This story isn’t much about the dwarf, although she played a significant role. About 1984 or so, I was working full time in the E.R.s of mid-south Texas: Kingsville, Alice, and such. A company contacted me saying they needed a board-certified physician to be the medical director of a small E.R. in a little town, I don’t remember exactly which one. The job required driving the three hours down to the hospital from my home in Corpus Christi to attend a meeting once a month and paid $500. Seemed like a pretty good gig at the time.
My first trip there I discovered how dysfunction was the hospital. Staffed by a small handful of non-certified itinerate ER doctors who worked 24 hour-shifts, a purview of the roster of patients floored me. These guys were treating about four patients an hour non-stop, up to 50 patients a day, almost all of them non-paying Mexicans. At the luncheon meeting, I was representing an ER that I had no idea how it functioned, ER doctors who’d I never met and really couldn’t even name, and with no idea about any issues of staffing, equipment, or procedures.
At the first meeting it became clear within minutes that the administrator was an incompetent bipolar buffoon, who made decisions on whims and ruled with intimidation. His arbitrary pronouncements rolled out in endless contradictions, mostly based on fantasy and speculation. I sat dumbfounded, glad I had little to contribute to this bizarre disquisition.
After the meeting I followed the assistant administrator into her office for a debriefing. I’m not making this up, although it sounds like a bad television sitcom, this woman was an Hispanic dwarf, who clearly ran the hospital, ignoring everything the administrator said and making intelligent decisions. She outlined some issues with the E.R. and suggested some solutions. When I returned home that evening, I e-mailed a report with those recommendations to my employer.
The job didn’t last long. On my fourth visit or so, the administrator presented his plans for the rebuilding of the hospital. It included reducing the number of ICU beds in his hospital from eight to four. I pointed out that the trend in American medicine was for outpatient care when possible, and that those who came into the hospital tended to be older and sicker and needed more intensive care. I suggested instead of halving the ICU beds they should be doubled.
He laid into me with vehemence, telling me I had no idea what I was talking about and that he would be sure I never worked at his hospital again … not that I’d ever had a single shift there anyway.
After that meeting the dwarf took me into her office, told me I was right, but I shouldn’t have said anything. My contract was terminated, which, really, was a good thing. It wasn’t worth the six-hour drive and clown show, even for the easy money.
I’m currently writing my memoir, “I Saved Lives,” about my forty-two year as an emergency medicine physician. This is one of the chapters.