Romance, betrayal, and disloyalty — in a hospital? "Grey’s Anatomy," the television show, would have us think so. 

However, according to Doug Chin, physician’s assistant and nurse practitioner at the emergency room at the University of California-San Francisco, working at a hospital is not nearly as theatrical. 

One Tuesday, I visited UCSF to see what working in a hospital is really like. Not only did I learn about the realities of the ER, but I also got a glimpse of what it takes to work on the front lines of medicine.

Personal drama aside, working in the ER can be pretty exciting. 

“It’s a lot of running around,” says Chin, who also participates in 100-mile “century rides” to improve his “mental, physiological, and physical heath.”

Chin has been working in the ER for 12 years. He is a physician’s assistant, and not a doctor, meaning that he did not go through the residency process, which typically takes three to seven years, depending upon the field of study.  

The emergency room is one of the busiest parts of the hospital. Each physician has at least five or six patients at one time. Consequently, physicians' assistants have to be  “good at multitasking,” says Chin, and those who work in the ER work under “constant pressure.”

Compassion also is a must. One of Chin’s patients was a woman in her mid-30’s who was suffering from badly infected spider bites. The woman was homeless; she and her boyfriend lived on Haight Street. They showed signs of a hard life, without access to shelter or toilet facilities. Chin and I were overcome with the smell of unwashed skin and dirt as we entered the small room where she was to be treated. 

Yet Chin surveyed the scene without judgment, listening to the woman’s story impassively. He was upfront and did not shy away from asking awkward questions. The woman was clearly embarrassed that she had to come to the ER;  she and her boyfriend became defensive when asked about their substance use. Chin pressed on, using slang to ask about the patient’s drug and alcohol history. 

Such trendy vernacular seemed bizarre coming from Chin, whose manner was otherwise formal. But he explained that using words such as  “skin popping” (injecting drugs under the skin but not into the vein), or “speedball” (a mixture of heroine and speed), makes people feel more “confident in situations that are generally uncomfortable.”

As I watched, Chin took his patient’s health history, asking her how often she used hard drugs, smoked cigarettes and drank alcohol. Eyes cast downward, the woman reluctantly admitted that she smoked a pack of cigarettes every two days, and regularly drank a beer with her friends. She was quick to defend her use of heroin, saying that she does not use as much as she used to. 

Afterwards, Chin said that such substance abuse was “classic.” Alcohol in particular “weakens the immune system” and increases the likelihood of prolonged infection. Such problems are common at UCSF, he said. Up to 10 percent of UCSF’s ER patients are homeless, a direct result of its mid-city location. 

Such human drama is an everyday fact of life in the ER. Millions of Americans use the ER for first-stop care because they do not have a private doctor, they do not have health insurance, or their needs are so acute that they need to be seen immediately. 

According to Chin, the ER acts as a “catchall” — no one is turned away, and no one complains no matter how many patients flood the waiting room. “It’s a nationwide problem,” says Chin.

The Centers for Disease Control reports that there were approximately 119 million visits to emergency rooms in the United States in 2006, up from 90 million in 1996, an increase of 32 percent. 

Instead of going to the ER, some patients go to clinics, which deal with longer-term problems. These include illnesses requiring specialized care in fields such as cardiology and neurology. Rare or exotic diseases also go though clinic. Working in a clinic provides doctors with an opportunity to get to know the patients more intimately, which can be a plus for some people. 

But Chin prefers the ER: “The emergency room is more stimulating than (a) clinic,” he says. The variety of patients and the spontaneity appeals to him, plus the fact that ER doctors deal with “bread and butter” issues, like a sprained ankle or a cut in need of stitches — most of the time.

“There are so many weird things” that happen at the ER, Chin notes. ”Just think of every imaginable object stuffed up every imaginable orifice.”  

The ER can be a very difficult place to work. Patients come in complaining of no appetite or a bloated stomach, and leave with a diagnosis of HIV or cancer. According to Chin, it’s the worst part of his job — telling someone who came in with a “minor” problem that their condition is much worse. 

“You just do it,” he says, adding “you have to remove yourself (from the situation) to some degree.”

Like television drama, the ER has its ups and downs, but for Chin it seems constantly rewarding. In visiting the ER, I felt the adrenaline rush that comes from being involved in such an important field. It’s an experience that appealed to me and it won’t be forgotten soon.