working in the ghetto

I was thinking how much my ER has changed over the years. When I started, even though we were in the middle of a poor neighborhood, we were more like a suburban ER.  Our clientele was more suburban, white, very few neighborhood folks came in.  They went to another hospital in the neighborhood.  Then that hospital closed.

More neighborhood people starting to come in, but a lot of them still went to the county hospital downtown. I think eventually they figured out that if they came to us, the wait was less. They also figured out the chance of scoring some narcs was higher with us.

Now our ER has become what it always has been: an inner city ER in the middle of the ghetto.  We see lots of neighborhood people now.  We are seeing more of the folks living on the edge of society: drug users, criminals, drunks. People you would expect an ER in our location to see.  Its not unusual to have a heroin OD in one room, a crackhead in another and some guy getting arrested in yet another.

The rest of the hospital still maintains its suburbanite feel for the most part.  The areas of medicine that the hospital specializes in attract people from all over for admission. The specialties are where the money is in medicine. Thats where the money goes.  Those areas are brand new.  They have to be.  They attract the people with insurance where the reimbursement is better.  Its what those with insurance expect.

Meanwhile the ER looks like the  neighborhood we serve: rundown, falling apart.  We aren't a priority in todays healthcare.  Our patients are on medicare and medical assistance,  not money makers.

We live in a different world in the ER, compared to the inpatient side. We are like run down  island of the poor and dysfunctional in the midst of a shiny suburban mall.  No one pays much attention to us.