Friday, August 21, 2009

A tale of two patients.

Meet Zack. Zack is 26, and will be dead by age 30. He has severe hypertension (240s systolic tyically, because he will not take medications to control his blood pressure). His kidneys have been blown out for a few years due to that bustin pressure, and he has an appointment slot at a clinic.

He doesn't go.

Last month, he was in Hospital A's ER "because he felt like ****." We dialyzed him, and he left AMA (against medical advice). He did not go to his scheduled dialysis appointments. Four days later, he returned to Hospital A's ER "feeling like ****." I dialyzed him, we discharged.

Last week, I saw him being dialyzed at Hospital B by one of my colleagues. I didn't ask why or when or whether he ended up again, leaving AMA.

Today, he was being dialyzed by a different colleague at Hospital C. He walked unaided to the inpatient dialysis room. This delightful boy flopped on the chair and barked at my colleage, "I'm having some ******ing pain, I need some ****ing Dilaudid. Those pills never work. It's chest pain. Eight out of ten." By the time we did our end-of-day hospital charges, his name was greyed out as being 'discharged'. me stupid, but if you're going to different hospitals and sleeping over at least twice a week, going to your thrice weekly outpatient appointments seems like less bother. So is it about the ******ing Dilaudid that makes you want to spend the night at different hotels around town? If it's really that great, why not stay in the hospital and keep getting more?

I don't know for a fact that Zack doesn't pay for hospital bills, which cannot be less than $10,000 each visit.

But I do know that it is being paid for somehow, by somebody. The hospitals may write it off, but they do not take a cut in profit for someone like Zack. Those costs shift to elevated costs on other patients.

The next time I see Zack, I may ask him if he pays his multiple hosptial bills. I will be standing out of arm's length (he's thrown a punch at one of my colleagues, who is 60something and a grandmother and sweet as pie).

But I'll bet you're wondering the same thing, and for you, gentle reader, it might be worth the string of expletives.


Meet Josephine. She is 82. She is trim and active. Her two sons and their families live close by, and she has a strong network of friends. She went to the ER yesterday "feeling strange and nauseous" and they found Josephine to be in a rapid AFib. She was cardioverted today, and popped (tentatively) into sinus rhythm. (Cardioversion = low-end electric shock to heart in controlled environment.) (This can hurt.)

We also found her creatinine and BUN to be elevated enough that acute dialysis was appropriate. The cause of the acute kidney failure isn't yet clear.

She was profoundly exhausted when I arrived to dialyze. The fentanyl and versed had knocked her tiny, drug naive body SO hard that she got Narcan'ed and Romazicon'ed (reversal drugs...unpleasant to even watch them being administered). Fortunately, she does not remember this. She just really, really wants to sleep.

So I set up my half-ton of equipment and did my chart review and lab review and normal routine. Got her blood spinnin. I had assured her that once it was going, she'd have a nice quiet nap. If she woke up, I'd be at her bedside, charting and reading if she needed anything. Easy. That's what we did.

A few minutes into her dozing off, her eyes suddenly snapped open, "Is this? (she points to me and to my machines) Is this paid for by my Medicare?"

...."I'm sorry??"

"Because I have Medicare and supplemental insurance through ABC Company." She was genuinely worried.


Here's a LOL (little old lady) who just had 50 or so Joules direct to her heart, a cocktail of narcotic and anxiolytic that tied up her brain's opioid and other happy receptors so completely, her respiratory drive started to crap out...and then they administered meds to rip all those happy molecules right off her brain (ouch!)...and then I come in, slurp her blood into a machine, whip it around, pul off more electrically charged molecules, dumpin protein into her body to keep the blood pressure stable...and...

And she couldn't drift off to sleep because she wants to make sure she can pay for my services.




RehabNurse said...

Oh, jo! If only we had a few more patients like this.

I've decided that on my unit, we're just aiding and abetting the carnage. People get bored and come to us for a nice vacation of sorts. 24/7 service, laundry, etc.

Sure beats staying home and having to do everything for yourself...or have to hire help!

overactive-imagination said...

Sadly and from experience I know that the LOL is few and far between in being concerned about whether her procedure is being covered and if she can afford to pay.
In my ER we get soooooo many people who could care less who foots the bill for their frivilous visits, it's sickening really.

"My child is SICK".....ME: Can you be more specific? Mom: She coughed this morning....I think she may have swine flu......Oh and can I get a taxi voucher home?

That! is how most of my days go. Head desk*

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