Neverwhere and back again

Monday. A lesson on why reading Neverwhere in an emergency room waiting area is significant, at least in Toronto, Canada.

8:00pm: The patient has a dull but intense pain directly beneath her lower ribs on the right side, plus a lighter but sharper pain on her back, level with the pain at the front. The pain started at 3:00pm and has intensified throughout the afternoon. Two extra-strength Tylenol were taken an hour ago, and have had no discernible effect. No fever present.

Recommendation: go to emergency for examination and treatment. This report will be faxed to the hospital the patient said she would visit. The patient is advised not to drive herself to the hospital, and not to eat or drink anything until a doctor confirms it's all right for her to do so.

9:00pm: The patient disembarks from a cab and queues to talk to the triage nurse. The triage nurse data enters the patient's name, health card number, contact information. She takes a list of symptoms and records the patient's pulse rate, blood pressure, and temperature. She gives no indication of whether the patient is normal or abnormal in these measurements. She tells the patient to see the registering nurse.

9:15pm: The registering nurse takes more detailed contact information and notes an emergency contact. She tells the patient to wait in the waiting room. The patient takes a seat and tries to estimate how many people are in the queue in front of her by trying to deduce who in the waiting room are patients and who are simply accompanying patients. Ironically, House is on the television. Dr. House claims that a patient's general niceness is a sign of brain infection or head trauma.

12:00am: The patient has been at the hospital for three hours. An episode of The Simpsons has just finished playing on the television, and the time of infomercials has begun. The pain has subsided to below the "scary" threshold, but is still present and worrisome. Some of the other people in the waiting room are wearing surgical masks, supposedly to reduce the risk of spreading germs. Most of them have pulled the mask down to their chin so they can talk and breathe more easily.

The waiting room population doesn't change very quickly. Once every hour or hour and a quarter a nurse comes to the entrance of the waiting room and calls out a name. Sometimes someone gets up and follows her to the examination area. More often the person is no longer there. If that happens, the nurse leaves alone, not to return for another hour.

The patient and a woman who arrived shortly before her decide to ask how much longer the wait will be, since they've both been there for three hours and it's getting very late. The nurse gets annoyed with them, but finally says that they are only seeing people who arrived at 6:00pm now. All right,, thinks the patient, on a geometric scale that's three more hours to wait. 3:00am. The patient and the woman sit down again. The patient sits closer to the waiting room entrance and pulls out her copy of Neverwhere. Richard Mayhew, the hero, is well-embroiled in the affairs of London Below, and the patient realises, as she shifts into a position that hurts less, that the waiting room is a kind of Toronto Below. Only the nurse who calls out names acknowledges those waiting at all.

1:30am The woman who checked on waiting times with the patient leaves, still unsure if it was food poisoning, an allergic reaction, or just bad luck that she had. The patient decides to wait until the deadline she set.

A jovial elderly man with a badly scraped shin sways over to the Coke machine and gets help from a young mother waiting with her husband and baby as to how to buy a drink from it. "Doesn't it sell whiskey?" he asks. She shakes her head no. "Are you sure?" he says, and checks all of the buttons himself. "It should sell whiskey," he says as he sits down with his soft drink. The patient agrees silently and continues reading.

3:00am The young woman who helped the elderly man buy a soft drink has been called to the examination area with her family.

The patient has finished Neverwhere — 250 pages of paperback read in one sitting. Richard Mayhew returns to London Above and his old, non-fantastical life, only to choose to return to the society of London Below. The patient decides to mirror his decisions. She goes to the registration desk and announces she is leaving.

"You need to see the triage nurse," the registration nurse says. "You're next."

Just then, the triage nurse walks in with a sandwich packed in a bag. The patient waits for her to get settled behind her desk and then explains she is leaving. The triage nurse says, "Okay, let's take your blood pressure and temperature again."

She also takes the patient's pulse, then extracts four vials of blood from the patient's left arm. "We should get a urine sample from you too," she says. "Here," and she hands the patient a urine jar.

The patient goes to the ladies' room and does the needful, which is pretty impressive considering she hasn't had anything to eat or drink in over seven hours. She returns to the triage desk and hands the urine jar to the triage nurse.

"Well, you've got my contact information," the patient says. "Goodnight."

"Where are you going?" the triage nurse says, surprised.

The patient takes a deep breath, mindful of the signs posted everywhere that say verbal abuse will not be tolerated. "Like I said, I'm going home. I've been here for six and a half hours, I need to get up to go to work at six AM because I get paid by the hour and my projects are in crunch mode, and the pain has subsided. Not to mention I've been up for twenty-three hours, which alone can't be good for my health."

"Then why did you let me take all this?" says the triage nurse, gesturing to the collected bodily fluids.

"You didn't say what it was for," says the patient. "And I'd already said I was leaving."

"But you're next," the registration nurse pipes up.

"And how long will I have to wait once I get admitted to examination?" says the patient.

"That depends on what's wrong with whoever's ahead of you," says the triage nurse.

"Exactly," says the patient. "Thank you. Good night."

3:30am The patient finally gets into the cab she called. She has spent the fifteen minutes' wait pacing up and down the sidewalk outside the emergency room entrance, talking into her internet tablet's microphone, making memos about all the things that went wrong with the health care system tonight. She also spends several minutes watching the hospital's automatic sprinkler system water a lawn half the size of her living room. Most of the water runs off the lawn onto the hospital's driveway, and down the drain in front of the emergency room entrance.

The cab comes and takes her home. She sleeps for ninety minutes, then wakes up to go to work, once more a citizen of Toronto Above.

For the patient, still pending; an appointment with the GP has been made.

For the hospital; dementia, possibly accompanied by catatonia.

Physicians, heal thyselves.