To the hospital’s finance department, each case like Cynthia’s is another base hit, a fuss-free bill to collect from the insurance company requiring minimal work from E.R. personnel. But to what extent will this hospital stay prevent Cynthia from returning in two weeks, when she is again due for chemotherapy?

Maybe a different regimen of cancer drugs would sit better with Cynthia. But finding it involves trial and error and is seen as work that doesn’t have to be done — work that could get the oncologist in trouble for rocking the boat, that exposes the hospital to liability. A plan focused on keeping Cynthia out of the hospital would require more frequent check-ins at her home, which the hospital isn’t set up to do. We are choosing the path of least resistance for us, even though it is the path of last resort for her.

Twenty percent of people who stay in American hospitals are on the same morbid merry-go-round as Cynthia and Jean-Luc and will wind up back in the E.R. within one month of leaving. We tell ourselves the E.R. is meant only to stabilize patients, that someone else will handle the rest. But the problems I punt in the E.R. are also punted by the hospital’s doctors upstairs and by primary care doctors outside. No matter where I send patients, these gaping holes in care fester, like bed sores tunneling to bone.

So I wait in the E.R. for the same patients to return even sicker and even more dependent on the hospital. I’m thinking about this when an overhead speaker calls me to the resuscitation room for a “Level 1,” the highest level of urgency in the E.R. I hang up on Cynthia’s oncologist and head to the north side of the department.

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4:12 a.m.

A young woman is gasping loudly through the oxygen mask that paramedics put over her face, screaming, crying and thrashing all at once. She swats at the nurses trying to hold her arm down to place an IV, and at the technicians cutting her clothes off with shears. Her sweat prevents the electrical leads we try to attach to her chest from sticking.

This is routine for us. Many things can make a patient acutely agitated: pain, drugs, rapid blood loss or a shortage of air. Until we know the cause, we carry on even when patients resist. With little explanation, we surround them on all sides, pin them down and undress them, placing probes and leads while we get our bearings.