It's early afternoon in the MUSC emergency room, and the ambulance has just delivered a mo-ped driver who got into a scuffle with a car.

He lost.

While a team of doctors and nurses patch him up, the rest of the staff juggles more than 30 beds full of sick or injured people. They are so crowded that one guy is on a stretcher in the hallway, about to get a nasty gash in his head stapled — just as soon as they find someone who can ask him, in Espanol, if he wants pain medicine.

"Si!" is the answer, by the way.

This is a typical day at MUSC's emergency department. "Typical" in this case means no day is ever the same at the only Level One Trauma Center in the Lowcountry, one of only three in the state.

A recent report from the Institute of Medicine said emergency departments across South Carolina are more crowded than ever. More uninsured people are coming in, and they are sicker than ever.

Dr. Larry Raney, director of MUSC's division of emergency medicine, said he hasn't really noticed a sizeable increase.

Of course, he notes, that's because it's hard to get any busier than "at capacity," which is where MUSC has been for a long time.

Full beds, full waiting room

If you have the misfortune to need the services of these people, rest assured you are in good hands. These days, the folks in emergency departments like MUSC's are true specialists — front-line, first responders who have seen it all. They often have the uncanny ability to diagnose you on sight.

A nurse peruses the list of patients, reading their ailments, looking for the warning signs of trouble. Something that might seem simple could be much more serious.

Like the guy who thought he'd pulled a muscle starting the lawn mower but instead was having a heart attack.

These nurses say they use all five senses, can pick out the sickest person in the room. They are remarkably good at it, but they have to be. Most days, the waiting room is full of people who use the ER as a regular doctor's office because, thanks to the biggest unfunded mandate in history, emergency rooms cannot deny health care to anyone, regardless of their insurance or ability to pay. A lot of people in this country can't afford health care and have no other choice.

This is one of the biggest problems with health care, a vicious cycle that costs each of us more every year. And they see it here firsthand.

Imagine what these folks thought two years ago when President Bush said, "I mean, people have access to health care in America. After all, you just go to an emergency room."

Heckuva job, Brownie.

Life and death

The Institute of Medicine report also says patients are getting more violent, less patient — no pun intended. The staff at MUSC is kind, saying only that they deal with all kinds of folks.

There's not much room to complain. The average person sees a doctor within 16 minutes, which has to be some kind of record. And most of these medical professionals — folks who obviously do not crave a routine — do their extremely hectic, emotionally draining jobs with a smile.

So if you do have to visit the ER, be polite.

They are working hard. And they may have just had to tell a mother that her child has died. This is ground zero for life and death, even if people don't treat it that way anymore.