Thursday, March 5, 2009

The big day

So here it is, another year. Though really, I feel the same as yesterday. It has been a wonderful day though. I did choose to work, and take my paid day off in a couple of weeks with a weekend and a floating holiday. Thanks for the messages of love from so many.

I have to say it is a little funny to call mom and start to tell her something, and her say "Oh, I read the blog!" Well, Hi Mom!

I want to address healthcare. I know this is my pet issue, because I am a consumer (well, isn't everyone? But I am a serious consumer, with a chronic illness) as well as part of the health care system.

It is broken. it is heartbreakingly broken.

Today I helped prepare a woman for a casting of the wrist she broke 2 weeks ago. She was seen then in the ER.They only splinted it, and sent her to her "Primary Care Provider" for the casting. I imagine they wanted wait until after swelling went down a bit.(I want to believe that was the reason, and not a lack of desire to provider additional services that would not be paid for. Surely, but I imagine that sort of passing the buck is not uncommon in the nation when hospitals are being swamped by the needs of the uninsured, the poor, the weary)

The idea, the expectation of her having a primary care provider is ridiculous. She is homeless, transiently passing through town, wanting to head out on her "adventure" as soon as she can. She was told to call my clinic, because we are the net that catches the falling souls. Unfortunately we only have so much room in our net.

We are fighting a huge flu outbreak, along with a wicked virus. Each day we are sending established patients to the ER or Urgent care because we just can't see any more patients. You have to understand that most Dr's offices see 20 or so patients a day, give or take a few. The Dr's in my clinic see between 28 and 32.(In fact I know of one wonderful pediatrician who managed to get 19 very sick children through his rooms in just the morning, because he had to attend meetings in the afternoon) We are seeing as many people as physically possible, and we can barely keep up with that many. (each visit comes with prescriptions, labs, messages, orders, recheck appointments, referrals, so on and so on. I have never left working feeling as if I completed my job, because it will never even be near caught up. We are just always doing damage control, triage and mop up)

So we have to limit how many new patients we see each day, in order to save as many slots as possible for the established patients. Other clinics can say "no new patients, our practice is full". Not community health care. Federal and state dollars come with the stipulation that nobody is turned away. Nobody is turned away, but we have to slowly add new patients.

I know personally that things were squeezed a bit to get this patient in, this woman with the broken wrist. Most likely it would have been another week, if the "rules" were followed. To clarify, any children we get in immediately if they are sick or injured. They don't have to wait, we will squeeze them in that day if needed. OB patients (pregnant women) are in the same category. Just to start prenatal care they may need to wait a few weeks, but if they are hurting or bleeding we will put them in no matter what. (even if the Dr's all have their 28 slots full, which is why we end up with 30 or more patients most days)

How is it that in a country with as many resources as ours, people would have to wait weeks to get an arm casted? How is it that with so much money involved in the health care system, we have a wide chasm many fall into? Why is it that the burden of meeting the immense needs of the many are left in the hands of a few?

So as I was washing this woman's arm, which had been under a splint and bandages for two weeks, she kept washing her face, her other arm, with the soapy water. She said it was so dusty outside. I asked where she had been showering and she said she had used the one at the day shelter about once a week, but she felt awful. I had her stuff two packages of baby wipes in her pockets to take with her. I asked where she had been sleeping, and she said that after the friend she moved out here to live with kicked her out, she had been just doing her best to find out of the way places to go unnoticed at night. Some nights she was in the shelter, but she was afraid of the other people there.

I must add here that I see all sorts, the very mentally ill, the disabled, the addicted, and I really think she was not entirely hopeless. I can see that probably not long ago she was productive, functioning. I don't know her full story, nor did I ask. I just want to be the gentle smile and word of encouragement to those in front of me. That is why I am community health care. I have learned not to invest my heart, because then there is nothing left of me. this has not been the easiest lesson for me in this life.

She was clearly in a lot of pain. the process of washing and then casting her arm was not entirely gentle, and she shed some tears. She said that if she still had any of the vicodin she was given in the hospital she would have taken one ahead of time, but they were stolen. Her hospital record said that she was given 20 pain pills. It would have been entirely understandable if she had used them up in the two weeks she has been in pain, without a cast.

The Dr said not to worry about it, she would write her a prescription for more, say 20, but there would be no refills.

The patient asked her if she could make the prescription for less than that. In my healthcare experience, NOBODY asks for less pain pills. Even healthy people might think that the will use the few extras just in case, to have tucked away in case they re injure that knee or whatever.

This woman, in extreme pain, who has had to wait 2 weeks to get her wrist properly immobilized, said that she would have to panhandle in order to get enough money for a few pain pills. She asked for the Dr to only write it for 5.

Our system is broken. Seriously broken. This could be you, your mother, your sister, your old 2nd grade teacher. It could be the college student living on ramen or the new father, who gives up his own needs to meet the needs of his child.

The crisis out there, the one that most people don't see, it can't be fixed by just a few soldiers. We need an entire national effort to stop this.

I truly weep as I watch this finally being addressed by an administration. I don't care how many people tell me that individuals need to be responsible for their own health care. That it would be an un-democratic move to move in the direction of socialization. I invite any naysayers to just spend an afternoon sitting in the waiting room of a community health care center. Last I heard, it is likely that many of them will see themselves reflected in the faces of the estimated 40% who have no health insurance. That number is expected to rise in the next few years.

I wanted to pull a handful of bills out of my wallet, to help this woman manage her pain. but I can't fix it, I can't save them all alone. Are you willing to help? If so, send an email or letter to your representative, and tell them that health care reform is important to you. It is important to us all. Tell them that you believe every single American has the right to basic health care.

I was the first to sign her cast. I drew a great big red heart, with the words "Be Strong" boldly printed in black. I hope she is strong, and is ok in the end.

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