Monday, August 10, 2009

Public Hospital x2/~3

They will ask you your weight, at least 3 times in 2 visits, and you shall self-report it, only once noting out loud that they have not taken your weight, that you do not have a scale and that no one has weighed you in a long time.

Truman Medical Center intake staff are ex-circus performers.

I met a Somalian man (young man) in a wheelchair because I was no longer, after one visit to the ER, fascinated enough with the coral reef / tropical fish tank there that divides General Waiting from (something like) Expedited Care. He looked as familiar as all my former students, and he described his situation as an accident, and he lives on Garfield Avenue, near a school where I once taught. Also, people from other countries, religions and cultures etc. are more interesting and less socially threatening to talk to in a place where I stand out a bit from the crowd. And most other people in the waiting rooms are pissed off or wrangling children. No one reads anything. I don't know how they can stand it.

The RN/LPN of today wished an x-ray (Madeline from Radiology was nice, and it was sad to overhear her dealing with some tedious phone-line transferring issue while I was waiting — the little cracks in the technology become evident, along with all the other cracks that make working in a place stressful, that make you wish that systems did not have such systemic problems and that people could just do their jobs outright and to the best of their ability).

The two doctors who actually saw me Sunday (neither of whose name was listed on my paperwork as the doctors who were there) had decided against an x-ray. When an infection seems mostly improved … why dig into the bone level? Foreign matter was the goal; but I was pretty sure the only thing keeping one of my hands puffy (look, Ma, no tendons!) is the deep punctured hole sitting on top of it.

Having a second arm bracelet exclusively for the fun of displaying your insurance status is quite ____. Wednesday, when I go back for my second follow-up, I shall look about at others' bracelets. White is for private insurance, and I have a feeling there are other colors.

There was a woman (which I kindly thought was a dummy / teaching tool the third time I saw her) curled up on a bench inside the spot where one becomes admitted.

My insurance cut me off from St. Luke's … but the public hospital is excruciatingly convenient anyway, and I am most used to declassé situations. Mind, that is a misuse of the word, but the waiting room is rather like a giant, non-moving bus. After making a decision to move from the section of chairs reserved (says sign) for people waiting to check in to a spot deeper in the waiting room between two male humans, there was a smell as I read my PETA propaganda picked up from the yoga studio in the office building where I work. Nothing traceable to anyone in particular, so what's the point of moving again? It's a lottery …

It was my second visit, and I keep laughing but it shouldn't be funny that I have had to declare the last date of my last period at least seven times to seven different people (always having to look it up and probably at least once or twice mis-reading my calendar, dyslexing a 3 for a 6 or vice-versa) … and no one (one did ask) actually took any samples to check; shouldn't it be funny that I answered "no" at least 5 times about prescription medication or medication in general but I still received the "may decrease the effectiveness of birth control pills" speech two or three times?

And I got an x-ray without any lead vest? And am taking giant doses of antibiotics?

The part about restating your name and DOB every time they hand you something new is fine; I get that, and so the round-about ways of asking whether someone is pregnant, making sure again and again, must be some legal issue, too. But, unlike Dr. House, they trust your answers.

I have spent eight hours and an unknown amount of medical expenses on the consequences of my trying to get my ("my") stupid and psychotic cat indoors Saturday night. I only had the sense to hold the 17-pound beast away from my face. You think you have a grasp of something, and then you realize it's thrashing beyond your control. It happens quickly. Cats have instincts, and my human ones were suppressed by the goal. I guess I should have let him fight the other cat and then let him be the one to go to the vet. Which outcome would make me a better cat-owner? Ha ha.

The person today had no more information than I had about the IV cocktail of antibiotics I was given on Sunday (even less, because I had to inform her twice that I had taken them the day before; I guess she was distracted? I had overheard her talking about how she would have taken this library job — her favorite job ever — were it not for the fact that she had been about to go into the Navy and "everything was in motion" to the loud RN man who sounded every bit as arrogant as a doctor until I met him: short, wedding ring, balding, glasses, trim, literary, "knows every animal shelter," and whose cat "does not bite…").

Though I had scribbled the funny brand-names of all the equipment I was left with for 2 or 3 hours on Sunday, I figured (stupidly, I see), that my discharging paperwork would disclose my treatment. The healthcare practitioner today did not find it necessary to look up details; she did, though, act surprised before her ears contacted her brain when I answered her question about my pills, "I'm on Augmentin, or the generic form of it, but I have only taken two so far" (meaning that the drug probably hasn't had much chance to work yet). She got all bug-eyed: "Why only two?!?" Sigh: "Because I started it Sunday and it's a 12-hour dose and I do it at the 9's."

Oh. Can't imagine what annoyances her day serves up to lead to all that.

When you go to the doctors', you have to pay too much attention; you might as well be ordering fried chicken at a drive-through, you have to repeat yourself so much.

I will say that most people I met there are nice, considerate and fine. As good as or better than those I have encountered in so-called private sector health care. One of my fellow patients today (as I overheard; yes, doctor-types are loud-ass MFers who will talk about anything anytime and whose voices carry through the walls but who talk in the halls, referring to you as "12" or "4," anyway) apparently works at the IRS. Knowing her condition, it would not have been polite of me to peek out and see if we knew each other; having heard what RN man said to her about needing to make and appointment to get up to the OBG clinic made me think he was way-too-tuning his explanation way way down. It was insulting to all of us within earshot and with brains. No mention of cervical cancer screening. He wrote down I should read Christopher Moore's "Island of the Sequined Love Nun" (when noting that I was reading).

The fact that I have not paid a dime out of my pocket, despite the fact that my insurance card clearly says "$100" for an e-room visit and "$25" (it may be $30) for any doctor event, disturbs me. I have not had any paperwork that lists any costs. I have signed a few that, with long language, imply my consent to be treated and to pay for it. What kind of system asks you to sign a blank check? A check that you will pay after your insurance decides what things cost (for you/for them/that particular day) and what portion of that cost is their responsibility and whether or not certain caps and thresholds have been met for the calendar year and/or lifetime.

So, now I have had at least one "emergency room" visit, and I will have clocked two additional clinic events, which are in-taken through "emergency;" I can forgive (not) the Walgreen's Take Care LPN I saw on Sunday morning who was reticent about explaining anything and not at all sympathetic. I had to lead her into every clause of her sentence re: why I could not get antibiotics from here there and then. They would have helped, and I'm sure I still would have gone for more care, given the alarmist nature of Internet accounts of cat-bite infections, the amount of pain and loss of mobility due to swelling and, well, pain. But they have their rules.

The fear of the unknown expense contributes poorly to the getting well thing. I want to follow directions and am only going back for the second follow-up Wednesday morning out of fear. You know, no one wants to lose parts of their hands. But, instinct tells me that things are improving, and arrogance tells me that I would know it if things took a turn for the worse.

Everyone believed me when I said it was my cat that had bit me, not some stray, and that he was up-to-date on vaccinations. "I have the paperwork if anyone cares to see it." No. Amazing. It's all true, of course; but there is no reason for them to believe me. Except that my English is great and that I have insurance and a sense of humor.

My 140/bpm heart rate upon initial intake is what got me in ASAP, I was told. What a ticket, eh? Long live anxiety. I even explained that the last time I was at Walgreen's (for a supposed strep-throat infection that I did not have), the tech made me go back out and wait in order to get my BP and heart-rate down, that I was probably fine. Of course, things eventually stabilized Sunday and the rate was in the lower 80s after that. However, the amount of follow-ups assigned leads me to believe that it would have been bad care for them to let me go home un-antibiodied on Sunday. All a bit arbitrary, isn't it?

PS, don't ever ask me to take a lie-detector test. Disaster.

PPS, tetanus shots make it feel like you lifted 50 pounds 50 times with only one muscle group. I can barely get my arm over my head at this point. I don't like my blown vein, either. My legs are doing fine. My ankle could be better. My internal organs are not self-reporting. I do not ever want another cat/dog in my care again. They are too expensive, and I'm too selfish to pay for things I consider extraneous or akin to buying "love." I am worn out with the little furry bundle of needs that provides very little benefit in return, just noise and dirt; besides, I have birds. Avian flu, salmonella and little (predictable) beak-bites, I can handle.


Anonymous said...

so which experience is better? Public hospital or private?
Should dots be connected and infrences, well, infered about gov't sponsered healthcare? do tell. from architektonikos

Nick said...

One of Truman's docs lives around the corner from us. He's a lovely man who can no more discipline his kinder than make a winning wager on the Kentucky Derby, which we know to be sadly true as we annually sip mint juleps in his great room, making funny chit chat while his children race around and around and around and around the house matching the absent digital horses run for those gorgeous roses, dust kicking up on the Kentucky track almost as furiously as the carpet nap and dust bunnies raised by the too near children.

Last year, or was it the year before, he wagered his poke on a likely comer who had us all standing and screaming at the wire, the horse placed or showed, I do not recall which now, but then fell, multiple broken bones in one leg, no, both forelegs shattered and the beast was destroyed where she lay, it would have been too painful, too cruel to even carry her to a private euthanization.

He noted that many of his days at Truman passed much the same. And he’s ‘just’ a psyche doc.

Applecart T. said...

Don't recall private hospital care.
That's the thing: I have insurance, so my care is private no matter where I go.
The bill (for two days; I did not go back on Wednesday, and I'm going to have to say I'm angry no one suggested that I go see my primary care physician — which surely I have but was not asked about on any paperwork, which means to me they assume too much) for what amounted to two ER visits was $1,700.

I just got a call today from the billing person who was trying to enter my information correctly, since I'm not actually (despite what the card says) with United Health Care but with American Medical Security and UHC was rejecting my SS#, DOB and name. WTF indeed.

And, poor A. in billing, she was so kind about my "I thought they photocopied that card."

OOOOOH, bureaucracy. THIS is what makes our health care inefficient and #37 in the world.

La France, anyone?

Sure, they have strikes (la greve) every 10 minutes, but …