Funny about Money

The only thing necessary for the triumph of evil is for good men to do nothing. ―Edmund Burke

Life before the Affordable Care Act

Inside appendicitis

Over at Quora, someone wondered why it is that when you show up at an emergency room, none of the staff seems to understand that “emergency” means “urgent.”

A number of medical workers were quick to explain that the “emergency” in “emergency room” does not mean “urgent,” and that if you don’t have a life-threatening condition, you have to wait until they get done dealing with people who do. And that certainly is true: who would want their stubbed toe or their broken arm treated ahead of some soul with a heart attack, a stroke, or a gunshot wound?

All of us can understand that ER workers are stressed to the max and that they have to make quick decisions about who needs care and when. But…

Back in the day before ACA, poor people here used the ERs for medical care whenever their kids had a bad cold or flu and for conditions adults and children should have had treated in their GP’s office. Phoenix has a large population of working poor and unemployed, many of whom live, shall we say, very close to the bone. And in those days, if you didn’t have insurance, you couldn’t even get in to see most doctors. Many people did not have a GP and never saw doctors for routine care.

An ER, on the other hand, is not allowed to turn you away. So, when someone without insurance or cash needed to see a doctor for a minor ailment, they would go to the ER and sit there until they could finally get in. This meant waits for everyone that extended for many hours.

It was Christmas time. A flu epidemic was raging. And conveniently, my body chose that moment to develop appendicitis.

In terrible pain and throwing up, I persuaded my ex-husband to take me to the ER at St Joseph’s, a large regional medical center in the central part of the city. It was late at night.

The ER was packed. The receptionist, overworked and miserable, was rude to me and gave me a dirty look when I threw up into the bucket I’d brought.

There was no place to sit down. The floor was truly filthy, so I didn’t feel I could sit or lay down on the floor. Three hours later, I found myself sitting outside on a concrete bench, in the cold, next to a woman who was miscarrying and who had been waiting over four hours. We waited another couple of hours without anyone caring whether we lived or died.

Finally, I gave up. I figured if I was going to die, I’d rather die at home in my bed than in that place. I called a friend, waking her out of a sound sleep, and persuaded her to come get me.

At dawn I was in agony. I called the Mayo Clinic, where my old doctor was practicing. They told me to call 911 and have them bring me there. I said I thought they would take me back to St. Joe’s and I couldn’t withstand another fruitless, endless wait. She said no, they have to take you where you ask them to take you.

That, as it developed, was wrong. They would not take me to the Mayo — the twenty-minute drive would take them out of their area. I sent them away and called another friend, who kindly drove me to the Mayo.

The Mayo, being in a more upscale part of town, was not crowded with people who couldn’t afford to see a doctor. Within minutes after I walked in, they were rolling me into surgery. In the elderly, appendicitis may be life-threatening, especially if it goes  untreated. Afterwards, the surgeons said the appendix was “a mess,” one of the worst they’d seen.

On the one hand, my feeling is that you wouldn’t go to the ER if you didn’t have an emergency. Obviously, I needed to be seen in less than four hours, and obviously the young woman I took up with on the bench in the winter cold needed to be seen. Obviously, we needed to be seen when I came in.

On the other, I surely understand that when everybody and his little brother and sister use the ER for routine medical care and show up when they have a bad cold or flu, the staff is overwhelmed and the likelihood that they will fail to recognize a true emergency is high. I also understand that an inner-city ER staff sees not only the routine heart attacks, strokes, accident, and appendicitis cases, but a steady flow of knifings, gunshot wounds, car wreck victims, and drug overdoses, and so of course they do not have time to deal with people’s colds and tummyaches.

With the ACA, this problem was somewhat relieved because more poor people could get insured. Once that goes away, though, we can expect to see those conditions to return. When people can’t get insurance and doctors turn the poor away because they’re uninsured and can’t pay, then ERs will fill up again with folks who need routine medical care. And the next time you have a serious condition that really does need immediate attention, you may not be able to get it.

Section of acutely inflamed appendix: By Ed Uthman from Houston, TX, USA – Acute Appendicitis, CC BY 2.0
Banner image of the day: DepositPhotos, © sepavone

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  1. Wow, I’m so relieved that you could get medical treatment in time! Of course, I agree with you about medical treatment for the poor, that we don’t need clogged emergency rooms. Just wish certain people in government could understand the situation. I’m still reeling from the DC shootings and just don’t feel like getting too worked up right now. *sigh* I have disaster fatigue.

    • honesttogod, I think we all do. As Americans, we need to draw together and work against the demented polarization that is pulling our country apart.

  2. My brother almost died from an undiagnosed subdural hematoma while waiting in the ER. By the time they examined him and realized how serious his condition was, his pulse rate and blood pressure were so low that they had to stabilize him overnight before they could operate. Fortunately, he made a full recovery.

    And yes, that was before the ACA.

    • Oh, my goodness. That’s terrifying.

      I haven’t had the greatest of care in ERs myself — one doctor prescribed a drug that was contraindicated (!! by its manufacturer) for the condition about which I was whining. Another blithely delivered a wrong diagnosis. What can one say? By and large, though, I’d rather have ERs than not have ERs.

  3. I think that as with most, if not all, things, where you are and the quality of the local healthcare workers, is the more important issue. I grew up in a fairly small town and even today, having moved from Northern New England to near the Twin Cities of Minnesota have noticed that our ER care depends on the staff and the symptoms we report when we come in.
    I have had occassion to use the ER in just about every town I’ve lived in – some are good and some are not, and guess what – the same ER with different staff is a different experience.
    I haven’t noticed any difference in the waiting rooms or treatment at ERs before or after, I just notice differences based on how full the waiting room is and my determination of the quality of the staff and their commitment to getting answers and getting us in and out healthy. That is my personal experience.

    • I had a pretty funny experience with the Mayo’s ER here. It _wouldn’t_ have been funny if the issue had been very serious.

      So I wake up one morning with this frantic itching around my eye. Get up, look in the mirror, and EEEEEKKKK! It’s all red and swollen and clearly I’m on my last legs!!!!!

      Well, as the day proceeds, it gets worse. NATURALLY it’s a Sunday (that’s my day of choice for these little crises). I call my doc’s resident, who tells me I should go to the ER.

      Oh, ugh. I do NOT want to go to the ER. I think I’ll try the Urgent Care facility just up the road. Well…you’d better not have anything urgent happen to you on a weekend: Urgent Care is closed on weekends.

      So eventually I drive up to the Mayo’s ER, feeling a bit like a fool. Wait around for awhile — they’re not very crowded, so I get in pretty quickly. An elderly doc hobbles in, inspects the eye, and proclaims it infected. He hands me a prescription for a killer antibiotic.

      In my experience, killer antibiotics tend to kill me. The older I get, the more side effects I enjoy, and the more unpleasant the side effects tend to be. I am not convinced this is an infection. I think it’s an insect bite, and that it may be a spider bite.

      Monday I get in to see Young Dr. Kildare. This entails driving to Maryvale, where he now practices: a slum on the Darkest West Side. Dodging bullets, I dart into his office.

      He listens to this story in long-suffering silence. He inspects the supposedly diseased eye. Then he says: “That is not an infection.”

      “The Mayo doc says it is,” I report, brandishing the prescription.

      “I know that is not an infection, because I have been to medical school. Do not take that stuff. Take some Benadryl. If it doesn’t improve, then we’ll reconsider. Meanwhile, put some ice on it.”

      I mull this over. A doc practicing at the Mayo clinic vs. a doc practicing in a desperate slum. A doc who has been to some high-powered medical school vs. a doc who has been to Midwestern University, a proprietary school (albeit apparently a pretty good one). Hm.

      An old guy who does not know me vs. a young man with a rare, sterling quality: common sense. Hm.

      Finally I went with common sense.

      And he was right. A day or two on Benadryl and it started to heal up. It definitely was NOT an infection.

  4. An ER is only as good as their triage department. Sounds like St. Joes was definitely not putting a whole lot into their triage efforts that day. I mean someone with no medical training whatsoever can probably diagnose appendicitis at least half the time. Glad you were able to find somewhere that would give you the care you needed.

    • Well, y’know…there were extenuating circumstances. It was Christmas Eve, heaven help us. No doubt all the staff who could took the night off. And you never SAW so many people crammed into one room in your life! It was the flu season, and everyone who felt like crap — which was just about third person in the city — was seeking medical attention.

      I never got triaged. They never even got that far.