I walked into the room. In it sat a man about ten years younger than me. The triage sheet said “panic, anxiety”. He was calm, but looked sad.

I introduced myself, “Hi, I’m Dr. Ahronheim, the Emergency physician today. How are you?”.

He smiled kindly and said “how are you today?”. Emphasis on the “you”.

It shook me.

And I realized, those simple words, expressed with such empathy and true feeling, “how are you today?” can make an enormous difference in one’s day.

Working as an emerg doc in a wildly busy department has become soul-crushing. The sheer volume of patients who come in with anything from a hangnail to truly severe, life-threatening illness, has become overwhelming. Over the last few weeks, I and my colleagues, be they physicians, nurses or support staff, have had to basically cross our fingers and make a wish that nothing will go terribly wrong each shift. Our newly built and superbly designed department was created specifically to avoid placing patients on stretchers in hallways. These days, the number of hallway patients just keeps growing. In our overflow area near triage, we had a full quorum of twenty patients most days last week. That is the number of rooms we have in each of our pods (stretcher zones). This means we would need an entire additional pod to house all these really sick patients.

Please understand – these are not patients with headaches, flu, or even kidney stones. These are patients with heart attacks, abnormal heart rhythms, severe abdominal pain, car accident victims, cancer patients, covid patients, and more. Many are elderly, infirm, or have a disability.

All these patients get care; we devote an attending physician to assessing and managing them, and a nurse to take vitals and start investigations. However, for medications and true management, they have to wait to be brought into a room. This is scary, and not at the level we are used to functioning.

Why is this situation like this, you may ask? Well, the largest issue is the volume of patients. They come from all over the city, and from sometimes way outside the city. Patients hear that our hospital and specifically our ED, is one of the best in the province. And so they come – they ignore their local hospitals, which might even be a block away from home – and come to ours. We can’t send them away. We can transfer them to their local site only once we assess and begin treatment, and only if that hospital accepts them. Often, the request for transfer is rejected, or the patient refuses a transfer. Then they stay with us. Which brings me to the next major issue – there is no room on the wards for patients. We can’t move patients upstairs to rooms until the wards discharge patients who are already there. The hospital is full, always.

And I didn’t even tell you about the “vertical” patients yet…

When I met Mr. How Are You, I was working in our “Rapid Assessment Zone”, also called “Vertical” because it was designed for patients who walk in (ie not brought by ambulance, not needing a stretcher). These days, the RAZ has morphed into essentially a grab-bag of non-acute and super sick patients. Every day, I see a mix of patients ranging from minor scrapes and bruises, hang nails or warts, to cancer patients who are short of breath, elderly people with chest pain, and severe allergic reactions. You just never know. That not knowing is one of the elements that drew me to Emergency Medicine; I love the uncertainty, the mystery, the excitement of each new case. However, this very same ambiguity has started to create an underlying tension in each of us; we no longer have the confidence that the RAZ waiting room has only stable patients. The day I met Mr. How Are You, I had one eighty-year-old man come out of an exam room into our doctor’s area, and collapse on the floor. He had been waiting eight hours in the waiting room. Then, I had a patient develop a severe allergic reaction necessitating epinephrine and a transfer to a cardiac monitor (luckily we had one available). Finally, I had a middle-aged woman with metastatic cancer who had been in the waiting room for ten hours, and by the time I saw her she was clutching her chest in severe pain. It turned out she had a complication in her lung from her cancer and needed admission with urgent intervention.

So RAZ has become a minefield.

In the middle of chaos and exhaustion, Mr. How Are You reminded me of the importance of taking just a moment to slow down. He reminded me that there are some patients who recognize that their doctor is also a person. So many patients these days are aggravated, frustrated, and concerned about the wait time – understandably so. They tend to forget that we, their physicians, are just as exasperated, just as discouraged, and just as frightened. We are doing our very best to ensure our patients receive the help they require and deserve, but we also need care. We need to be cared about.

So thank you, Mr. How Are You, for caring.