I’ve been to the emergency room (E.R.) only a few times for myself or family members. Usually we’ve experienced a fast response and care. Nationally, however, E.R. wait times have increased since the recent economic downturn. A 2010 Press Ganey Pulse Report revealed that the average length of a visit to a U.S. emergency department has increased to four hours and seven minutes.

More people are using the E.R. for primary care. This was evident recently when my brother Jack came to my house around midnight with a bloody hand. He had cut it on a lawnmower blade earlier that night. I immediately took him to the E.R. at the neighborhood hospital. Following are the approximate times of our night.

12:30am: I take Jack to the E.R. The desk nurse puts some gauze on the deep gash and wraps it with a bandage.

12:40am: He is checked in. Someone takes his blood pressure. We sit in the waiting area. About 25 to 30 people, half of them people of color, are also waiting. Some appear to have sprains. Some are coughing. One man has a bag of ice on his jaw. A woman near me looks like she is about to vomit.

1:30am: Jack is registered.

2:30am: My brother nods off in the waiting area. I ask the desk nurse if we should just go to our family clinic when it opens at 7:30am. She cautions that it is a serious cut and he should be seen right away. I remind them it has been two hours.

2:35am: The desk nurse apologizes to everyone in the waiting area. Ambulances have been bringing people through the back entrance, she says. An elderly woman moans, "But I arrived on an ambulance a long time ago."

3:10am: A young man in a leg brace and his two friends leave the E.R. laughing. A woman being pushed in a wheelchair passes by, munching on a sandwich. My brother is in pain. He’s received no medication. About 20 people are in stages of sleep around me.

3:15am: My brother’s name is finally called and we take a long walk to the treatment area. We see nurses and doctors chatting and laughing. No one seems to be in emergency mode. I’ve walked into more hectic offices. We’re shown into a room with a hospital bed and are left there.

3:20am: A nurse enters and asks if I’m a family member. I say yes. She asks my brother to take his pullover shirt off so she can take his blood pressure, but he’s scared to hurt his hand. I later look at his chart and it says "patient refused to remove shirt." The nurse pulls the curtain in front of the sliding door so we cannot see out.

3:25am: I open the curtain to look at the nursing station. The same nurse who took Jack’s blood pressure asks if there’s a problem. I say, "Yes, my brother has a deep cut and we’re waiting." I stare out so we won’t be forgotten. I read out loud a sign posted on the wall about patients’ rights and advocacy. The title: "SPEAK UP."

4:00am: The doctor appears. He says the cut needs to be cleaned and asks my brother if that’s all right. Jack’s tired and in pain and isn’t responding. I say, "Yes, it’s all right. Let’s do it." The doctor is perturbed. "Are you a family member?" I reply, "Yes, and we’ve been waiting since 12:30am." He apologizes and says that when he came to work at 10:30pm, he already had 20 cases. "Must be a full moon," he ponders.

4:10am: The doctor sticks a needle filled with lidocaine several times into Jack’s hand. Jack groans in pain. The doctor leaves.

4:20am: A different nurse washes Jack’s wound. I hear the doctor on the phone in the hallway.

4:30 to 4:45am: The doctor returns. I watch him make seven sutures. I’m relieved the wound isn’t exposed anymore. The doctor talks about follow-up care and a temporary cast. We’re relieved the ordeal is almost over. We wait.

5:00am: A young nurse enters and says he’s going to make a plaster cast. He says a fiberglass cast would be faster, but he likes to do plaster ones. I say, "Whatever is quicker. We’ve been here since 12:30am." He replies back that he’s been there since 10:30pm. He leaves.

5:15am: The nurse returns with a cast, molds it around my brother’s forearm, and bandages it. It takes about 10 minutes, but we still need to wait to be released.

5:35am: We exit through the waiting area. The desk nurse waves goodbye. It might have been a full moon, but we didn’t see it. It’s now daybreak.

I don’t know if this is a portent of things to come or if this wait time was an anomaly for Portland. I left angry and disappointed, not with the care itself, but with the lack of urgency. I know if I hadn’t been there as an advocate, it might have taken even longer. Quiet people seemed to wait longer to be seen. Maybe the medical staff moved more quickly on the emergencies brought in the back entrance, but it didn’t seem like they were in emergency mode to us. I wonder if the hospital could truly handle critical emergencies if something catastrophic occurred. With more people unable to obtain insurance or primary healthcare, I can’t help but think that the increasing number of visits to the emergency room will only lengthen the wait.