Why Health Care Reform Won't Work

Today I worked a day shift in the Emergency Room (i.e. business hours). In my short time, I saw 21 patients. All of the patients I saw today had some sort of medical coverage, mostly Medicaid, but some private insurance as well. Out of all of these, 19 complained about their wait time and 2 thanked me. However, much more importantly, 20 didn't need to be there and 1 person seriously had an appendix that needed to come out that second, but he had to wait 4 hours behind "ear pain," "STD check," "sore throat" and "rash." Before I started my shift, I made it a point to be sure and document if each patient had access to a primary care provider, either a pediatrician or family medicine doctor. Out of 21 patients, all 21 answered "Yes" to having a primary care doctor, and knowing how to contact them. Two patients had contacted their PMD before coming to the Emergency Room. The first one was the appy, whose pediatrician had taken one look at him and sent him straight to the ER for a surgical consult. The only other person who had actually called their PMD was a child who fell off a kitchen chair. The reasons that 19 other parents didn't call their primary care doctor and instead came to sit in the Emergency Room were as follows:

"Didn't think about it" = 6
"Couldn't get in to be seen today" (all could be seen before Christmas, however) = 9
"Don't get along with my PMD" 1
"The ER is closer than my doctor's office" = 2
"Thought this was an emergency" = 1

Just because people have medical coverage and ample access to primary care providers, does not mean our Emergency Rooms will be any less crowded. Just because people have access to a primary care provider does not mean they will not be impatient. It does not mean they will not want care "RIGHT NOW" and it surely does not mean they will understand the difference between a minor annoyance and a full blown emergency. I try to educate families on appropriate uses for the Emergency Room, and some parents actually feel comforted by that. They are glad to know a plan of attack, and what things should worry them. Most parents, however, just roll their eyes at me and ask, "How much longer?"

A long time, my friends. A very, very long time.

Foot and Mouth Disease

While trying to comfort a teenager who felt silly about bringing up a fairly impressive complaint in her genital area:

"Well, I don't know what that is, but it definitely isn't normal."

Foot, meet Mouth.



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Now playing: Andrew Bird's Bowl Of Fire - MX Missiles
via FoxyTunes

Common Good

It's amazing how you forget, so easily, what it felt like to be whole. I've been back at work for a week now, and though I can still remember home, in pictures, I cannot make my skin remember the warmth of the wood-burning stove.

I think working the night shift in the ER is painful penance for every time I should have gone to sleep on the top bunk instead of pestering my sisters below me. In general, I guess, being forced to work in the ER every few months is penance for all my greatest regrets. It is, truly, my nemesis.

I am not sure how I continually convince myself that living this way is good. I surely know it is not normal. But somewhere, somehow I have bought into this idea that being treated this way is for the common good. That this was my choice and I deserve nothing better. Working 80-100 hours a week, staying awake 30 hours at a time, being belittled by staff members, eating saltine crackers and water on the run, not even having time to go to the bathroom. Being exhausted all of the time. Hurting babies. Losing relationships. You're a doctor, Danielle. You deserve that. Really? Really?

When it is bad, it is very bad. And when it is good, mostly, it's just OK. I am thankful to have a job, even when it breaks my back and my spirit. Some days (and nights) I just have to suck it up and make a living. And the lie I tell myself is that I should feel bad about admitting that.

NOVA did a special on 7 physicians followed from medical school through residency and into practice. Though the footage may seem somewhat dated, due to their attire, the portrayal of real life is absolutely dead-on.

PBS allows you to view this entire documentary online here: http://www.pbs.org/wgbh/nova/doctors/

I would be curious to know your reaction. Do historically prestigious professions, especially those working directly with people, deserve to be brutalized for the sake of the common good?

Good Medicine

I went back home for a few days to bask in the warmth of family, a wood-burning stove, hot coffee and flannel.

During a visit with my brother-in-law, he held up his ring finger to me, showing off a big, purple. busted-up fingernail.

"Is this going to fall off?" he asked.

"No."

To which my mom added, "That will be fifty dollars."


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Now playing: Katie Herzig - Two Hearts Are Better Than One
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Together Feathers

I work 80-100 hours a week with these people. And all I want to do on my day off is be with them.

You make a family.

We had to work the next day, on a 30-hour shift. About noon a text page went out that said, "Thanksgiving Part 2?" And we all ran upstairs, in our scrubs, to heat up the leftovers. Together.


You want us to take care of your kids, because we are a team. Together, we are better.


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Now playing: Andrew Bird's Bowl Of Fire - Sovay
via FoxyTunes

All of My Days

On a very busy night, in a very busy hospital, I admitted a curly-haired little girl for dehydration. Or, at least that was the cover story. She had some chronic medical problems that were a lot to take care of, and so, somewhat conveniently before her mom was set to go out of town, she got dropped off in the Emergency Department. I truly don't blame the mother for wanting a break, and our hospital somewhat encourages this behavior. "Hey! Drop your kid off here and NOT on their head or out a car window!"

When she finally got up to the floor, the nurses gave her a bath and dressed her in an over-sized hospital t-shirt. She plopped down in her crib, put her thumb in her mouth and settled in to her new home.

I walked back and forth past her room many times that night, because just beyond her was a child who was getting very, very ill. I needed to be in his room frequently. Every time I walked by, the little girl was happily playing with her doll, like she had been entertaining herself for years. She didn't cry at all, and no one heard a peep from her that night. It bothered me that she wasn't sad and didn't seem to notice that she was all alone and should be scared. Her neighbor, on the other hand, screamed bloody murder when I walked into the room, and tried to bite me as I dragged him out from under his dad's chair.

Around 4am, when I was just sure that I could not be nice anymore, and I had to go lie down for at least a half a second, I popped back in the room to check on my little dehydrated peanut. She was lying in her crib, eyes wide open, thumb in her mouth. I unzipped the crib top, and lowered the railing. The rattling sounded like opening a lion cage or something. She wasn't bothered, and calmly let me listen to her heart and lungs, just blinking. And being alone. She looked and sounded great. I started to put the railing on the crib back up, when she popped her thumb out of her mouth.

"Hold you?" she said, in the most quiet, precious way.

"You want me to hold you?" I whispered.

She sat up, and nodded, reaching her thin little arms up in the air.

I picked her up, IV lines getting tangled with my stethoscope. She settled into my chest, lying her head on my scrubs, reaching her little arm around my neck and patting it, like she was trying to soothe me. She popped her thumb back into her mouth and closed her eyes.

And we both stood there, for a long while, being held.


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Now playing: Alexi Murdoch - All of My Days

The one where I kill Ralph

The problem started very innocently. My cat, The Great and Powerful Phoebe ("fee-bee"), started showing some interest in one of her 200 unused toys. A little stuffed mouse with an opening in the top to insert catnip. Or Ferrero Rocher. I came downstairs one morning to find the toy in the middle of the floor. Phoebe looked so proud (I'm a real cat, now!).

A mere two days later, it happened. I heard her JUMP off the couch (she weighs about 16 pounds, it makes the whole house shake) and run towards the door. I peaked around the corner to admire her new pretend play capabilities, and much to my horror, she was standing, teeth poised, over a real, live rodent. I didn't get a good glimpse, secondary to the hysterical blindness caused by my shrill screaming. I jumped on a kitchen chair, screaming and immediately called a friend. Still screaming, I tried to convince him to come over and exterminate. His wife tried to calm me down, which angered me to no end. I NEED HELP! MAYDAY! I AM LOSING IT!! I still am not speaking to her because of this.

Four little feet jetted across the living room, followed by my slow, obese cat. More screaming ensued. After three phone calls, 45 minutes of kitchen-chair-standing and one minor heart palpitation when it scurried over my running shoes, I worked up enough courage to tiptoe across the kitchen chairs, grab my keys and leap out the back door. I escaped. Then I picked up 10 of the most powerful, killing machines I have ever purchased. Well, mostly ones with a lot of plastic so I didn't have to actually SEE the critter, once captured.

In one of the most difficult moments of my life, I carefully baited and set each trap in mousey hot spots. Phoebe, breathless and asthmatic at this point, sprawled out on the rug and watched.

The next morning, sadly, all of the traps were empty. I went away to work, with baited breath, and a Gladiator mouse arena in my apartment. The mice had to die, but special Phoebe had to be protected from the traps as well. It took much thought and planning, the killing did.

I arrived home, and excitedly checked all the traps. My most prized trap, in the mousiest area...was MISSING! Let me just tell you, don't Google 'missing mouse trap.' I then became quite certain that I had both a mouse problem, and a mouse/mousetrap-eating snake problem. More screaming ensued, as did a call to my landlord. However, it was late, no one was home, and I simply put out another trap and went to bed.

You guessed it, ANOTHER trap went missing. One absolutely impossible to be reached by The Great and Powerful (wheeze, wheeze) Phoebe. At that moment, I was absolutely one hundred percent convinced that somewhere, in my house was a 3-foot rat with two traps attached to its fleshy white body. I called my landlord again and demanded that someone come over. Now.

When Frank, the maintenance man came over, he laughed and said in all the years he's worked here, he has never SEEN a mouse. Sure, whatever, that's what they all say. He pulled the dishwasher out from behind the wall, as this is where the first trap went missing. I started calling moving companies, to get me out of this expensive rat hole. Frank, belly flat on the floor, pants way too low for my comfort said, "Ah ha. Here's the trap. But no mouse....oh, uh, well, not all of the mouse..." I closed my eyes, threw my arm over my head, just like an old Southern Belle and said "Oh, come quickly, Jesus!" Frank went to move the stove, and I jumped on the kitchen chair, poised and ready for him to find the rat nest with lots of rat babies.

:::screech::: The stove said. I was hyperventilating and drinking vodka out of a mug at this point.

"Uh oh" Frank said. "I was afraid this might be the case. You won't believe who's back here."

"Who? WHO!? Al Capone? Paul Anca? Templeton from Charlotte's Web? My gosh, man! Spit it out!"

Frank reached down to pick something up, and then, sort of cradled it in his hands. "Well, that's a shame. I hate to tell you this, but you trapped your neighbor boy's pet mouse. See the coloring. He's brown, with a white belly. Went missin' not too long back now."

And this kind, loving, gentle Pediatrician said, "Good. Put him in dumpster please."