The Reality of NYC Safety-Net Hospitals
Street entrance to The Brooklyn Hospital Center emergency wing | Photo by Lucas Drumond
Worn-down armrest-less chairs occupied by the occasional patient lined the walls of the room. There were two vending machines off to the side. One sold beverages. The other sold cheap snacks: Doritos, potato chips, pretzels, peanut butter M&Ms, probably some odd breakfast pastry too. I always found it strange to put pastries in a vending machine. Something about it seems unnatural.
Cold fluorescent lights bounced off the tile floor and hummed faintly as my college roommate Alexandria (Alex) Kemsley and I stood waiting for someone at the reception desk to help us. We were checking into the Brooklyn Hospital Center.
Alex resembles a young Cher from the 60s with her tall and slim figure, long sleek hair and striking eyes. In fact, she used to be a professional model, having worn her fair share of chic clothing for the runways and cameras.
That day she wore an oversized t-shirt, athletic shorts and sneakers. I wore a similar outfit. She also wore sunglasses even though we were inside, not as an imposing Editor-in-Chief of Vogue Anna Wintour-esque statement, but because light-sensitivity was one of her symptoms; that and sound sensitivity, migraines, a stiff neck, sore throat and stuffy nose.
Alex was sick, and I was the dutiful roommate there for moral support.
Alex felt unwell in the weeks prior, and when she finally called a doctor using TimelyMD, a telemedicine service, he told her to find the nearest hospital because she might have meningitis. He said he already called ahead and not to be surprised if they quarantined her immediately.
Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, sometimes requiring urgent treatment according to the Center for Disease Control and Prevention (CDC). It’s highly contagious depending on what specific kind it is.
I figured if I hadn’t caught it yet, I would soon. After all, we shared a small bedroom and bathroom. Hence, I went with her to the hospital—a hospital rated 2.8 out of 5 stars based on over 300 Google reviews.
So, we stood there for 15 minutes waiting to be checked in, which was curious considering there wasn’t a line and it didn’t seem busy. It felt like the DMV of hospitals.
They eventually noticed us, called us up and lazily punched in Alex’s information, her parents’ information and insurance details.
After that agonizingly slow process was finally completed, we joined the ranks of the few others sitting down. One of the chairs was covered in a pile of crumpled, used tissues. Some of the cushion covers were ripped open like a patient lying open on the table, exposing the stains underneath.
We sat there for an hour. 60 minutes. 3,600 seconds. I wondered if the immediate quarantine that the TimelyMD doctor promised us was still going to happen.
The doors to The Downtown Brooklyn Hospital emergency center | Photo by Lucas Drumond
We were finally taken back to the triage. The equipment there looked outdated. I stared at the boxy computer that looked like the ones from the early 2000s, the kind I used to play Webkinz on…
The nurse examining Alex was the breakfast pastry of the vending machine. She enthusiastically bumbled on about young people needing to chase their dreams or something like that. I wasn’t really listening. Finally, she told us in an excited tone—one that seemed out of place in the glum setting—that arrangements were being made for us to have a corner room.
Hooray.
I assumed it was to minimize the spread of meningitis if that was in fact what Alex had. Either way, I was relieved we’d have a private space to relax for however long we’d be there. Maybe there’d even be a window.
“Their idea of a corner room was different than what I was expecting by a longshot,” Alex said.
They dumped us off in the corner of a room—a large room filled with dozens of other weary patients lying in hospital beds. Blood red curtains attached to the ceiling on a sliding metal track offered some semblance of privacy, but the windows I hoped for were nowhere near. Instead, we got white walls with strips of peeling paint.
At least we had a bed. Then again, everyone in the room had a bed. Alex sat cross-legged while I sat leaning against the wall.
Across the room behind another set of closed curtains, we heard a doctor speaking to his patient.
“What happened to your catheter?” He asked.
There was a long moment of silence before we heard the doctor, in sudden realization and horror, ask, “Did you take it out!”
I turned slowly and looked at my meningitis-stricken roommate with wide eyes.
“What the fuck,” she whispered.
According to a study from the U.S. National Library of Medicine, “Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine the residents’ access to health care, independently of their own individual characteristics.”
It is unclear, however, how this relationship applies to urban areas. The study concluded that low-income neighborhoods rely less on physician offices and greater on safety-net health centers and outpatient clinics. ("Safety-nets” are medical centers that provide healthcare for individuals regardless of their insurance status.)
The study’s findings indicate that urban, low-income neighborhoods heavily rely on these programs for medical care.
Dr. Darius Abadi, practicing general surgeon of 20 years and Medical Staff President at the University of Pittsburgh Medical Center (UPMC) Wellsboro commented on the issue:
“Many of these patients don’t have healthcare,” he said in regards to safety-nets like Brooklyn Hospital. “And a high percentage of uninsured patients doesn’t provide income, so [these hospitals] can’t provide adequate service. The facility may not be updated, the equipment might be old, the employees might be underpaid and unhappy, so the care goes down.”
He summarized that a hospital is ultimately a business in this aspect; treating uninsured patients is money lost. This explained our 2.8-star experience.
Ambulance bay at The Brooklyn Hospital | Photo by Lucas Drumond
Alex and I said goodbye to our corner room when we were moved yet again. This area was much less crowded. We sat in two blue cushioned recliner-like chairs. The walls in here weren’t peeling, the tiles weren’t stained. It felt more like the hospitals in medical dramas on television.
While my roommate was further examined, another patient entered the room in a wheelchair. He was a teenager, probably high school-aged, seriously scuffed up and bleeding from the head.
As the nurse wheeled him in, two adults, presumably his parents, followed. All three yelled back and forth at each other. The bloodied teen explained what happened to him.
He was in a fight. A huge fight, according to him. From what I could make sense of, he and a group of friends ran into another group of guys on the subway. He was ultimately abandoned by his group and the others jumped him.
The more he recounted, the more worked up he became, cursing and thrashing in his rickety chair. I heard a couple of nurses discussing giving him morphine…
In the end, the doctors weren’t sure what was wrong with Alex, but they told us it wasn’t meningitis. They couldn’t do anything more for us.
We left the confines of the hospital around 10 p.m. unsatisfied. Six hours spent in an alternate reality and we came out of it with no more answers and, for Alex, no more symptom relief than when we first entered.
Our meningitis-scare happened in September before the first COVID-19 outbreak in New York City. Locations like this would soon be at maximum capacity. How could they possibly handle that?
In another study, researchers used Brooklyn Hospital as the sample for characterizing critically ill coronavirus patients. From March 1 to April 20, approximately 2,000 patients were tested. More than 80% were African American or Hispanic. The results of this study and others indicate that minority groups are disproportionately affected by COVID-19. This disparity stems from a larger issue: the lack of investment in low-income neighborhoods.
“The government is spending money in the wrong places. People need to be able to work and be able to pay for health care, but they can’t do that until they’re given the opportunity,” Dr. Abadi said.
The flow of money, or rather lack thereof, from low-income neighborhoods to safety-net hospitals such as the Brooklyn Hospital is like a runaway train speeding downhill without any brakes. The problem cannot fix itself.
But there is a solution. The government needs to invest more funds in neighborhoods with low socioeconomic statuses rather than the hospitals themselves according to Dr. Abadi. He says we need to treat the disease, not just the symptoms.