Inpathy

Inpathy:   An emotional dysfunction whereby one turns inward any difficult feelings.  Those feelings may be native or present due to being witness to the suffering of those around you.

This definition is from Matt's dysfunctional completely unabridged dictionary of life.   I had a longer title in mind but found that anything stretching over 2 lines losses its UMPH!  It, as a term, came to when contemplating my seeming lack of empathy for the struggles of those around me.  It was only half a joke when I described the trait and used myself as an example in a sentence.  I am currently resisting all the "Spelling Bee" jokes.  Origin, Root word, etc.  Not that they are too easy, but I have bigger fish to fry.  I don't even like fish, but I do like the metaphorical frying of fish.  Sometimes.  Sometimes I get metaphorical grease burns...and those hurt. 

What follows is an actual story.  By story I mean it represents actual events as much as I can recollect.  No names have been changed because I don't know them.  Well, I know one name but is really a wholly lack luster name for a villian and so I will not use it.  Better you should come up with your own and apply as liberally and as often as you see fit.   This is another patient encounter that demonstrated, starkly, the inadequate state of healthcare today.  Injustices happen everyday and while there are some that labor day in and day out to be the hands and feet of Christ ( Alli Mitchell) most of us ( Humans ) are preoccupied and apathetically content to step over the homeless and lecture our children about finishing their food because people are starving.  

It is about 9am in a small, rural emergency department that serves the community.  Being the only ER for about 30 miles around.  In trauma 2 is the next patient.  Chart reads:  "Needs cast removed."  It's early, not too busy, and strolling in I see a 6 1/2 year old toe headed little boy with a cast all the way down his left leg.  Beautiful little boy as calm as could be with bright blue eyes.  His mother was with him.  She was neither calm nor beautiful.  In addition to showing a disproportionate amount of wear and tear ( looking much older than her age ) her countenance was one of a distressed mother.  Anxious, escalating volume during the telling of her story, pointing of some fingers both actual and metaphorical and finally exasperation colored her overall presence.  

It turns out that the little boy, whom I will call emmanuel ( I just learned what that meant last night ) had broken his femur about 31/2 weeks ago.  He had come into the ER where I work, been seen by the "On Call" orthopeadic physician and had a long leg cast applied.  Furthermore this pt had a particularly unique fracture that involved the " growth plate."  This may seem counter intuitive,  but bones grow not from the middle but from the ends.  This is a big deal because if a kid has a fracture that impedes growth he could develop one leg that is shorter than the other.  And while we, as a society, all pay homage to the " Pimp Stroll " nobody wants their kid sporting it.  Certainly not outside the teen years.  

(The statement above is by no means meant to confer my approval of, support for, or even apathetic disregard for Pimps, Pimping, or the damage to the human spirit and soul that occurs to the victims of and participants in the whole process.)

In any event, this pt had been treated appropriately.  Wait for it...now the bad news.  Despite having seen the child initially the orthopedist did not accept medicaid and had instructed to the patients mother to call "one of the docs on the list".  Apparently, there is a list of saw bones (orthopedist) who accept medicaid and they are contractually obliged to see the patient.  I say apparently, because there was some disagreement.  Specifically, the mother was repeated told by each physician that because they did not see the patient initially that they were under no obligation to see the patient now.  There disinclination to see the patient was heightened by the gravity of his particular injury.  While the mother called all the listed providers...it didn't take long.  A list of only six was provided to her.  Big state, small list. The mother went back to the orthopedist, who via the front desk clerk, reiterated his position and someone else's responsibility.  So, she calls the medicaid office who refers her to the initial list or the initial doc, her choice.  No one seems to be listening to her.  Can't be seen, can't get seen, can't get help and child is all the while...still in the cast that needs to be removed.  Now, to be honest and to his credit, the initial orthopedist said that while he wanted to help he simply couldn't!   " I'm not on their list, I do this and I won't even get paid.  The docs on that list have to see em'  You know how it is...they come in and can't pay...someone on that list has to see em' Their primary doc is responsible for getting them follow...it's in his contract..."

Ahh yes.  A difficult situation he was in, wanting to help if only they had money or he was on the list.  However, despite all of his insipid excuses for not helping...he had helped.  He had given me the thread.  The thread which I would pull on to try and unravel this mess. 

So, the mother approaches me after over hearing some of the discussion and asks plaintively " is anyone going to help us "?  So...I lied saying of course and that I just needed to make another phone call.  Or two.   Off I go...get me Dr. XX's office I bellowed to the clerk.  The initial exchange had been a little more emotional and a little louder than what is reflected in this writing.   What I get is  Dr. XX's office manager..."this is so and so...how can I help you?"  Well, given that this was the first offering of help for the day, I thought I should make the most of it and gave it to her with both barrels. Telling her EXACTLY what she could do and EXACTLY what her boss could do.  It turns out that when the mother was telling me the story of everyone she called, well...she was...actually ...wait for it... TELLING THE TRUTH.  I know, you are all thinking " so what " ?  Well, it is a big deal.  I get more people lying to me than the IRS.  Ms. So and so was well versed with the situation and had personally helped to get "the list" and had made calls also.  I rapidly lost all of my machismo, realizing that a legitimate effort had been made and deftly deflected by the specialists.  After more discussion she agreed to readdress the issue with the pediatrician while I called Atlanta to speak to the Medicaid office.  

More looks by the family ensued.  A good bit of time used in explaining, that while I am capable of removing a cast, I am not capable of managing this fracture appropriately and the risks long term were simply too high.  Translation:  I can but I won't.  Didn't go over too well.  

After what seemed like an eternity, during which I had already called the initial orthopedist back to further press my case and subsequently lecture a man 30 years my senior about my opinion on his legal, medical and ethical obligations to this little boy. ( I heartily doubt that a 50 year old alcoholic smoker would have compelled me to such lengths.  But then again this little boy was cute and sympathetic.)  As you may have already discerned, I got NO WHERE with this Dr.   I spoke with the medicaid office briefly, to someone who knew next to nothing about virtually everything.  So armed with little more than I had started with, I waited for Ms. So and so to call back.  All the while trying to avoid eye contact and discussion with the mom who was making more frequent trips to my desk to inquire as to the progress.  Or lack thereof.  

Dr. E it's for you.  I have no idea how I answered the phone...all I remember is hearing a polished office voice say " I talked to Dr. XX and he said there is nothing that we can..." WHAT?  I screamed!  I literally started to raise my voice higher and higher, seething into the phone exactly what I was feeling about this whole situation and the complete and total renunciation of their responsibilities.   I demanded to speak with the Doctor.   In hind sight, I think she actually appreciated my petition to move up the chain of command.  Just a guess.  

"This is doctor So and so.  I have done everything I know to do.  I don't have anything to offer"  Well what I am supposed to do?  " I don't know but I can't help"  Can't help?  You absolutely can help.  You will help because you are legally required to.  You signed a contract and as a result are " the point person for all secondary care and follow up".  I have contacted the Atlanta office and discussed this case in detail...  I am sending this patient and his mother to your office directly from here with full knowledge of your responsibilities and obligations.  

O.K.  it is important at this time to say that the above dialogue occurred at a decibel such that anyone and everyone was involved in the discussion.  In fact it was so loud, so heated that when I slammed the phone down...no one, not a single person asked me "what happened, what's the matter, what'd he say"?  none of it.  I don't know how much of my empty threats he even heard because he was hollering just as much as I was.  Honestly, I can't say I blame him...too much.  Ernest efforts had been made.  But that's not always enough.  Oh yeah...the " I talked to the Atlanta office" sure it was true but it was completely devoid of any significance other than to be used as a bluff.  Whatever.   Sometimes a little info ( courtesy the villian ) can go a long way. 

Long story shorter...The orthopedic doc called me later that day.  He informed me that he had in fact seen the patient.  That the pediatrician had written a personal check to cover the costs...but that he obviously didn't take it.  Rather he threw it away.  Weird, if this mother on medicaid had managed to sell enough plasma or borrow enough money to be seen he would have taken it.  But given that this situation had blown up it was no longer about money.  I guess I should disregard his previous comments from earlier that morning about not getting paid.  I did breathe a sigh of relief when he told me he didn't keep the pediatrician's check.  Whew!  

What if this had not worked out?  What are we really doing as a society about healthcare?  We are continuing down a path of spending more than any other country but having an ever increasing disparity in the care provided.  We, as a system, simultaneously provide the most cutting edge therapy available and completely disregard the need for even the most basic of services.