spends 3 months of the year fighting the urge to get into pajamas before seven. I am reminded of this as I write from the beach of a Island in Belize where I am lucky enough to spend this week.

I fell in love with scuba diving when I was 22 and bumming around SE Asia. I got certified, and then got some more specialty certifications a few years later in Costa Rica. I am always embarrassed when I say that I dive- it is such an expensive and frivolous thing to do, but I love it. I love being weightless and in a silent, foreign world. I love even more that no one can talk to you. The most one can do is bang on their tank to get your attention and gesture, hoping to be understood. The most I have to do (unless I am about to be eaten by a shark or run out of air) is smile and give the “ok” sign. Dreamy.

ANYHOO, I took the kids on a shallow dive a few years ago and they both liked it so their christmas present this year was the certification course and then this trip to dive. The weather is beautiful and the visibility underwater has been almost perfect. Weve seen Eagle Rays and Moray Eels and all sorts of fish. My only complaint is that food is expensive as all get out here- like, every meal is comparable to a nice meal out at home which we do NOT eat very often because it is so frizzling expensive. I am working hard to be chill and think of it as an extra work shift or two and NOT a reason to stress out on vacation.

I think about work a lot. My mind ruminates on different patient interactions, treatments and scenarios, and wonders why something was done a certain way or if I should have clued in to something sooner. Most of all, I think about the last few shifts before I left. When I say there were no beds in the ER I mean that we had more people on stretchers in the hallways than I had ever seen. We had opened a section called “the chairs” (even though they are also beds in the hallways), which I had never seen used before. There were multiple times throughout each shift where all 3 trauma bays were full and every bed in the department had a body in it. What if there had been a pile up on the interstate? A mass shooting? An industrial accident?

Perhaps more scary than that- what if you or someone you love walked in to the waiting room and were having a true emergency that was hard to detect given what you said and how you presented? All of my amazing colleagues work their butts off to make sure people who need immediate care get it but when you are one person in charge of 50 people in the waiting room, 5 of whom are having psychiatric emergencies that require lots of attention and often security, four of whom are screaming in pain even though they have a hang nail or a touch of ye olde gas, one of whom just puked on the floor and another who has clogged the only two waiting room toilets with diarrhea of a probably infectious nature, and you know that even if you have a very sick person walk in there is no immediate place to send them, the chances of something “slipping through the cracks” increases exponentially.

Administrators tell us that the ED is full because the hospital is full so we can’t get the patients who need to be admitted out of our department and into another. There is lots of talk of staffing shortages at all levels. That makes it sound like it is a problem of the education system, or the hiring mechanisms and while those two things play a part the “staffing shortage” excuse is, overall, a lame one.

We are short staffed because providing health care has become an exhausting, thankless and potentially physically dangerous profession that is run by corporations who care more about their bottom line than about their staff or the patients they purport to serve. On a larger level our health care system in general, from dental to primary to prenatal care, has become inaccessible to so many that we are forcing people to avoid seeking help for easily treatable conditions. They can’t access care for “small” problems like high blood pressure so wait until the problem becoms a full blown emergency. We have patients every day who wait for 5-10 hours to refill a prescription. They have no access to a primary care doctor. These are people who are trying to take care of themselves. They are loosing a days wages to take care of themselves. We sometimes roll our eyes: “can you believe this dude waited so long just for a refill?!” But the truth is they should be lauded for going to such lengths to take care of themselves. They should also be provided with a primary care provider because if they are not (and while the ED we can give you some phone numbers we can do nothing about your insurance situation or the fact that its going to take you 8 months to get an appointment) they will be back every 30 days for the same reason, until they get too frustrated and decide instead to let their blood pressure go untreated. Then we will see them in 18-36 months as a heart attack and, if we are watching our bottom line, that costs a lot more than an in-office med refill.

There are lots of people who study this and know way more than I do but from my scant experience (plus the experience of living with a doctor for the past 20 years) it is NOT a staffing problem and to let it be perceived as one allows those responsible for creating it off the hook way too easily, and leads those looking for solutions down the wrong path.

Rant over.

Happy nursing thought- I was working a few weeks ago and realized that I was sharing my “zone” with two women who have been working there since I spent a day in the ED as a student. I remember looking at them and thinking how smart they were. So knowledgeable and cool under pressure. So kind. So cute in their scrubs. And there I was next to them! Right where I want to be.

Just as I am right now. About to pour a glass of wine and read my book as the sun sets over the ocean.