NEW YORK NURSE: July/August 2007
by Rolando Tomas Infante
On Friday, April 27, as the New York Yankees filled the stands at sold-out Yankee Stadium, there was another standing-room-only crowd gathering 23 blocks away.
More than 30 walk-in patients would come through the doors of the emergency department at Lincoln Medical and Mental Health Center that evening. Lincoln, the only city hospital in the South Bronx, typically has a high volume of emergency patients, especially during weekend nighttime hours.
According to the New York City Health & Hospitals Corporation, Lincoln is the third busiest hospital in the nation, processing about 400 patients daily. In 2006 the emergency department had more visits than any other hospital in the city system, exceeding second-place Kings County Hospital Center by 56,000.
In the Lincoln adult emergency room that Friday evening, nurses kept up a frenzied pace as they went from patient to patient administering medications, monitoring conditions, and assuring patients they would be well cared for.
For Milagros Diaz-Acosta, head nurse in the adult emergency room and South Bronx native, the hectic scene was “just another routine day.”
“I have been here at Lincoln for 31 years,” she said. “I miss it when I am not here. I have run into several of my former patients in the neighborhood and we greet each other and I ask how they are doing – it’s like family here.”
Acosta spoke proudly of the care given, not only to South Bronx residents, but to residents from across the city who have made Lincoln their hospital of choice. “There are patients from Brooklyn, Queens, Manhattan, and even from Puerto Rico – who fly in and come here for their care,” said Acosta. “We take pride in the level of care we provide here for everybody.”
In addition to the adult emergency room, Lincoln also has psychiatric amd pediatric emergency rooms. The pediatric ER cares for approximately 40,000 children each year, equal to the total number of annual emergency room visits at Lenox Hill Hospital on the Upper East Side.
While the pediatric facility has cheerful, child-friendly rooms, the psychiatric emergency room features a permanent police presence, bulletproof glass, and locked doors. The nurses who work in the psychiatric ER are ever mindful of indications that a patient may become violent.
Francella Grey-Barrett has worked at Lincoln for three years, and has spent the past year working in the psychiatric emergency room. She acknowledged the dangers of working on the unit after a colleague mentioned that a nurse had been hit in the face just two days before.
Grey-Barrett said, however, that as long as nurses maintain their vigilance about their surroundings, they will be fine. She added that the psychiatric ER is probably one of the safest areas to work because of the constant presence of hospital police.
“We receive patients that have been restrained and brought over by EMS,” said Grey-Barrett, “but we also do have walk-ins that either request psychiatric attention or are regulars that come for a hot meal, a bed, and a shower.”
The scene in Lincoln’s three emergency rooms is one of constant motion. It resembles a subway platform in the middle of rush hour, except that the hospital staff are catering to an overwhelming number of people in need of varying levels of care.
Joann Casado is a researcher at Bronx Health Link, a non-profit community-based healthcare organization serving the borough. “When I make healthcare presentations,” she said, “I start off saying that my dream is for the South Bronx to have the same level of care as the Upper East Side.”
“We are on the edge of an impending storm in the South Bronx in terms of care,” said Casado. “The community is getting older and sicker. We have among the highest rates of asthma, diabetes, and heart disease. And this is just the tip of an iceberg because of the lack of preventive care. The community’s health is reaching critical condition because of the number of people who are uninformed and uninsured.”
Casado said access to care in the Bronx has been reduced because of the large influx of immigrants to this area, mainly from Mexico and West Africa. “Many of these immigrants, because of their residency status, fear deportation and refuse to seek medical attention until they can’t ignore it any longer,” said Casado.
Unlike their affluent Upper East Side neighbors, many South Bronx residents do not receive preventive care. “Take, for example, a South Bronx resident who works at the local McDonalds,” said Casado. “How can he take a day off to visit a doctor, when he might not get paid for a missed day or could lose his job because he didn’t report to work? And this is assuming that he has health insurance in the first place. In many cases, workers are uninsured. They report to work sick, hoping that household remedies will make their sickness go away.”
When the symptoms are no longer bearable, residents come into the hospital as walk-ins without insurance cards. A Mexican family that came to the ER that Friday night took their seats in the waiting room without complaint and pulled out CD players and cartoon DVD players to entertain themselves during the extended wait.
On March 7, 2007, the High Bridge house fire in the South Bronx killed 10 members of two West African families. Multiple EMS units, including one from Lincoln Hospital, responded to the scene. According to emergency medical technician Melvin Maldonado, his battalion rushed several of the victims to Lincoln’s pediatric emergency room.
Some of the nurses who attended to the fire victims were so traumatized that they required counseling. Edna Fallorin, a head nurse in Lincoln’s pediatric ER, said that a nurse who was on duty that night required extensive psychiatric treatment to help him cope with what he saw and felt.
This nurse and his colleagues, said Fallorin, were overwhelmed with a sense of futility as they tried to save the tiny burn victims who died within the pastel blue and pink walls of the pediatric ER. Lincoln’s emergency room staff also treated the victims of the city’s worst fire disaster 17 years ago, when the Happy Land nightclub arson fire killed 87 people.
The pressures of the Lincoln ER have taught rookie nurse Theo Okonkwo a lesson in providing health care in the South Bronx community where he was born and raised. “In a 12-hour shift, I would see about 20 patients,” said Okonkwo.“For the past four months since I came here as a new nurse, I have experienced trial by fire.