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VICE Long Reads

I Spent 18 Hours in One of New York City’s Busiest Emergency Rooms

In many ways, Brookdale University Hospital's emergency room—one of the busiest in New York City—acts as a bizarro microcosm of the inequitable American healthcare system.
8.4.16
Illustrations by Tyler Boss

10:00

When I walked into the emergency room at Brookdale University Hospital and Medical Center in Brownsville, Brooklyn, Jerry Springer was playing on a flat-screen bolted to the wall.

"Do you think your boyfriend or girlfriend is having sex with one of your family members?" Jerry asked.

The rows of metallic chairs in the small, DMV-drab room all faced the TV, and the theme of the show, at one point, was "Tranny Take Downs," in which the introduction of a transgender man or woman is the surprise in a love tryst. The studio audience was loving it, and for the next few hours, as kids ran around and one woman wiped away tears, this trash television was our sole source of entertainment.

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As I quietly took my seat, I glanced up at the posters on the beige, brick wall. One reassured patients of security measures taken with the New York City Police Department to keep this room safe (there have been brawls in the past); another advised patients on what to do if they didn't have health insurance. A ticker up front endlessly scrolled by, like a neon sign at a bad cellphone store: "ACTIVE SHOOTER SEMINAR. GANG AWARENESS."

Sitting at the eastern edge of Brooklyn, far from the waterfront condos of Williamsburg, Brownsville is best known to the rest of the city for carrying two troubled trophies: its generations-long low-income levels, and its historically high crime rates. Nearly 40 percent of its citizens live below the poverty line—an enduring economic degradation that is apparent the minute you get off the subway here. In the first half of 2014, there were more shootings in Brownsville's 73rd Precinct than all of Manhattan. So far this year, there have been five—and there were six this time last year.

It is amid this backdrop that Brookdale—the only hospital in a two-mile radius, with its patch of plain-beige, no-frills facilities—operates.

Amongst its residents, who are proud of living in Brownsville, but not the grim realities that come with it, Brookdale has a bad rep, and I knew that going in. When I told a friend of mine, who was born in Brownsville, what I was doing, he smirked, and replied, "I was born in Brookdale… well, somewhere in Brookdale. I don't think it was in a delivery room." And online, the reviews were just as harsh: "If I could give no star at all and pull the switch to shut this bitch down…," one patient wrote on Google, ominously.

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In many ways, Brookdale's emergency room—which is one of the busiest in New York City, with 100,000 visits annually, a hospital spokesperson later told me—acts as a bizarro microcosm of the world outside those doors.

At my other job, as a crime reporter for the New York Times, I had been here twice before. The first was two summers ago, after the stabbing of a six-year-old boy in nearby East New York. A group of reporters, myself included, stood outside of Brookdale at 01:00, watching as the boy was rushed inside from the ambulance, covered in bedsheets so no photos could be taken. He would die of his wounds a few hours later. Then, in February, I returned to the hospital after a man who shot two police officers was brought here. He would survive.

In many ways, Brookdale's emergency room—which is one of the busiest in New York City, with 100,000 visits annually, a hospital spokesperson later told me—acts as a bizarro microcosm of the world outside those doors. It serves as another cog in these cycles of violence and poverty, offering a front-row seat into the struggles of an underprivileged neighborhood in modern America. Here, you can actually see the inequalities of a healthcare system that favors the highest payer, burdening an area which, arguably, needs it to work the most.

As the morning rush began, I met an older man named Mark Thomas*, who lived in nearby Crown Heights, and was waiting outside for a friend to get off work. When I told him that I was staying at an ER for an entire day, he quickly replied, "Well, you came to the right place."

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Thomas said he stopped coming to Brookdale years ago, after his mother and father both died here, situations he argued could've been avoided had it not been for long wait times and faulty medical care. In the past, the Brookdale ER has been assailed with claims of malpractice like these: One 2011 investigation said a patient had to wait over three hours to be given pain medication for a back and knee injury, amongst other horror stories. That same year, a newborn died to an apparent antibiotic overdose in the ER.

Now, Thomas goes to Kings County Hospital, in East Flatbush—a city-run hospital two miles away that numerous patients later referenced to me as a reliable Plan B. "They don't care about anyone here," Thomas told me. "And it's been like that forever."

He continued, voicing the same sentiments that I'd hear throughout the day: "Honestly, at this point, they need to shut this place down."

16:00

By the afternoon, I was anxious to hear the results of the lie-detector test. It was the third or fourth mind-numbing episode of Springer, and the room had grown interested. Several individuals who were waiting, along with the security guard on duty, chuckled to themselves and jeered as fights broke out onstage. They had become part of the studio audience—which, in this room, was a surprisingly solid way to pass the long lapses of time.

The ER waiting room in Brookdale has four service windows. Most of the time, two or three employees are seated there, behind glass, fielding the stream of incoming patients, most of whom, from what I heard and those I spoke with, had little to no healthcare. Once they take their seat, a door to the rest of the hospital eventually opens, and a nurse calls their name. Those with something urgent, or those who arrive by ambulance, are prioritized, or what the hospital calls "fast-tracked."

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That is, of course, if everything goes smoothly. By most accounts, that doesn't usually happen.

According to data gathered by ProPublica between April 2013 and March 2014, Brookdale's figures—for wait times, transfers, and ultimately securing a room in the general hospital—were way above the national and state averages. Specifically, in the ER, a person typically had to wait 53 minutes before being seen by a doctor. In New York, the average is 27 minutes. Across the country? 24.

I started to notice this distinction in real-time by the early afternoon, as a handful of people who were seated on the uncomfortable rows next to me had been there for over an hour. My questions of wait times were met with an eye roll and a sigh, as if this delay were expected. One woman went up to the door leading to the ER, and asked, in a hollow tone, "Hello?" Others just bided their time, watching Jerry Springer.

Outside, I spoke with a 28-year-old named Steward Rhodes, who was here with his friend, Shawn, to apply for disability. Rhodes told me that in 2006 he was shot at a barbecue in Brownsville, and he had been treated here, at Brookdale. Two years later, he said, after suffering from back pain, he discovered that one of the bullets was accidentally left in him, and the wound was now infected. Years later, he still walks with a limp. (Due to federally mandated privacy restrictions, the hospital cannot disclose patient histories.)

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"If you want to die, you come here," Rhodes told me. He added, "It's always been like that. But where else am I gonna go?" His friend Shawn interjected: "It's Brooklyn!"

One woman went up to the door leading to the ER, and asked, in a hollow tone, "Hello?" Others just bided their time, watching Jerry Springer.

There are many people who have been blamed for how Brookdale got like this. The patients told me it's the hospital's management, not the doctors or nurses themselves. In 2011, the New York Daily News reported that the hospital was cited in inspections as having a litany of infractions, ranging from infants being left unattended in rooms to privacy infringements. And, in 2012, the former CEO of the hospital's parent company was even convicted of bribing state legislators to gain profit.

Earlier in the day, Thomas recounted the troubles that the community hospital has faced financially over the past few years, starting first with the 2009 layoff of 240 doctors, nurses, and medical workers. "That was huge," he told me. "People came back from the weekend and found out that their jobs were just gone." That was followed by an additional cut of 114 employees the following year. The millions of dollars in long-term debt that the hospital had incurred led employees to even reportedly swipe toilet paper from patients' rooms in 2012.

The employees themselves have previously said poor financial planning is at fault for how the hospital operates—or, perhaps, doesn't operate. The healthcare employees union, 1199 SEIU, which represents thousands of Brookdale workers, has had issues with the administration in the past: In 2011, SEIU workers temporarily lost their own healthcare as a result of backed-up payments on behalf of the hospital's parent company. Patients also voiced complaints of personnel—something I heard from the staff myself while I was eating lunch at the hospital's diner: "We're always either understaffed, or overstaffed here," two nurses behind me grumbled.

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As talks of closing down Brookdale have recently intensified, the hospital received $158 million [€138,8 million EUR] in state grants to stay afloat in 2014, which, a hospital spokesperson told me, was used for capital projects and ongoing operations. There have also been murmurs from Governor Andrew Cuomo's office, which set aside $700 million in capital funds for this purpose last year, to build a brand new plant to replace Brookdale and two other failing facilities in eastern and central Brooklyn—a proposal that SEIU, according to its policy and legislative director, Helen Schaub, is working toward.

"It's really a vital hospital, and I think everyone understands that it needs to continue to be there, and there needs to be a high-quality emergency room, in addition to other medical services, in that community," Schaub told me in an interview, days after I visited Brookdale. "Because it's quite far from any other facility.

"I think the members recognize a lot of problems with the physical plant, and many are there because they live in the community and are very dedicated to providing services to the community," she added later. "But I think they understand that it's difficult to do that because of the financial and physical condition the hospital is in."

A new hospital attached to a larger network, Schaub argued, could lead to higher reimbursement rates and the return of old clients who were displeased with Brookdale, like Thomas. But, she continued, it must also be coupled with the support of neighborhood clinics and primary care physicians (of which many patients I spoke with did not have), so people aren't sitting in the ER for antibiotics. In the meantime, Brookdale has created a grant-funded urgent care unit—which offers medical assistance to non-life-threatening and less serious illnesses, like the common cold and the flu—across the street.

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A spokesperson for the hospital said that roughly 86 percent of Brookdale's patients were Medicaid and Medicare recipients. And, under new Affordable Care Act provisions, doctors are incentivized to stay away from Medicaid programs, thereby setting off a chain reaction, which puts the average Brownsville resident—and taxpayer, for that matter—in a perpetual bind: less primary care doctors, worse care, more people ending up in the expensive emergency room.

And, since hospitals rely on their patients' healthcare spending, Brownsville's overall poverty is almost structurally designed to inhibit Brookdale. In turn, richer Brooklynites balk at the idea of coming to a place like this. And that is why white, middle-class folk like myself rarely see ERs quite like this.

Throughout the night, the two lone vending machines in the waiting room weren't enough, so I would leave the ER, and head to the hospital's diner around the corner to refuel with coffee and food. The main lobby of Brookdale University Hospital and Medical Center exists in direct contrast to the ER. Actually, it's like what the ER of Brookdale should look like: the colors, lively; the aesthetic, refreshingly modern—according to a spokesperson, it was repainted by the hospital itself, and a local assemblyman paid for disability upgrades. (The diner, which was created and funded by a tenant separate from the hospital, is also solid, offering a variety of wraps and salads that you can enjoy alongside doctors stuck on the graveyard shift.)

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But going back and forth between the lobby and the ER was a constant reality check. The ER is the most important room here, and as a result of circumstance, the worst one to be in. And you can feel that dismal dichotomy: While this nicer facility exists in the very same hospital, it's not what most Brownsville residents will get to see. Some told me they didn't even know it existed.

I thought about this when discussing hospital care in New York with a woman named Donna, who wouldn't give her last name, around sundown. Donna had been waiting for an hour to hear back about a debilitating stomach ache she had. The Brownsville resident, who lived in a public housing project nearby, generally liked Brookdale—she gave birth to her two sons here—but spoke nostalgically of the times she's visited Columbia University Medical Center, in Manhattan's Washington Heights. "It's just so clean, and beautiful," she said, admiringly.

"Why is it always in Manhattan?" Donna asked, sternly. "Why can't we have that here?"

22:00

Every so often during our conversation, Victor Rivera, 21, would hop on one foot to the window and ask the nurse what was going on. Rivera's ankle was the size of an avocado; he had sprained it playing basketball, and one of his friends brought the Brownsville native to Brookdale immediately after. Rivera had hopped his way in here just before 19:00, as the room started to fill with the evening crowd.

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When I asked if he had been here before, Rivera replied, "I was born here!" We then dove into all sorts of random shit—he was a big Bernie guy, so, naturally, we spoke at length about the prospects of a Trump presidency. Our conversation then shifted to video games, movies, and how his ankle would affect his new lifeguard job.

Rivera, I quickly learned, knew that you had to pass the time somehow here. But nearly two hours of Trump talk later, I had almost forgotten that we were in an emergency room, and this kid was still sitting here with a sprained ankle—no ice pack or meds to hold him over. (Although there are no stats for sprains, according to ProPublica, the New York State average for seeing a doctor with a broken bone is a little less than an hour.)

"I call this shit the death room," he told me. "This is worse than the DMV. I'd have my license and be driving by now."

As the night dragged on, Rivera joined the growing chorus of discontent in the waiting room. He asked a security guard to see if the doctor was coming in. (His response: "That's not my job.") One young mother, whose two sons were running around with Easter eggs, said that when she delivered her kids here, she knew to avoid the ER at all costs. Another older man named David told me that he was in the middle of having his vitals tested when a shooting victim was brought into the trauma unit. "So then they threw me back in here," he said, shrugging.

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After a while, the wait times grew darkly comical, and the ER began to resemble an unruly after-school detention. Rivera would laugh with the other women when they heard no response from the staff, but eventually the laughter turned to anger. One woman started to get loud with the nurses, asking why it was taking "so fucking long." Rivera shook his head to me, and added, as a matter of fact, "There's always something crazy happening here."

I posed the same question to Paulette Forbes, an advanced imaging technologist in Brookdale's ER (and not an official hospital spokesperson), later in the week. Forbes, who is in charge of X-rays, MRIs, and other imaging procedures (which the hospital just recently upgraded), works right next to the trauma unit. "What," I asked her over the phone, "is the hold up?"

"The main reason is the sheer volume of patients we get here," she explained to me. "Let's say we're short staffed. Even if you gave us all the staffing that we need, that wouldn't resolve the issue." (According to a hospital spokesperson, the square footage of the Brookdale ER "accommodates roughly one-third of the capacity that it currently sees on an annual basis.")

"Because where we're located, there is no hospital around us within a fifteen-minute radius, or timing," she continued. "The population we're serving is so vast that on any given day, even with the right patient-staff ratio, it would not solve the issue. It's just Brookdale here, and that's why Brookdale is so important to this community."

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In the past, Brownsville was cast as one of the most densely populated districts in the city. And remnants of that overpopulation still remain: The massive public housing community itself serves about 21,000 people, which, according to the Nation, in 2013 was more than the entire neighborhood of Tribeca. And Forbes, a 28-year veteran at Brookdale, said the problem of crowding is only getting worse: With new migration to Brooklyn—a 17 percent increase between 2000 and 2013—the influx of patients is increasing, but the resources to accommodate are not.

There was a sense of ownership and pride that I heard often from patients about Brookdale.

Her fellow employees, she added, are doing the absolute best they can to keep Brookdale going. "It's not getting better here [in the community]," she argued. "That's why we're begging the politicians to release that money to us, so we can rebuild or remodel. The sooner, the better."

There was a sense of ownership and pride that I heard often from patients about Brookdale—that even Rivera, someone who was born here and passionately dislikes it, knows that this is his hospital no matter what. That, amidst its deep fissures and flaws, Brookdale could, and should, be better. That the community deserves better than this.

"Brookdale is a critical institution for our community, and we take our commitment seriously in providing high-quality healthcare to those who need it," a hospital spokesperson told me over email. "There is simply no alternative hospital in the area that could accommodate the volume of patients we treat on a daily basis. Our challenge is to continue providing first rate medical care while stabilizing our finances so that we can continue to meet the needs of our community for years to come."

I heard this from Forbes, too.

"I'm not just speaking only as an employee, but as someone who lives in the community," she told me. "If I get sick, this is where I go. I raised three children in this community. This is where we feel at home when it comes to healthcare."

She added, later, "There is no hospital right now that is as needed as Brookdale."

04:00

At some point past midnight, I turned around from my seat—which was located directly in front of a marathon of Blue Bloods, the pro-cop drama starring Tom Selleck (perfect post-Springer fodder)—and realized that everyone in the waiting room was asleep. One couple on the back perched their heads on each other's shoulders. A guy behind me was passed out, drooling. And a young boy was on his mom's lap, snoozing.

Shortly after, Rivera hopped out of the waiting room with a cast on, holding crutches. He had spent a total of five hours here, and now, it was time to go home. Outside, we said our goodbyes, as police cars and ambulances rolled up.

I had been in the ER for so long that I half expected to hear my name called out. That's when I knew it was time to go. The stream of new patients began to dry up, as nurses awoke those who were sleeping, and the room slowly began to clear out. The cab drivers waiting outside were even asleep in their cars. One driver with sleepy eyes, who hung around in the foyer of the waiting room, told me, "Some nights are slow; others, not so much."

This, he said, was a slow night.

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*Names of non-hospital staff have been changed to protect their identities and medical records.