10 February 2010

Charlie Foxtrot: Part Deux

To all my loyal readers,firstly "Thank You" and I appoligize for my extended absence. There are many things I can do, but think, write and engage in dual emittance is not one of them. I had a bad "bug" for a few days...but we're all better now. So, back to business!!

When we last left our mild-mannered medic, he was laboriously toiling away at work; doing really important stuff, like reading, studying and strengthening his intellectual horizons…he was reading blogs.

Searching for truth.

Digging for facts.

Yearning for knowledge and insight.

Longing for the understanding that seemed so distant.

Then the phone rang. “Who needs me now? What face of death must I stare into?”, he wondered silently with great anticipation.

But alas, the great medic cape need not be donned, for it was not that evil was afoot…but yet another flaw in our health care system.

* * * * * * * * * * *

I listened as the supervisor took the call. From the one sided conversation I could only gather one thing; an emergency it was not. This due to the repeated attempts to tell the caller that if we send a truck to pick him up, we would not divert regardless of the nature of the call.

We saddled up and started towards the “scene”. I was told that this guy who called was at a convenience store waiting outside for us. He was involved in an MVC about two weeks ago and was now wanting to go to the emergency room because his back hurts, but if we got a more important call, “we could go to it and then come back for him”. Now, of course I have my doubts and rightfully so. This is just not adding up at all. I tell my partner that I’ll take this one…get the refusal ready. I wasn’t going to go and show my butt or anything, but I was going to really get a feel for what the problem really was and treat accordingly. I just had my radar on for system abuse due to some recent happenings.

We pull up at the convenience store and I see a young lady talking to a guy standing at the front doors. They both look our way acknowledging our arrival, she throws her hand up as she turns to leave and he tells her that he’ll see her tomorrow. The guy starts walking over towards me, puts a little spot of spittle on the end of his finger and dabs out the Black n’ Mild he’s smoking.

“I know…it’s already out”, he says sticking out his hand as if to shake mine as we close our distance.

“What…what’s out”, I ask stupidly while reaching for an ink pen to occupy both hands.

“This”, he says lifting the now extinguished Black 'n Mild into the air with great fanfare.

“Oh, gotcha. You know those things can kill ya, right?”

“Well sompens gonna eventually” he answers as if it’s his standard reply.

I size the guy up. He’s probably about fifty-ish with long oily looking hair sticking out from under a mesh type ball cap. Scraggly beard. Clothes are rather disheveled and would probably scare a whole box of laundry detergent away if he came anywhere near it. His gait wasn’t the least bit indicative of someone with back problems…we’ve all seen the backache walk.

“So what’s the problem this morning” I ask, ready for whatever may come.

And he starts, “I had a wreck on the 21st…hit a deer out on County Line Rd….damn thing came through the windshield and I ran off the road into a ditch.”

“O.K…..so what’s the problem this morning?”, I ask again as patiently as I can.

“My backs a hurt’n”, says he.

“Where about”, I ask while positioning myself so I could see exactly where he was going to point.

“Man, just all over”, he says as he throws his arms up in anger and disgust with my probing, “just take me to the hospital so I can get me something for the pain”.

Well, now I know what this is all about…as if I didn’t know before.

“Did you go to the doctor when you had the wreck”, I queried.

“Hell no, I didn’t have no money”, he spouted back at me.

“So, how have you been tolerating the pain until this point?” I asked causally, “or have you done something recently to aggravate it?”

“M’friend ga’me some ‘Codones’ and that helped a little bit”, he told me. I could sense he was getting a little perturbed with me at this point. This guy just wanted to go to the hospital.

I told him that before we go anywhere he was going to get a full work up from me first so that I could rule out any life threatening injuries. I did the whole CNS bit, grin…follow my finger…PERL, you know the drill. Then he went crazy.

“Man, ‘nuff of this, just take me to the dang hospital…I need sompn for pain…I can’t bend over”, he said as he leaned forward in an attempt to show me how limited his ROM was.

“All right, all right, don’t get in a tizzy and hurt yourself” I cautioned him, “but I do have just one more question”.

“What” he asked gruffly.

“How’d you get here…to the store” I asked.

Get ready, here it comes.

“That lady I was talkn’ to over thar…she brung me here because we was at the Dutch Inn and they was gonna close and they told me I had to leave”, he explained as if it made perfect sense.

“Why didn’t you just get her to carry you to the hospital…it’s only two miles in the other direction”, I said matter-of-factly.

“B’cause she was going that way…not that way”, he yelled while flailing his arms about like a conductor in the crescendo of a musical masterpiece, “now c’mon, let’s go” he told me and started off for the other side of the truck towards the curb door.

It was about three steps into his trek to the hospital that he realized he had dropped his cigar while flailing his arms, backtracked, bent over (fully) and picked it up and then continued to the side door.

I open the door for him, put him in the captains seat and asked that the seat belt be put on. He complied while stating “I told ya’ll when I called that if anything more important came up that ya’ll could go take care of it and I would be waiting when ya’ll got done”.

I somewhat admired the guy for owning up to the fact that this was not an emergency. However, under state law he was entitled to transport to definitive care, emergent or otherwise.

* * * * * * * * * * *

Well, this is not a news flash here, but our system is indeed broke in so many ways. There are a couple of things that stick out in my memory about this call that kind of lumps a whole bunch of problems into one incident.

I’m not going to give rationale so much as I am just shedding some light on the issues we have in America with healthcare and EMS in general.

1) This guy was in an accident and declined evaluation and possible treatment all because he “didn’t have the money for it”.

2) The patient in question has a treatable sign/symptom, for which he wants to go to the ER to have fixed. He admittedly can not pay the bill and most likely will not be able to pay for the pain meds if he is given a prescription.

3) Chances are, he was probably unemployed and most likely would not have contributed much to the National Health Plan if there was one.

4) He called out an ALS ambulance when he had alternative transportation available.

5) This was our last ambulance available. If we had a serious life threatening emergency call while we were dealing with this guy, somebody could have suffered needlessly.

6) When a citizen calls for emergency service, someone has to respond…regardless.

7) I have no other options available to me other than to transport to the ER. What if we did have a 24hr. free clinic available?

8) This guy could/can/did dictate to me where and when I was going to take him.

9) The service we rendered will not reimbursed for, neither will it be collectable.

10) What if this had been a true emergency and the patient refused care because of inability to pay for treatment.

We’ve got a problem. The 64 million dollar question is….How do we fix it to accommodate everybody? Surly not every locality or municipality can be pigeon holed, we’ve got to start somewhere. Any ideas?

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