Blink_ The Power of Thinking Without Thinking - Malcolm Gladwell [49]
“In the old days,” says one physician at the hospital, “if you wanted to examine a patient in the middle of the night, there was only one light switch, so if you turned on the light, the whole ward lit up. It wasn’t until the mid-seventies that they got individual bed lights. Because it wasn’t air-conditioned, they had these big fans, and you can imagine the racket they made. There would be all kinds of police around because Cook County was where they brought patients from the jails, so you’d see prisoners shackled to the beds. The patients would bring in TVs and radios, and they would be blaring, and people would sit out in the hallways like they were sitting on a porch on a summer evening. There was only one bathroom for these hallways filled with patients, so people would be walking up and down, dragging their IVs. Then there were the nurses’ bells that you buzzed to get a nurse. But of course there weren’t enough nurses, so the bells would constantly be going, ringing and ringing. Try listening to someone’s heart or lungs in that setting. It was a crazy place.”
Reilly had begun his medical career at the medical center at Dartmouth College, a beautiful, prosperous state-of-the-art hospital nestled in the breezy, rolling hills of New Hampshire. West Harrison Street was another world. “The first summer I was here was the summer of ninety-five, when Chicago had a heat wave that killed hundreds of people, and of course the hospital wasn’t air-conditioned,” Reilly remembers. “The heat index inside the hospital was a hundred and twenty. We had patients — sick patients — trying to live in that environment. One of the first things I did was grab one of the administrators and just walk her down the hall and have her stand in the middle of one of the wards. She lasted about eight seconds.”
The list of problems Reilly faced was endless. But the Emergency Department (the ED) seemed to cry out for special attention. Because so few Cook County patients had health insurance, most of them entered the hospital through the Emergency Department, and the smart patients would come first thing in the morning and pack a lunch and a dinner. There were long lines down the hall.
The rooms were jammed. A staggering 250,000 patients came through the ED every year.
“A lot of times,” says Reilly, “I’d have trouble even walking through the ED. It was one gurney on top of another. There was constant pressure about how to take care of these folks. The sick ones had to be admitted to the hospital, and that’s when it got interesting. It’s a system with constrained resources. How do you figure out who needs what? How do you figure out how to direct resources to those who need them the most?” A lot of those people were suffering from asthma, because Chicago has one of the worst asthma problems in the United States. So Reilly worked with his staff to develop specific protocols for efficiently treating asthma patients, and another set of programs for treating the homeless.
But from the beginning, the question of how to deal with heart attacks was front and center. A significant number of those people filing into the ED — on average, about thirty a day — were worried that they were having a heart attack. And those thirty used more than their share of beds and nurses and doctors and stayed around a lot longer than other patients. Chest-pain patients were resource-intensive. The treatment protocol was long and elaborate and — worst of all — maddeningly