Emergency says the red sign over the automatic doors. The scene inside seems to belie the label. By the desk a family, maybe folks that have driven in from a nearby farm town, huddles to compare notes they have compared once already. Women at workstations in various uniforms solicit answers from petitioners at the altar of high healthcare. Across the big room security staff manages the ebb and flow of traffic with a calm aplomb.

Fran passed under the sign and joins the cue of supplicants. Her pain is driven by late stage cancer but nausea prevents her pain relief from being effective. Questions are posed and answers are dutifully entered in “the system”.

With a long history of personal independence and an assertiveness unexpected from her now diminished stature Fran requests relief and makes clear she wants it now. In an almost cartoonish response we are directed to sit patiently in the far reaches of a room with fifty others. Fran soon is cat-napping. Meanwhile a thirtysomething guy parts the sliding doors. Resplendent in the yellow and black colors of the Steelers he paces dramatically, proclaims his suffering, is rebuffed by the cue-controllers and resorts to lying outstretched on his back. Ooooh he moans. I’m gonna be sick on everyone he threatens. I’m gonna leave if you don’t treat me he utters in some strange reverse logic bribe.

A nurse shouts Frances, Ms Frances from the door of a triage room. Over the course of the day we will see her first and last name used interchangeably by the caregivers as if it were an exotic moniker from Uzbekistan of one of China’s remote provinces. No matter.  The Irishwoman with the beautiful head of silver curls rises to the call and staggers into the cramped room for care. Pain on the ten point scale they ask? 9 she responds!

I don’t want to belabor the point that the young man lacked an endearing bedside manner. It’s only that this shortcoming stood in dramatic contrast to his remarkable nursing efficiency. Almost a solo ballet, he blithely tripped from medicine cabinet to “the system” to some IV supplies then back to the patient with curt questions and a minimum of explanations. Perhaps he represents the prototypical perfect person to serve the front lines of big hospital medicine. Here are fluids and meds; now please return to the waiting room!

The next two hours involved more naps interrupted by a shout of Glover! F Glover! before she was wheeled off for X-Rays. It was during this period that the slowly shifting population of that waiting room began to resemble the cast of a tired but comfortable soap opera. The father in the wheelchair talking with loud good humor to a daughter in Spanish; the woman in the nearby wheelchair, solitary in her waiting and waiting. Was she 70? 80? More? Certainly a woman who had witnessed her share of troubles and bore these current ones with a quiet resolve. The Steelers man had indeed eventually walked out but not before parading his withdrawal symptoms to no great effect on the staff or the waiting mass.

Eventually – Glover! –  my friend was wheeled into the beehive of acute care ED. Off with the clothes thrown on when escaping the pain at home. On with the classic skimpy gown. Up on a bed with wheels but going nowhere; a bed with elaborate controls but feeling out of control. Now the napping seemed like a serious possibility but the beeps, buzzers, vital sign checkers, docs-in-training tours and the nursing routines would keep real rest at bay for hours. How do your rate your pain Frances? Again 9.

If New York is the city that never sleeps the hospital ED is the windowless fluorescent filled place where there are no safe times to sleep. As I quietly rise to slip away Fran twitches once and I am unsure if it’s the returning pain or the alarm from the adjoining patient’s equipment. As I walk out into the frigid air I wonder how my friend will remember these moments because tomorrow? Up to the cancer floor.