Every once in a while you get one of those jobs that isn’t just a wage-slave grind for peanuts. You know what I mean, the kind of occupation where all your coworkers are cool, the work is rewarding, and clocking in means you get to hang out with your friends all day.
For me, working as an EMT in Pioneer Community Hospital’s Emergency Department was one such job. I originally wanted the position for a single reason; to get clinical experience in a small, understaffed and frequently over-crowded rural ER. I didn’t take the job for the money; my ambulance work paid 40% more. I already knew most of the staff at Pioneer from working for the private EMS service stationed within the hospital, a state of affairs that benefited me immensely in getting hired.
My typical day in the ER would begin at 0700 hours and run on until 1900. Because I lived roughly an hour away and already had a bed in the EMS bunkroom, I would schedule my shifts to overlap with my ambulance schedule and sleep inside the hospital. Doing this meant my “commute” consisted of putting on my black scrubs and shuffling over to the time clock before swiping my badge to enter the Emergency Department. Our ER had six rooms, two of which were trauma bays. On a busy day, we might roll out another cot from Acute Care as a hall-bed and bring up our total count to seven, but as you can imagine, this was effectively the equivalent of a M*A*S*H tent with worse climate control.
My usual shifts went something like this:
As with ambulances, the day starts with checking off the supplies. I start with the trauma bays, attaching electrodes to EKG leads, putting tape in the drawers, and restocking any missing nasal cannulas or non rebreathers. Superstition and Mojo are the currency of the realm in emergency medicine, meaning that certain rituals become ingrained over time as a defense against the vagaries of fate. For me this involves putting one stainless steel instrument stand alongside each trauma bay bed and jacking both cots up to the height of an EMS stretcher. I then arrange the 4-lead EKG leads on the instrument stand with electrodes already attached, laying an adult large and adult regular BF cuff next to the leads with the tubing neatly coiled under them, before topping it off with the SPO2 lead and a digital thermometer.
By now the smell of fresh coffee wafts down the polished main corridor of the ER and I head to the breakroom. I can usually count on our receptionist to get it brewing sometime around 0730, as she understands that the metabolisms of Emergency Department staff depend on gallons of cheap java kept at a mere 2 degrees above room temperature.
“Doctor Vader,” says one of the cleaning ladies, greeting me with a nickname I earned from my penchant for wearing black scrubs and playing “Imperial March” on my Iphone. I smile at her, retrieve my cup of bitter caffeine, and go to the triage station.
Pioneer was unique in the fact triage was handled almost entirely by EMTs. The usual skeleton crew was one doctor, one nurse, and one tech. This arrangement resulted in the tech becoming the real foot soldier of the department, doing most of the hands on and filtering patients through the triage process. Major hospitals typically want triage performed by an RN with at least one year of ER experience, but in this facility, the station was occupied by EMTs, some of whom were still in their teens.
At 8005 our first patient arrives, a twenty eight year old male suffering from an anxiety attack. I do a full set of vitals, listen sympathetically to his personal experiences with life stress and confusion, all the while entering his information into the triage report. The doctor can’t place orders and the nurse won’t be able to do her job until I get a fairly detailed history, vital signs, medlist, and allergies put into this system along with a synopsis of the problem. Finally, based on my perception of his acuity, I assign him a room. Minor complaints and repeat customers colloquially referred to as “frequent flyers” go to room Five or Six, leaving the trauma bays and the beds closer to the nurse’s station available.
A crucial skill here involves looking out across the waiting room and evaluating which patient has the highest acuity. They get to move to the front of the line. Showing up with bleeding wounds, respiratory distress, chest pain, or stroke symptoms will get you party favors.
By 0855 the wheels have come off the bus and we’re slammed. ER 3 has almost smashed his finger off, ER 4 has a possible hip fracture, ER 6 has a migraine, and EMS is bringing us another one. Meanwhile I’m in ER 2, doing a chest-pain protocol on our favorite frequent flyer, Mister L. I’ve run this patient several times on the EMS side and he remembers me as “the guy who showed up to his apartment on a road bike”, a story he never fails to tell to anyone who will listen to him. Mister L likes to come to the ER with a complaint of chest pain a couple times a week, and I do a 12 lead EKG and stick him in the same vein I’ve already used at least three times in the past for an IV/blood draw before radiology wheels in an X-ray machine to get a scan of his chest. Coincidentally, Mister L always leaves sometime after the cafeteria brings him lunch later in the day.
This was my life for months. Some days we were slow, some days it was flu season and the waiting room was packed with sick people while the local rescue squads held an impromptu ambulance convention in our parking lot. We stitched together working class rural white people with various extremity lacerations caused by everything from saw blades to airplane propellers. I treated a pregnant teenager who had been body slammed by her boyfriend while in the next ER bay a crystal meth user cried about losing his family to drug addiction. A woman with mild chest pain went into cardiac arrest right in the middle of ER2 and we performed life-saving CPR and ACLS protocols until she was stable enough to be loaded onto a helicopter. A week later she walked back into the hospital under her own power to get evaluated for symptoms that turned out to be related to ribs we had bruised previously doing chest compressions. Nearly everyone in the hospital got along like family; being such a small facility meant we were on a first name basis with all the staff from the cafeteria down to the supply room. There were doctors, nurses and techs I genuinely loved to work with. Over time, that old hospital became a second home to me, a place I saw no less welcoming than my own living room.
Unlike many times in my career, I could say with confidence that we made a difference at Pioneer Community Hospital.
The facility itself had existed in Stuart, Virginia since 1962, and once carried the name “RJ Reynolds Memorial Hospital” in honor of the famous tobacco company founder. Reynolds himself was born near Critz, Virginia in Patrick County and to this day an ambulance with the old title can be found next to the local greenway. RJR Memorial had been bought and sold many times over the decades; being in a rural area meant it was frequently struggling despite a regular influx of Medicare patients from the adjoining nursing home. The renovation that moved the ER to the second level and gave us those spacious trauma bays appeared to have made the hospital insolvent, resulting in Pioneer filing for bankruptcy on March 30, 2016. It would take well over a year before the hospital shut down, but on September 13th 2017 the ER department went on diversion and no longer accepted patients. Within the week, the entire facility was emptied.
By this time I was only PRN at Pioneer, but seeing the local news cover the closure of the facility and driving past that empty parking lot with caution tape draped unceremoniously over the ER doors made me feel some real sadness. I loved that old hospital with the bad climate control and the scary haunted basement. I missed sitting around the nurse’s station talking to my favorite RN about local real estate prices while the ER doc gradually fell asleep in his chair. I also knew that the closure of this facility would overwhelm the already strained EMS system that up to this point was almost entirely made up of volunteer providers, so I went back to work part time in the 911 system as they began to hire paid staff. We are now the last and only line of defense in the entire county. Instead of taking patients to a facility ideally situated in the middle of the district, we have to transport either to Martinsville Memorial, about 30 miles away, or completely out of the state to Northern Surry Hospital of North Carolina. The routine calls could formerly be transported to the ER in less than five minutes and on busy days an ambulance could turn and burn to the next emergency straight from Pioneer. Now it takes closer to an hour to get the unit back into position and ready for the next 911 response, increasing a total call time from about 30 minutes to 2-4 hours.
To complicate matters further the hospital license expired December 31st, 2017. Reinstating the license for an old hospital like the one sitting on a hill in Patrick County can be a difficult process and would make the facility far less appealing to potential buyers. Senator Bill Stanley of neighboring Franklin County was well aware of this and sponsored emergency legislation to retroactively extend the hospital license for another year, a seemingly uncontroversial and benevolent proposal designed to do anything possible for the residents of Stuart.
Unwittingly this lead to one of the most egregious examples of callous Democrat obstructionism in recent memory.
Ten senate Democrats formed a voting block against the measure, demanding that Republicans support Medicaid expansion in exchange for any votes supporting an emergency extension of the hospital license. Getting a simple license extension had turned into a ransom-note for political favors. Democrat Senator Janet Howell of Fairfax made the meta-politics of the situation abundantly clear in her own statements,
“I’m very angry that I have constituents — yes, even in Northern Virginia, even in wealthy Fairfax County and Arlington County — that have no health care. They’re suffering. A few of them died. … I think we need to get together to figure out a way we can provide health care throughout the commonwealth and not pick one, small community.”
It goes without saying this is clear pandering to blacks and Hispanics who reliably vote Democrat, and given Howell’s track record of gerrymandering her own district, maybe this isn’t so surprising. At best, this represents a total callous indifference towards rural white conservatives in her own state, and at worst, it’s outright malicious hatred towards a demographic most on the left want to see eradicated. Democrats explicitly became the party of minorities and illegal immigrants a long time ago, and now they’re jeopardizing the lives of residents in a community I serve just to further displace Trump supporting whites. That “small community” does not matter to Janet Howell.
Does Medicaid expansion even produce better health outcomes? If we’re really trying to do evidence based medicine the research sure doesn’t seem to support the liberal assumptions here.
These are the life and death stakes. The leftist political establishment wants you die, and when you’re gone, they’ll mouth some platitude about how this all could’ve been prevented if their opposition had simply approved more Medicaid for Gautamalans. Most conservatives are oblivious to the demographics game that Democrats are playing here and refuse to bluntly call attention to the fact that more dead southern whites helps NoVa’s leftwing carpetbagger political establishment take over Virginia. Every rural southerner put in the grave is one less Republican vote and the Dems in NoVa are well aware of this fact.
My friends, fellow travelers and overall political movement have taken a lot of heat from the same people openly hostile to keeping hospitals open in rural communities. The left likes to call us “Nazis”, or “fascists” and we’ve had acid thrown in our faces just for attempting to have a political rally. The news media is obsessed with categorizing us as a “hate group” and you can lose your job for just being seen in our midst. We’re unapologetically pro-white and advocate for the rights of our own people to exist, which in 2018 is apparently a highly controversial stance. At the end of the day though, if you aren’t really sure about the alt-right or where we stand, just remember one thing:
The ones calling us Nazis want to see you dead and it’s people like me who are literally trying to save your life.