LESSONS FROM ER

Lessons From the ER

Navigating a family health emergency, one policy expert learns it's not just doctors who make mistakes--systems can make them worse.



I held my wife Veronica's hand as the technician applied cool gel to her chest. At first, the ultrasound images were the fuzzy black-and-whites I remembered from before our daughters Rebecca and Hannah were born. After a few touches to the LCD screen, a breathtaking three-dimensional movie began to run. It featured Veronica's heart, its thick walls beating yellow against a black background.

The technician maneuvered a trackball to reveal the various parts undulating in unison. Colored regions displayed blood velocity and turbulence through the different chambers. Suspended in virtual space, Veronica's heart looked every millimeter the impregnable pump I had always assumed it was.

Veronica is 46, does four hard workouts every week on the stepping machine, eats sensibly, and has a resting pulse of 60. So when she woke me at 2 A.M. and calmly reported funny chest pains radiating to her shoulder blades and down her arms, the obvious came to mind, but it was hard to really believe. Veronica and Rebecca had been coughing and feverish for a week. The three of us had embarrassing cold sores. Acid reflux, a sore diaphragm -- anything seemed more likely than a heart attack.

You need a hard head and a soft heart to manage a loved one's medical emergency. It's surprisingly easy for smart people to be nudged by circumstance and human frailty into doing careless or foolish things. We had two sleeping daughters across the hall. The thought of them waking up to flashing ambulance lights was daunting. We worried about leaving them or dragging them to an emergency room. Still, Veronica had never felt anything like this. We had to do something. So we threw on some clothes, and drove to the 24-hour urgent-care center a half-mile from our house.