The emergency room at Elmhurst Hospital Center has more than a few frequent visitors.
“We know some of them by their first names,” said Dr. Stuart Kessler, director of the Emergency Department and a 15-year veteran of the hospital. The most familiar are patients suffering from alcoholism, many of whom visit the emergency room chronically intoxicated as often as three times a day and more than 80 times a month. “We will tell them, ‘enough is enough.’ But the truth is, many of them have every full intention of going back and drinking. We know that they will return to the hospital in a few hours or the next day,” Kessler said.
Elmhurst Hospital Center, a public hospital run by the city Health and Hospitals Corporation, serves Queens community districts 1 through 6 — about one million people from Astoria, Sunnyside, Woodside, Jackson Heights, Forest Hills, Corona, Elmhurst, Maspeth, Ridgewood, Rego Park and Long Island City. The emergency room, with space for 65 patients, 60 emergency medicine residents and 25 attending physicians, is a labyrinth of bays, each enclosed by moss green curtains. The ER waiting room, with an entrance and information desk separate from that of the main hospital, bustles audibly in Spanish, Bengali and English.
In many ways, the hospital is a microcosm of the community it serves. It shows at once the diversity of the population and the universality of certain afflictions.
Alcohol consumption is at the top of the list of “neighborhood problems.”
A city Department of Health and Hygiene report released last month found alcohol-related visits to the emergency room reached city highs in the area served by Elmhurst Hospital. In its emergency room, an average of 10 patients every day — or one in 25 — arrive with signs of alcoholism, their sole diagnosis being “too drunk.” Those patients are offered not just medical attention, but a host of psycho-social services through the hospital’s Comprehensive Psychiatric Emergency Program.
“But sometimes, when you see patients for the third time, you don’t give them magnesium again,” said Kessler, referring to a mineral deficiency that occurs in alcoholics because of increased urination. “Nor do you try and persuade them to detox. You just allow them to sleep and when they are sober enough, they leave.”
But alcohol consumption is often trickier business, because it can be the root cause of a host of complex conditions. A man in his 50s might come with liver failure caused by chronic alcoholism; a young man, picked up by Emergency Medical Services from a sidewalk outside a bar with a stab wound, might have been drunk and vulnerable; an emergency call might come from a home where a woman falls off a ladder due to alcohol-induced disorientation.
Or an intoxicated driver might hit a pedestrian.
Pedestrians hit by cars, or “ped struck” as doctors call them, comprise 21 percent of Elmhurst Hospital’s trauma patients. A side door of the emergency room, called the ambulance door, swings open right next to its Level 1 trauma center. Arranged in a semi- circle around the three beds in this room is a jungle gym of medical equiptment — a monitor that shows vital stats and heart rate, shock paddles of a defibrillator, a dangling entanglement of heart sensors, a bevy of test tubes laid out for blood collection, a bright orange case of emergency meds and intubation materials and an overhead X-ray machine. This is where the hospital’s “ped struck” are treated by the trauma team and a host of specialized doctors.
According to the hospital’s Trauma Registry, the number of “ped struck” cases has increased from 155 in 2003 to 256 in 2009.
In Januarylastyear, the hospital hosted its Second Annual Pedestrian Injury Summit, where it released a study showing that Elmhurst Hospital’s cases of traffic accidents involving pedestrians are the highest among seven other city hospitals, including Kings County Hospital in Brooklyn, Lincoln Hospital in the Bronx and St. Barnabas in New Jersey.
Dr. Jamie Ullman, the director of neurosurgery and one of the chief investigators of the study, singled out Queens Boulevard as the main hotspot for pedestrian accidents, noting that speeding and pedestrian carelessness had made this strip the “Boulevard of Death.” Roosevelt Avenue, where the elevated subway line blocks the sunlight, and Northern Boulevard are problematic too, she added.
“We work in pedestrian dense neighborhoods, which is why there is a need to educate people about street safety,” said Ullman, who recommends multi-lingual outreach programs to create awareness about safe crossing, not just through ad campaigns but by using volunteer educators at traffic signals and bus stops. “It is incumbent upon receiving hospitals to raise awareness, because pedestrians with serious injuries, whose average hospital stay is 10 days, are on the rise in our trauma centers. But the fact is, we don’t have enough money and are looking for partners.”
In emergency room lingo, pedestrian injuries are called “blunt” injuries, as opposed to “penetrating” injuries which, as Kessler put it, belong to the “knife and gun club.” While the number of patients with stab wounds — a group five times larger than patients with gunshot wounds — has dropped from 203 to 174 in one year, this category of patients still accounts for nearly 30 percent of Elmhurst Hospital Center’s trauma cases.
“Violence and interpersonal injuries have always been a problem in our neighborhood,” said Anju Galer, the hospital’s trauma nurse coordinator. “But New York City in general suffers from this problem.”
One way in which Elmhurst Hospital’s emergency room is different, Galer said, is in the high incidence of conditions known to be prevalent in some of its dominant populations — Hispanics and South Asians. Heart disease strikes these populations, sometimes at very young ages, owing to high-fat diets.
The hospital recently received $1 million in grant money from Councilman Danny Dromm (D-Jackson Heights) to accommodate a new chest painobservationunit, a one-stop triage and testing center for patients showing symptoms of heart problems.
Doctors say that along with heart problems, diabetes is another ailment that hits Queens’ ethnic communities hard. West Queens’ 2006 Community Health Profile by the Department of Heath and Mental Hygiene found one in 12 adults in the area have diabetes. The disease can present itself in the emergency room as a peripheral neuropathy, which is nerve damage caused by high blood sugar levels, or a kidney disorder.
“It’s not that we do a finger stick diabetes test on a patient who comes to us with an upper respiratory tract infection, only because he is genetically inclined to diabetes,” said Kessler. “But we are more aware of the possibility given the backgrounds of our patients.”
He said the hospital must be especially vigilant because many patients aren’t aware of their health conditions.
“If we had a hospital full of English-speaking American patients, we would do a very different kind of workup,” said Kessler. He explained that language barriers, which may prolong the doctors’ process, are not a major problem since a team of interpreters was available in person or over a three-way phone call. However cultural differences often require the hospital’s doctors to think broadly, he said, citing the simple example of describing chest pain. “When I ask a patient if he has chest pain, he will say ‘No,’ because in his culture, chest pain means a certain kind of pain.” Kessler must ask in many different ways to be sure: Is your chest tight? Do you feel like there’s an elephant on your chest? Do you feel like someone is tightening a belt around your chest?
At Elmhurst Hospital Center, there are many other reasons for doctors to cast a wide net. Patients who travel to their home countries often pick up diseases like malaria or food poisoning. They may even have undergone surgery in a country where the standard of treatment is lower than that expected in the United States.
Still, whether they get sick in their own countries or in America, whethertheyhave a minor condition or a grave one, one third of adults in western Queens don’t have a primary healthcare provider, the city’s Community Health Profile reports. Many families have not seen a doctor in five years, some workers ignore aches and other symptoms because they can’t afford to take a day off, frequently patients don’t fill prescriptions because they can’t foot the bill, undocumented immigrants are often afraid of seeking treatment because they don’t want to be exposed to authorities. For many of the uninsured, the emergency room is the only primary care provider.
The hospital’s ER, one of two in Queens run by the city, deals with everything, from HIV testing to cardiac arrest.
Since St. John’s Queens Hospital in Elmhurst and Mary Immaculate Hospital in Jamaica closed down two years ago, Elmhurst Hospital Center has seen a double digit increases in its volume of patients — 12 percent in 2009 and 15 percent in 2010. Despite workflow improvements and increased staffing, wait times have increased, said Chris Constantino, the executive director of the hospital.
One of the busiest sections of the hospitalis a room called “fast-track,” for patients with less critical problems, like a sprained ankle or a cold.
“But whether the condition is minor or critical, our doctors have to think through everything very thoroughly because many of our patients don’t have any financial or family support after they exit our doors,” Kessler said.
“We are aware that for many people from our neighborhoods, their time in the ER is the only contact with physicians they are going to have,” he added.