Man Calls the Emergency Room Home

It’s a mystery, Gregory Goins insists, why his chest begins to hurt when it does.

He might be riding the bus, walking down the street, dozing on a park bench or smoking a cigarette. Suddenly, the pain comes on, spreading through his rib cage, and Goins remembers just how sick a man he is.

That’s when his thoughts turn to the emergency room at Highland Hospital. He knows there are doctors and nurses there, ready to help. There are medicines and EKG machines. There are sandwiches.

So Goins finds the nearest pay phone, punches 911, and soon the ambulance comes.

Every day now, the ambulance comes.

Goins is the ultimate “frequent flier,” the label that emergency-room workers give their most regular visitors. He has been to Highland Hospital’s emergency room more than 1,200 times since 1996, recently at the rate of once or twice a day.

His case, while extreme, is rooted in a widespread problem: America’s emergency rooms face a growing crush of patients, many uninsured and lacking other access to medical care. Among them are regular visitors who look to emergency rooms to provide food, human interaction or perhaps just a warm place to sit for a while.

No one else may consider their needs an emergency. But those patients do, and that’s enough to get them in the door.

Moral, Legal Obligations

“There’s a moral and legal obligation to take every complaint seriously,” says Dr. Richard O’Brien, a spokesman for the American College of Emergency Physicians. He considers patients like Goins an unavoidable part of the job.

“Rock stars go deaf. Football players break bones,” he says. “And emergency-room physicians deal with challenging patients.”

Gregory Goins’ emergency-room visits, ambulance rides and hospital stays have cost taxpayers an estimated $900,000. He has been called a shameless manipulator of the system, a burden on overworked nurses and doctors and a danger to other citizens in need of ambulances and hospital beds.

Goins is all of this. But he is something else as well. The staff at Highland hate to see him coming, yet many miss him when he stays away. Amid the emergency room’s anonymous stream of injury and illness, there is comfort in a familiar face--even when it belongs to someone as maddening as Goins.

“Gregory, Gregory, Gregory.” The sheriff’s deputy shakes his head as Goins is wheeled in for the 1,209th time. The triage area is noisy and crowded. Nurses dart back and forth. Paramedics squeeze gurneys into the hallway, jockeying for position.

Highland is a public hospital on the south side of Oakland, a county facility that takes all comers. Some can pay; many others, like Goins, cannot.

“Gregory!” a nurse shouts. “I haven’t seen you for a while.”

“You gotta be kidding me,” another nurse says. “This is his second time this week for me.”

“Get him out of the way!” the triage nurse barks, as yet another gurney arrives. “We’ve got a medical code coming in.”

A thermometer is stuck into Goins’ mouth, and a paramedic briefs one of the nurses: Patient was walking along Lakeshore Avenue when he developed chest pains and shortness of breath. CP/SOB, the nurse writes on Goins’ chart. The usual.

In a few minutes, they’ll take him back to an exam room for tests. For now, Goins remains parked by the wall, haranguing everyone near him.

“Hey, Shorty.” “Hey, man, can you get me a soda?” “Nurse, nurse, can I ask you something? Will you marry me?” “Officer, arrest that man.” “Got a quarter?” “Hey, you know me?”

Everyone here knows Goins.

Doctors and nurses call him Greg. Guards and paramedics call him “Shamu,” after the Sea World whale, a nickname bestowed a few years ago when he weighed more than 300 pounds.

He is 60 pounds lighter now, more walrus than whale, with a belly that bulges out through his unbuttoned shirt and hangs over beltless pants that keep sliding down to his knees. Even his smile is walrus-like, with two yellow tusks poking out from an otherwise empty upper gum.

He is 47 years old, penniless, jobless, and until recently, homeless. He has a history of cocaine abuse, though he says he is off drugs now. A psychologist recently pegged his IQ at 60, apparently missing his genius for bumming cigarettes from strangers or cajoling lunch from softhearted doctors.

Highland’s emergency room is the center of his universe, one of the few places where people actually talk to him.

They cannot make him go away, because Goins is truly ill. He has alarmingly high blood pressure, a chronic condition that has thickened the walls of his heart and made him vulnerable to strokes and heart attacks. Last year, blood vessels in his brain hemorrhaged, producing a massive stroke that doctors were sure would kill him.

Goins somehow survived, barely the worse for wear, and now he and the doctors at Highland have settled into a routine: He summons an ambulance once or twice a day. Emergency-room staff hook him up to an electrocardiograph, confirm that he’s within his usual readings, and admonish him to take his blood-pressure pills. On the way out, Goins tosses his prescriptions into the trash, thereby ensuring more trips to the emergency room.

“I think he is faking, manipulating quite a bit,” says Dr. Barry Simon, director of Highland’s emergency department. “But the reason he’s so difficult is that we all feel we’re playing Russian roulette with him. He has malignant, accelerated, uncontrolled, near-death hypertension. Given that, in the face of chest pains, nobody in their right mind would ever send him home.”

‘Distraction Puts Other Patients at Risk’

Not that they have time for Goins’ daily appearances. Highland’s ER doctors are hard-pressed to serve the 68,000 patients that stream through their doors annually. During Goins’ visit this day, five gurneys are lined up in the hall outside his examining room, all bearing patients awaiting beds.

“We need to pay attention to the people we really think we can help,” says Simon. “Every distraction puts other patients at risk. When I have to come out to the triage area to talk to Gregory again, after he’s cried wolf a thousand times, it’s a major distraction.”

It’s also a significant drain on resources. No national surveys exist, but a study at San Francisco General Hospital found that just 6% of ER patients there accounted for 25% of all visits.

Goins extends the phenomenon to an absurd extreme.

“He really enjoys the circus effect, the ability to have that kind of impact,” says Dr. Eric Snoey, an emergency physician. “He’s got his 15 minutes of notoriety every day of the week.”

Goins remembers his first ER visit, 10 years ago. He had chest pains.

“It hurt like hell, and it scared me a whole lot,” he says. “I came here, they gave me some medicine, and I felt like a brand-new baby.”

These days, since he rarely takes his medication, Goins seeks another form of healing, gleaning scraps of satisfaction when busy doctors or nurses slow down to spend a fleeting moment with him. Mostly they are terse, impersonal, even annoyed. But occasionally, Goins gets the kind of intimacy he can find nowhere else.

Like right now: Nurse Anita McCallion is removing an intravenous line from his wrist as he sits in the examining room. She presses a bandage against his skin and holds it there.

“Is it bleeding?” Goins asks.

“It’ll stop in a minute, Gregory.”

She stands close to him, as close as anyone ever does. If she minds his body odor--a foul blend of sweat, feces and cigarettes--she doesn’t mention it.

Goins’ free hand rises and grabs hers. It’s a classic Gregory move, embarrassing and inappropriate. But instead of pulling away, McCallion returns the squeeze. Her gaze meets his, and she smiles.

“You have the prettiest blue eyes,” Goins says.

“You’re looking good, Gregory. Keep taking your medicine.”

The bleeding stops. McCallion tapes him up, then heads for the door.

“Can I ask you something?” Goins says.

“Sure.”

“Can I kiss you?”

“Oh, Gregory.”

Doctors and nurses complain about Goins’ irresponsibility, his rudeness, his stench. They joke about buying a house for him across the street from the hospital to save on ambulance costs. A frustrated paramedic once paid Goins a dollar not to call 911 during his shift. (It didn’t work.)

For all their complaints, however, many Highland staffers confess that a day without Goins doesn’t seem complete.

“In emergency medicine, we don’t often hear the stories behind the bruises or alcoholism or chest pain,” Dr. Snoey says. “So there is a degree of comfort in seeing the same patient repeatedly. Greg is our most famous patient. He really is like a dysfunctional family member.”

Walt Searway, a paramedic, has a recurring dream in which he gives Goins his final ambulance ride.

“I’d hate to have to work him, but I’d be honored to be there too,” Searway says. “It’s just kind of a bond I feel to him. He’s a person who has the least of the good things in this world, and he deserves to have someone there who cares for him.”

Some doctors argue that Goins is not really the problem. Emergency rooms have always had such visitors, and in less crisis-driven times, they often were given a bed for a while, then sent home with a sandwich and some clothes from the free box.

But this is an era of huge medical costs, forced efficiencies and overwhelmed emergency rooms. With little hope of changing the system, the staff at Highland decided to change Goins.

About three years ago, they convened a 20-person committee of doctors, nurses, paramedics and social workers to brainstorm how to reduce Goins’ use of the emergency room.

They tried to make his hospital visits less appealing. Nurses kept him away from exam rooms, where he often fell asleep. Instead, they gave him EKGs in an uncomfortable chair in the triage area. Doctors spent as little time as possible talking to him. A restraining order banned him from the hospital unless he was receiving medical care.

His typical two-hour turnaround time was reduced to 30 minutes, but it only seemed to bring him back for more. Doctors eventually threw up their hands.

“There’s no system in the world created to manage someone like him,” says Simon.

Last winter, Goins’ daily visits abruptly stopped. He’d been jailed for violating an order banning him from a local cafe, where he’d made himself unwelcome by defecating on the floor.

Released in July, Goins immediately resumed his daily routine at Highland--until late August, when he was jailed for a few days for getting belligerent in the emergency room, then jailed again for visiting the off-limits cafe.

When he’s not behind bars, Goins now lives in a group home for developmentally disabled men. There, home director Vincent Bush nags Goins to take his blood-pressure pills, change his sheets, brush his teeth and put on his shoes.

Sitting on the home’s front porch, Bush lectures Goins on the errors of his Highland habit.

“Gregory, you’re costing the taxpayers an awful lot,” Bush says.

“If you don’t like it, fix my heart,” Goins replies.

A few minutes later, after Bush goes inside, Goins says he appreciates what people are doing for him. He says he likes the group home. He says he even likes Bush. But he doesn’t see his frequent visits to Highland as something he needs to change.

“Last year, they told me my bill was a quarter-million dollars,” he says. “I said, ‘So what? I’m sick. Take care of me.’ ”

With that, Goins announces it’s time for a walk.

In his slippers, he trudges down to Park Boulevard, where he occupies a bench until a friendly bus driver lets him board for free. Goins rides for a half-hour to nowhere, ending where he started.

It’s a cold and cloudy morning, 12 hours since Goins’ last visit to the emergency room. He shuffles along, greeting everyone he passes. Strangers mumble hello or say nothing, averting their eyes.

Goins says his chest is starting to hurt. He finds a phone by Walgreen’s pharmacy, but drops the receiver when he sees someone he knows at the check-cashing place across the street.

He walks over and bums a cigarette from a young man wearing lots of gold jewelry. Then he walks a few steps to another pay phone, where he looks down at his cigarette and suddenly remembers: They don’t let you smoke in the ambulance.

He sits on a bench, smokes the cigarette down to the filter, then returns to the phone and punches 911.

“I’m having chest pains. Yes, ma’am. My name is Gregory Goins. OK, thank you.”

He sits back down. Two minutes later, the wail of a siren cuts through the buzz of traffic. Far-off at first, it grows steadily louder, and Goins shuts his eyes and leans back, nodding his head.

He’s going to see his friends at Highland, and they’ll make him feel better again.