I thought his story might provoke some testimony from other people about the false starts, the long waits, the surly attitudes, the bureaucratic snafus, the diversions to other hospitals and all the other miseries of a trip to the ER.

As it happens, I did hear from a local man who seemed to know what he was talking about. And he said his piece pretty well.

His experience is part of a larger truth -- a vast shakeout that's reducing America's roster of hospitals and emergency rooms, even as more people try to use them.

Changing HMO policy, strict adherence to federal rules on access, growing numbers of uninsured Americans: All these things have contributed to the ER crisis, and to the frustration of those inside the system. Listen to one of those people, who works here in Louisville:

"I am a paramedic with a paid, professional EMS, and I would like to keep my job. Therefore, this must remain anonymous.

"Your piece on the misadventures of Johnnie J. Wheeler was the hot topic of conversation around the tables at my EMS building. I would love to have been present to hear the snorting and condescension that occurred around the local emergency departments.

"Allow me to give you some insight as to why Mr. Wheeler encountered the problems. To begin with, if he had called 911 and arrived by ambulance, he would have been seen over any walk-ins. This is where part of the problem begins.

"Many people wait until their health reaches the crisis point before they take any responsibility for their own behavior being a contributing factor to the problem. We cannot begin to tell you how many people call 911 for stubbed toes, sore throats, rashes, earaches, etc.

"We are bound by law to take these people to the emergency room, regardless of whether we think they are looking for a free ride, whether they are whiny crybabies, or whether their emergency is real.

"It doesn't matter. If they call 911, an ambulance will transport them. It is then up to the emergency room to decide who has what, and is seen in what order. But hospital policies dictate that, if they were healthy enough to walk in, then they can sit and wait.

"This translates into a situation in which a paper cut, arriving by ambulance, is seen over a radiating chest pain that walked in on his own. Now, granted your sharper triage nurses will figure this out, and expedite the chest pain. But I personally have had the experience many times of whooping into the hospital parking lot with lights and sirens, with a patient with a true emergency, only to be made to wait in line behind other ambulances who have whoknows-what -- their own heart attacks or strokes or traumas, or yet another sore throat.

"It is no wonder the hospitals are cynical. This past week I took two different women who were both in their upper 90s, senile and bed-ridden, from nursing homes to emergency rooms. Both were full codes, which means every medical miracle must be performed to save them, lest they go into cardiac arrest and die. No one ever dies in the back of the ambulance or at a nursing home.

"The majority of the time, a true emergency or even a dire situation like Mr. Wheeler's waits for the next available ambulance to drop off GreatGrandma. Like everyone else, the ambulances wait and wait for a hospital bed so we can leave and help those who truly need our help.

"There is something so wrong with the whole emergency system. Not that the hospitals will volunteer this information, or EMS can openly discuss it, but find out the average waiting time in the local emergency rooms. And what is the staff-to-patient ratio?

"The hospital public relations department that thinks up these compassionate billboards has never worked in the ER on a Saturday night. The pendulum has swung from people dying at home when they reached a certain number of years, or progression of disease, to people feeling entitled to fast fixes for the unfixable. "How reasonable is it that EMS has to perform CPR on 97-year-old bones so brittle that they crack under our hands? Will our heroics save this life? Most of the time, the answer is obvious.

"Meanwhile, people like Mr. Wheeler find out the medical community's dirty little secret . . . it's all about money. It's all about people using common sense and realism, and saving emergency rooms for situations like you described instead of what fills them 85 percent of the time.''

A recent article by Marilyn Serafini in National Journal, titled "Trouble in the ER,'' puts this local situation into national context. The bottom line: We are not alone.

Serafini's summary: "Not enough nurses. Not enough beds. Not enough money from Medicare, Medicaid and managed care companies. Too many paperwork requirements.''

Closures, mergers and acquisitions have contributed to a reduction in the number of emergency rooms across America, even as demand for them has increased.

It's not all that unusual for patients to languish in an emergency room two or three days, because there's no bed for them in the appropriate hospital wards.

And when things really get overloaded, the ambulances are sent elsewhere. A recent American Hospital Association survey found that 69 percent of the hospitals reporting had been on "diversion'' for some part of the previous year.

Serafini notes that the number of hospitals has dropped from 5,194 in 1995 to 4,956 now, and the number of those with emergency rooms slipped from 5,172 to 4,679 during the decade of the 1990s.

Add to that these facts: Many HMOs have relaxed their rules for emergency service; there's tighter enforcement of the federal statute barring hospitals from rejecting ER patients with no insurance; more and more of the 43 million Americans who have no insurance coverage are showing up at the emergency room door.

Is it surprising, then, that 285 of California's 355 emergency rooms operated in the red during fiscal 1999?

Is it any wonder that doctors and nurses are worn out with ER assignments, even though TV writers have made it look like one of the more exciting (and, in a perverse way, even romantic and glamorous) places to work? The hospital association calculates that, in a typical ER, one hour is spent on paperwork for every hour spent taking care of people who are sick or hurt.

We turn caregivers into paperpushers.