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opinion

My mom has been feeling lousy for weeks. She's shaky on her legs and has lost a lot of weight. She's in pain and isn't eating much. Her doctor checked her out and diagnosed possible pneumonia. When she got worse, he urged us to take her to the hospital.

Getting your mom admitted to a hospital can be a bit like trying to break into Fort Knox.

We knew that if we called an ambulance, Mom could wind up anywhere. But if you take her to Emerg yourself, they can't refuse to see her. The hospital we chose is one of the best in the country. The medical staff is highly competent, and the wings and halls and waiting rooms bear the names of grateful, well-heeled citizens who have made generous donations.

My brother figured that if he took her in first thing in the morning, the wait might not be too bad.

At 3 p.m., he e-mailed and said they were still waiting. Mom had been triaged and was obviously at the bottom of the list. No one had a clue how long it would be. He wondered if they should bail. I said I'd come and spell him off.

Mom was huddled in a chair, swathed in blankets provided by a kindly volunteer. At 4, we broke through the outer ring and were moved to a ward with cubicles and gurneys. All the cubicles were full and patients were parked on the open floor. Most were elderly, with a long list of chronic ailments. Many did not speak English. Several were all alone and looked demented. The place was a cacophony of beeping instruments and summonses by loudspeaker. "You're peeing on the floor!" a nurse admonished an old man in one of the cubicles. Environmental Services (formerly known as Cleaning) was quickly summoned to mop up.

It's trite to say this, but the ER is nothing like ER. Eventually, a nurse arrived to help my mom onto a gurney and to take her vital signs. A couple of hours after that, an ER doctor appeared, listened to her breathing and ordered some tests. I slipped out to get a sandwich. By then, the hallway was full of people on stretchers who had been offloaded from ambulances. Paramedics were standing around. The waiting room was more crowded than ever. On a counter was a pile of satisfaction surveys. "Let us know how we're doing!" they said.

Fifty years ago, many elderly people were cared for by a daughter or daughter-in-law, with home visits from the family doctor. But today, people's daughters are busy doing something else. No one wants my mom in the hospital, but for now, there's no other option.

Everybody wants to fix the ER problem, but nobody knows how. Crowded waiting rooms are a product of resource shortages and desperate efforts to contain costs. They are caused by bed-blockers - elderly people who are afflicted by one damn thing after and have nowhere else to go.

In Massachusetts, the system operates quite differently. My stepmother lives in a seniors' condo complex in the state not unlike my mother's. She has six or seven specialists, and sees them often. Everything is vastly more expensive. Her dermatologist recently billed $1,000 for removing a couple of cancerous moles. (Insurance covered most of it.) The ambulance is summoned at the least sign of trouble (probably for liability reasons), whereupon the patient is whisked to hospital, immediately given a battery of expensive tests and returned home within hours when it turns out there's nothing seriously wrong. That's why American medicine costs 60 per cent more than ours does.

At 11 p.m., with no sign of progress, my husband arrived at the hospital to spell me off. Around 5 in the morning, the ER doc, nearly asleep on his feet, said he had no idea what was wrong with Mom but was going to admit her anyway. We're relieved. When they will find a bed for her is anybody's guess.

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