$ 168

O.K.  2nd time is the charm.  I say this because this is sort of like vu jada.  Meaning I have already written it once but when it didn't post it disappeared.  I grumbled at the time, muttering something about not caring if it posted anyway...stupid ole' computer.  But obviously that is not entirely true as evidenced by this late night rant.  So sit back as I try to reconstruct the details and find ways to embellish for my own self gratification.  

So it's 4am.  I am standing in front of a guy on a stretcher who is billed as "foot pain, non traumatic" per the triage note.  I walked in to see a 50 year old man who looked much older sitting with one shoe on and conversely one off sans sock.  I introduce myself ( because that's what the customer service handouts say to do) and consider offering my hand but somewhere between hanging by my waist and being fully extended I think better of it and simply put it back in my pocket.  Safe and sound.  And clean. 

In any event it's late and as he begins to tell his tale of woe and begin to think about how badly my eyes are burning.  I want to close them and roll my eyes around, just for a minute, but before I can fully devote myself to this distraction I hear him say " 2 years."  I immediately tune in, thinking 2 years?  It's 4 am and your in here for something ( I wasn't quite clear on why 'exactly' he was here) that has been going on for 2 years!?  Of course this was an entirely mental dialogue.  An outsider would have heard something akin to "Hmmpf!" 

The 2 years also caught my attention because as an ER doc I don't do chronic pain.  By "do" I mean treat.  Or at the least endeavor to treat chronic pain.  At least in theory.  In reality I treat chronic pain everyday because people either can't see their doc's, won't see their doc's or can't see their docs.  It is not as redundant as it would seem at first glance.  However, I will save the diatribe on health policy for a later rant.  So, when this guy with non traumatic foot pain ( read Drug Seeker) comes in I immediately defer to hospital policy (non existent) in explaining that I don't treat chronic pain (completely untrue) and that he would need to follow up with his own doc.  

Bam! done.  I take a hard line with patients that I believe are drug seekers.  Sometimes.  Most of the time.  Unless I am not sure...better to be kind than be wrong.  But seriously, 2 years?  So, even though the mental decision is made I have to go through the requisite steps.  Namely the exam.  So, I put on some gloves, poke around a little bit, everything seems to be ok I say flatly.  I take a quick listen to the heart and lungs.  Not that it has anything to do with anything...but it looks good and I paid all that money for a good stethescope.  

Well, as I am telling him about his good fortune of not having a break, sprain, or infection he begins to tell me his story.  Or retell, at least some of it.  He had a bad on the job injury 2 years ago.  A local orthopedist fixed it right up and soon he was back at work.  That is until he was layed off about 3 months ago.  Losing both his health insurance and his 17.50/hr job in one fell swoop.  At about that time he had been having increased pain in his ankle where the screws were at.  He came to the ED and learned via XRays that the screws were indeed backing out and needed to be removed.  He called the orthopedist and was told that yes the screws needed to come out and for only $500 he would accomodate him.  "500 dollars?  If I had that kind of money I'd be rich" he said.  I raise my four grand kids with my wife.  Okay Okay...at this point despite being dog tired and having already given my pain management speech ...I was hooked on the story.  I wanted to know WTF?  Why was the guy raising the kids?

"My son was killed in a car accident 8 months ago and their momma ain't around" he said. "You know what?  I went to apply for food stamps and they turned me down said ' I made too much' me, I don't have a job and just got my first unemployment check.  I make too much".   "You know how much"?  he said.  At this point I am actually moved.  4 kids?  I know personally how hard it is with 4 kids...now do that without a job and in chronic pain...man that's rough.  So...I come to long to venture a guess.  $168 I said.  His face went flat..."How'd you know that?" he said.  Uhhh, it was just a guess.   But while I mutter one thing or another I am doing the math.  168/week, 14/day, 2/day per person for food.    Maybe my math is off, but that seems tight.  

I can't imagine the weight of what this guy feels.  4 little people looking to him as their sole means and he is layed off, on unemployment for the time being making a fraction of his prior wages and with no real hope for the future as he talks about the 2 previous ED visits garnering him a total bill of almost $ 7,000.  " I had a good name at the bank, but they (hospital collection people) tell me this is gonna go against my credit"  At this point I realize the plight of this poor guy and would be willing to treat him for free.  Only thing is I don't do surgery and that is what he needs.  Instead, due to a lack of compassion and $500 he will go on to use narcotics in an attempt to control his constant discomfort or pain.  Running up huge bills, getting further behind, potentially become dependent and likely suffering from depression as his ability to work his hampered by the economy and his ailment.  

So, I proffer the administration of pain medicine in the ED as well as a prescription.  He kindly accepts and goes home.  No happy ending.  Just a glaring example of a broken system and greed.  I am not so sure there is not a role for socialized healthcare...somewhere in the system we have now.  I mean waiting on surgery that is forthcoming is better than waiting on surgery that isn't.