To my doctors and friends:

I spent from 8pm Sunday night till noon today in the Beth Israel Emergency Department. If that factoid interests you, please read on.

Friday afternoon a friend of mine returned to me a few "bankers boxes" of photograph albums that I had stored at his place temporarily. Since he took the trouble to lug them over on foot in a shopping cart from his apartment about 1/4 of mile away, I felt it was my responsibility to climb up on a step ladder and lift them overhead to the top of a bookcase where they would now be stored. Everything went well.

Friday evening I ate some "meat ends" (end pieces of deli meat that are sold locally for $3 a pound) that had been lying at the bottom of my refridgerator for a few days. They were delicious.

Saturday morning I woke feeling a bit nauseous and suffering from a bit of diarrhea. I also felt weak and debilitated. I quickly diagnosed this as food poisoning and decided to just sleep as much as possible for the next 24 hours.

The nausea and diarrhea quickly went away, but as the afternoon wore on it became increasingly painful for me to walk to the bathroom. (Having benign prostate hypotrophy, I pee every hour or two.) The pain seemed localized in my lower limbs.

After 24 hours the pain wasn't getting any better. Finally I was encouraged by my old friend, Michael , who happened to be passing by and had dropped in for a visit, to see whethor my primary care physician thought I should head for the emergency room. It never occurs to me to bother doctors on the weekends, but my primary care physician had given me a number to use in an emergency so I left a message for him. He called me back in less than 10 minutes and said I shouldn't take any chances since I have so many risk factors. After calling my girlfriend in Berlin, a nephew who is my closest relative in NYC, and a local friend to feed my cat, I dialed 911. They came within 5 minutes and, when they saw how much pain I was in, carried me in a wheelchair down the flight of stairs from my apartment to the street level. Michael came with us to the hospital.

The people in the Emergency Department were wonderful. They took some blood, gave me another E.K.G. and X-rayed my legs. At least one resident asked lots of questions, but no one was willing to hazard a guess as to what was wrong with me. After a few hours the chief resident spoke to me and said they hadn't learned much but were willing to hold me overnight for observation. Did I want to be admitted?

I'm delighted that hospitals exist, but try to avoid them at all costs. So I said, "I don't think my opinion should be taken into account here. I'm not a doctor and will find staying in a hospital extremely unpleasant for reasons having nothing to do with health." Namely, that I will be unplugged from the world I now live in: chatting with my girlfriend in Berlin, emailing friends all around the world, and calling people on the phone. (What did retired people do before the planet had a nervous system?) Michael thought I should stay. Since I was feeling weak and didn't trust my own judgments, I gave in and stayed.

They were unable to allocate a room for me so I was kept in a tiny curtained-off area with the light dimmed. It was extremely cold, I think because E.D. doctors are very impressed these days with hypothermic treatments. For the next 12 hours I experienced what I can only describe as mild torture: sleep deprivation, cold, lack of food and water, and unending tones from machines. As a musician, I found the almost but not quite in-sync tones disconcerting, as if I were listening to a contemporary piece by a music student out to destroy Western meter as we know it.

As morning approached I found that the pain in my right knee was almost gone. It occurred to me that what had happened was quite possibly that I had indeed suffered mild food poisoning, coincidentally overlapping a delayed reaction to knee stress. I will review this with my doctors, but at the moment it seems obvious that what I need to do is 1) don't climb up on stepladders anymore and 2) don't leave meat ends in my refridgerator for more than 24 hours.

I decided that the psychic discomfort of being in limbo might be as stressful to my heart as anything else, so I decided to leave the Emergency Department. I agreed to wait till the results of the second round of blood tests came back in case something bad was found, which I was told would be around 9am or 10am. No results were ever announced, so around noon I signed the consent sheet saying that I understood I was denying care "against the advice of medical personnel", walked out on my own power, went home in a taxi, and sank into a deep sleep.

I have no complaints about my medical care. It's the best in the world. But if anyone would enjoy some ad-hoc speculations about how this experience could have been made even better for me, here they are:

I understand the legal pressure to practice defensive medicine, but don't torture the patient when you're 90% sure he's okay.

The E.D. is manned by people under 30. They looked utterly perplexed by my questions way too often for me to have much confidence in them. They make up for their lack of experience by strictly adhering to the medical protocols that have been drilled into them. Unfortunately, marching in lockstep is not the same thing as ballet.

The senior physician should not be a kid trying to make a name for himself as the best damned robot in the entire robot army, but an older, wiser person who has nothing to prove and actually enjoys relating to people at a friendly level. When you feel your doctor likes you it's easier relate to him, as for example in remembering things that might be medically relevant rather than giving rapid answers to specific questions. There's a tremendous difference between filling out a questionaire and having a conversation, so take a minute to break the ice.

When the ambulance arrived I gave the medical technicians a copy of the two-page medical profile I give to all my doctors, containing my history, the drugs I take, the names and numbers of my doctors and closest relatives, and even my wishes in case I'm unconscious. They gave the profile to the E.D. people. The first few people who spoke to me had seen the profile, but somehow during the day it was discarded and I had to answer a lot of questions by saying, "I don't remember. It's all in the medical profile".

The orderlies are friendly and helpful but you have to go out of your way to get their attention. So hand out a one-page sheet of paper entitled "How To Survive Your Emergency -- and Your Emergency Department". It should tell you 1) how to get phone service that won't be a totally opportunistic rip-off by the phone company, 2) how to operate your bed, 3) how to disconnect yourself from the monitor if you have to go to the men's room, and about half a dozen other, equally obvious things.

The bottom line here is that I'm extremely grateful to live in a country in which old people get the best medical treatment available anywhere. No one in their right mind would ever complain about that.