Here Comes Trouble: Stories from My Life

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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

April 15th, 2010 7:27 PM

24 Hours in a U.S. Patient’s Life with No Hope for Change

It’s 10:45 p.m. when the patient’s legs begin to shake.  First like a chill setting in and then more like a tremor.  The only thing that helps is standing.  As the shaking continues, the patient breaks out in a cold sweat and has a mild chest discomfort, something he has learned to listen to after 20 years of cardiac difficulty.  Both the patient and his wife dress quickly, get in the car and make the 10 mile drive to a local well-respected hospital emergency room.  

And the saga began that no insurance reform bill will fix.  It is only through a systemic transformation that this barbaric system of non-delivery of healthcare in the United States will be fixed.

Inside the ER waiting room, children are crying, a woman holds a plastic bowl on her lap as she vomits, a young man sits with gauze wrapped around a hand obviously cut, and there are no open seats not littered with fast food bags, soda bottles or other discarded pieces of trash.  It is now 11:30 p.m.

After filling out an intake form, the patient sits at a child’s table in a chair close to the floor that was made for a 5 year old but is called in to a triage area for a quick EKG and a blood draw just to rule out a heart attack.  Though his main worry is the tremors and a headache that has gone undiagnosed for almost 10 months, with his complicated cardiac history (including three open heart surgeries), the heart takes precedence for this medical staff.  But no one even asks about the tremor or the headache.  No one asks him to explain so that he can mention the fleeting numbness down his right side.  He had a brain MRI to try to find out what is going on the day before at an outpatient clinic for which results are not yet available, but the triage staff is uninterested in that and has done its immediate duty, and the patient is put back out into the general waiting area.  It is 12:15 a.m.

Before he left home, the patient took his normal medications – he had no way to know that he’d be seeking emergent medical care in the hours ahead. So the medication he takes at night before bed has left him groggy and even a bit disoriented.  His wife picks up trash from a few chairs, takes it to the overflowing women’s bathroom trash can and then wipes down a chair so she can sit next to him.  She already mentioned the messy waiting room to the staff, but no one came to clean up.  The vomiting woman is still there; the young man with the cut hand is slumped over a table-top sleeping and another young woman has brought a urine specimen cup out to the bathroom with the overflowing trash to give up a sample.  She looks like she feels terrible.  

The television drones on with late night talk shows and the closed captioning running slightly behind the sound.  Another patient in a wheelchair leans over to sleep and her family covers her with jackets to keep her warm. It’s now 1:30 a.m.  No one has returned to ask the patient how he feels or to check on any of his other symptoms or to tell him if the cardiac enzymes drawn were normal or not – he and his wife must guess that no communication means no heart attack.  But no one says that.  No one says anything.

The patient tries to dose sitting up but jerks himself awake as he worries what is happening inside his body.  No one calls his primary care doctor – that just isn’t done anymore.  Doctors do not generally race over in the dead of night; doctors do not generally call patients when the office has closed for the day.  Patients must fend for themselves with the internet as a symptom guide and a guess about whether an emergency room trip is needed or not.

By 2:30 a.m., the patient and his wife are wondering how long others have waited. Five hours.  Six hours.  Some seem grateful just to have anyone ask or notice them at all.  Little children are restless and crying if not sleeping.  And the patient’s headache continues along with the tremor and occasional numbness.  No one even peeks out from triage to see if he is still there or doing OK.  No one calls his name.  There are gurneys in the hallway with no one on them where the patient could lie down, but no one offers.

At 3:30 a.m., the patient and his wife realize that they might be safer at home and just a phone call away from 911assistance than they are in this emergency room waiting area.  The patient and his wife have not even seen a doctor much less spoken to one.  They realize that perhaps the soonest they will see a doctor is the next day when normal business hours arrive again and not in this hospital setting.

Finally, the patient and his wife ask that the IV needle be removed and that he just go home.  No one says they are sorry.  No one asks much of anything as it seems this is a fairly normal course of events for the staff.  More than three-an-a-half hours after arrival, the patient has no more information than when he arrived, he is now very weary and still suffering most of the symptoms that brought him to seek care.  No one cares.  One staff member tells the patient he could have waited for a bed, but she says it out of annoyance not out of concern.  Perhaps she’ll be reprimanded for losing a billable hour or bed in the ER. No matter.  The patient did not come first.

The patient walks to his car as his wife supports his unsteady gait, and they drive home.  Headache.  30-pound, unintentional weight loss in three months.  Now leg tremor and occasional numbness.  Months and months of worry and suffering, yet treatment is in very short supply.  The patient has insurance – Medicare and a private supplemental.  It is not a money issue.  No one really cares, and that is the issue for today’s patients.

Patients are part of an assembly line of profit-making and profit-taking.  Some may be lucky enough to find medical professionals who remember what caring about people means in terms of offering medical care, but few do anymore. They’ll write it off to overcrowding and overuse of services and they’ll blame it – always – on the patients they mistreat.  

The health insurance reform passed this year will not relieve these problems for patients.  In fact, as more people have insurance they may be fooled into thinking that means they’ll have care, and nothing could be less true.  Having insurance is not having healthcare.  Ask any one of those vomiting, bleeding,  trembling emergency room patients waiting in the night for some relief or even the slightest communication about when relief might be expected.

I believe in a progressively financed, single standard of high quality care for all because I think the funding mechanism we have now – the for-profit, private insurance model – drives this assembly line mentality ever forward.  But the problems in our healthcare system go way deeper than just the financing methods.  We have a human dignity and human rights problem.   

That patient is my husband.  But he could be anyone.  It’s a mess out there.  After months and months of appointments with specialists who treat one body part or system and rarely look beyond their own billing silos, there is the nearly inevitable crisis and the dreaded trip to the ER in the middle of the night.  But there surely is no diagnosis and no treatment. There are headaches and tremors and fear and pain.

And until we create a humane healthcare system in which treating people’s suffering and people’s illness is our priority, we can pay for it any which way we want to and it just won’t matter at 3:30 a.m. in a dirty, crowded emergency waiting area.  What have we come to?  

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