Tuesday, December 31, 2013

Just A Day, Just An Ordinary Day

New Year's Day
Seventh Circle Of Hell Hospital
0300 hours - Once upon a time

It's been a pleasant, and even abnormally q-word night. Every section of Main ER has open beds, so nobody's stressing. Homeless Hangout, AKA triage pit, is blissfully unoccupied. Someone, one of the clerks likely, has a battered boombox streaming out soft Christmas and seasonal music, in open defiance of policies. Good for her.

Then the Batphone rings.
City paramedics bringing a GSW victim in, in full arrest.
Virtually the entire staff, having nothing better to do, swings into action.
The Trauma Team is roused from their lair, and assemble too.
At 0302, in the softly jumbled glow of the flashing red and yellow lightbars on the outside wall, one of our gurneys comes in, bustled there by a beefy wave of firefighters, the smallest of them atop the victim doing chest compressions that would amply circulate King Kong.

Three nurses swarm IVs, getting both antecubitals and a hand, and saline and Ringer's go pouring in, while blood type and crossmatch, labs, blood sugar, and hemoglobin tests get drawn and run stat. In about 60 seconds, the monitor leads are attached, there's an ET tube in place, along with a foley catheter, and a femoral stick by the younger resident and med student team.

As I'm crawling through, over, and under the humanity to take over bagging, they're preparing a chest cutdown while the code progresses through the steps like a machine.

In fact, it ends up being bilateral chest cutdowns,  because blood is pouring out of this guy. He's essentially being cut in half from both sides to try and cross-clamp the aorta, trying to save his heart and brain until better work in surgery can save his life. And, failing that, it's good practice for young surgeons, since he's effectively dead anyway, despite the two three four units of O negative pouring into (and out of) his chest cavity even before he's cracked open.

The Chief Attending for Trauma calls it in about 60 seconds after that.
"This guy is done. My left and right index fingertips are touching through the entry and exit holes in his left ventricle. Non-salvageable."

Mr. Unlucky has been well and truly 10-ringed, right through the heart.

Before anybody can even peel gloves off, triage nurses bustle another delivery from the ambulance ramp, this one delivered by Homeboy Ambulance: two dudes in a Chevy saying "Our homie got shot." It's now 0308.

And judging by the amount of blood coming off and out of him, yes, he has indeed.

Contestant Number One in tonight's game of You Bet Your Life is literally pushed, still on the gurney and gutted like a fish, to one side, to give everyone a chance to pivot 180 degrees and start work on Number Two. Helpfully, they're all warmed up, and this one actually has a pulse and respirations, albeit with several more bullet holes in him than our unfortunate first contestant.

He looks good for stabilization, and the Trauma Team are excited to have someone they can actually have a chance of saving. As the arrangements for the surgical suite are being made, and he's being rigged for transport, the Batphone has gone off again. Another gunshot wound to the chest, another full arrest, inbound and 1 minute out.

At 0312 they arrive, pushing Contestant Two and his transport team aside, and wedging Contestant One, now with a sheet - rapidly becoming blood-tinged red - pulled over the body from head to toe, firmly along the far wall of the trauma bay.

Vulture's Row, the overhead observation area, now has a number of paramedics, cops, EMTs, etc., arrayed along it equal to the number of doctors and nurses working on the now third victim.

As we're doing the third version of IVs, ET tubes, central lines, foleys, blood tests, hanging O negative blood, CPR, and yet another chest cutdown, there comes the unmistakable voice of tonight's Queen Of Triage:

"There's another car on the landing all shot up, there's more gunshot victims inside, and I can still see the gunsmoke in the car!"

I stay in main trauma, while another bunch hustles outside to scoop up whatever Homeboy Ambulance Number Two has deposited on our doorstep.

Just as Contestant Number Two gets hustled out to surgery, they're calling the code on Contestant Number Three, despite his chest cut-down. No chance, and no blood left in him.
But then Contestant Number Four is wheeled in, turning out to have unfortunately stopped bullets to the abdomen and leg after they passed through her car door. Another guy in the car caught one in the arm, and is taken to a side treatment room. Most of the blood on the other occupants was from Number Four, but that's not apparent to us right away.

As most everyone shifts to the newest thing to play with, the two corpses sit along opposite walls, draining out every drop of blood, until we have time and staff to deal with the dead instead of the living. Everyone at this point is treading deliberately, as the floor is quite literally three quarters of an inch deep in the approximately six or seven gallons of blood and additional blood products which have drained all the way to the floor, and now cover the surface of the entire 20 by 35 foot trauma bay, not counting a huge liver-sized clot and numerous smaller coagulations plopped and strewn hither and yon in all the fuss. Every step makes the never-forgotten "shhhhwuck! squish! shhhhwuck! squish!" sounds of rubber-soled shoes pulled out of and placed back into the coagulating ocean of blood with which the entire bay is now carpeted.

It's 0315.

Contestant Number Four is stable, conscious and coherent, and apparently the bullets that hit her didn't hit vital organs or vessels. Fortunately there's no free fluid showing on the bedside ultrasound, and she's not in any distress except pain and shock at being in car full of people shot up by other folks.

Paramedics shuffle back to their firehouses, cops are everywhere, and we separate the belongings and blood-soaked clothing into piles for "evidence" versus "hazmat garbage", and a seemingly endless number of phone calls to coroner, relatives, and organ donation banks begins.

We begin mopping up, rather literally, filling large Roughneck trashcans full of oxygen and IV tubing, trash, and debris from three chest cutdowns, three intubations, three central lines, twelve IVs, four foley catheterizations, and four remaining units of O Negative blood from partial transfusions. Housekeeping is using the wall suction to try and tame the tsunami of blood, before they get down to the tile, and then bleach-disinfecting everything to the bloody grout. Body bags come out, tags are tied to toes and affixed to belongings, and a stream of labels are made for the pages of charts, documents, and other office work of sending someone to the Eternal Care Unit. Twice over.

It's now incredibly only 0320.

Sometime later, before sunrise signifies the impending end of shift, trauma surgery calls to let us know we're batting .500 for the night, 2 out of 4.

The two failures are now coroner's cases, bagged in white plastic zippered shrouds in refrigerators across the street, and the floor looks like none of it ever happened. The only traces left are the spreading ripples on the souls of those who were there, or friends and relatives who are just finding out about how the New Year started for those four people - none of them over thirty years old - this morning, after embarking on a New Year's Eve that certainly must have started for each of them so full of promise. Clearly, being around for the beginning of a day is no guarantee you'll see its end.

So much for the quiet New Year's Eve shift that wasn't.
I hate love hate love this job.

Wednesday, December 4, 2013

If Socialized Medicine Is So Bad

There's no if involved. But you don't have to take my word for it:

" At the beginning of 2012, over 281,000 patients in Norway, out of a population of five million, were awaiting treatment for some medical problem or other. Bureaucratic absurdities run rampant."

"And let’s not forget rationing. “Death panels”  are no fantasy. In a series of articles in 2010, Aftenposten reported on the decision by the Norwegian government’s health director to refuse certain treatments to certain “large patient groups” in order to curb costs. For example, “we can extend the lives of patients with heart failure by installing a heart pump…but this is a service we probably can’t offer. It’s too expensive.” The same goes for respirators in cases of emphysema or chronic bronchitis: “It could prolong the lives of patients, but it’s not something we can give to such a large group.” The elderly, likewise, are screwed: “we…spend too much money to extend the last phase of life for dying, often old, people.” Who’s to decide who receives treatment and who doesn’t? That, the health director answered, is a “political responsibility” – the job of politicians, not physicians."

Sweden: Tales From The Healthcare Crypt

"The clinics have security guards to keep patients from getting unruly as they wait hours to see a doctor. The guards also prevent new patients from entering the clinic when the waiting room is considered full. Uppsala, a city with 200,000 people, has only one specialist in mammography. Sweden's National Cancer Foundation reports that in a few years most Swedish women will not have access to mammography."

The truth about Canadian healthcare

"My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks."
"This is a country in which dogs can get a hip replacement in under a week, and in which humans can wait two to three years."

Coming soon to your doctor's office. Hope and change!

It's not like people haven't been explaining this news for thirty years. This sort of thing is only news to people who think Michael Moore makes accurate documentaries, rather than paeans to socialism on the order of Leni Reifenstahl and Sergei Eisenstein.

Now, when it's begun biting some people in the ass, they start to get it.
Welcome to Hell. Thanks for carpooling.

Tuesday, December 3, 2013

Dear Anonymous Troll

"Anonymous (troll) December 3, 2013 at 7:56 AM
I have a question: if subsidized health care is so bad (it is), how come it works so well in other countries?(It doesn't.) Take the Scandinavian peninsula countries for example, Sweden, Denmark, and especially Norway (who by the way have about the highest standard of living in the world)(actually, they don't), have all subsidized health care - and education btw. How come it's good for them but so abysmal for us? (It's abysmal for both; they just have a better track record of rolling over for nanny-state government.) Does it have to do with the "anti-socialism" brainwashing of Americans (they call that comparative government here) and failure to understand how this type of health care has to be organized in order to be made efficient?"(No, it's a success at understanding how this has to be organized, and recognition that it's contrary to our founding principles, our Constitution, and pretty much everything in American life and culture prior to about 1934.)
But out of fairness, Anny, let's check the videotape on your assertions:
Pop. 9.5M   15,765 immigrants annually
GDP 399B  35th world/26th per capita
AIDS deaths <100/yr
Pop 5.5M    13,600 immigrants annually
GDP 213B   55th world/32d per capita
AIDS deaths < 100/yr
Pop. 5M        8,400 immigrants annually
GDP 281B    46th world/9th per capita
AIDS deaths  <100/yr
United States
Pop 317M    1,153,880 immigrants annually
GDP 15,940B   2d world/14th per capita
AIDS deaths  >17,000/yr

{So as not fry your delicate grey cells, I left out the number of Nobel prizes in chemistry, biology, and medicine respective to Scandinavia vs. the U.S., the number of patents for medical devices for Scandinavia vs. the U.S., and the fact that the total amount spent on healthcare in the U.S. annually is more than the entire federal budget for any year prior to 2004, because clearly things like medical innovation are unimportant trivia, and I'm sure you think the federal government is doing such a great job on running itself in every other way already that the best choice in healthcare is to just hand it over to them too, right?}
Wow, this is quite a poser.

If I understand you correctly, you're asking how we, a country that takes in more immigrants annually than Sweden, Denmark, and Norway and 150 other countries combined might have different health care needs?
How our nation's needs could possibly differ from the needs of three countries whose combined population is surpassed merely by the number of folks living in the greater NYC area??
And why a country whose non-socialist output exceeds them in total by a mere 16 times  might not be so enamored of socialism as they (and apparently you) are? (And BTW, Norway doesn't have "about the highest living in the world", they're eclipsed by Qatar, Liechtenstein, Bermuda, Macau, Luxembourg, Monaco, Singapore, and Jersey, just for your rather sparse fund of information.)
Or why we, caring for an AIDS population almost 60 times larger than all three Scandinavian states combined, might just maybe have some different healthcare priorities than a miniscule, mainly white protestant homogenous bunch of countries with essentially zero population growth?
You realize, right, that more people live in Los Angeles County than in Norway and Denmark combined?
That Norway's largest city isn't even the equivalent size of merely San Jose?
That Copenhagen and Stockholm, their largest cities, are eclipsed by Dallas and San Diego, and that our top 6 cities have more people than all three of those countries?
Or that the number of 0-14 year olds in the United States is three times larger than the combined population of the three countries you mentioned, combined??
And that none of those nations would even make the Top Ten if they were U.S. states, ranking behind California, Texas, New York, Florida, Illinois, Pennsylvania, Ohio, Georgia, Michigan, and North Carolina. That'd be Sweden; Norway and Denmark would actually be down around 22nd, just ahead of Alabama. In more ways than one.

And when you touted that sort of system, of course you knew that the average Swede pays >50% of their annual income to the government for that "free" subsidized healthcare, right? And that a Swedish-style single-payer health insurance system would cost the median income household in the U.S. $17,200 per year in new health care taxes. Please, extoll the virtues of doubling income taxes on the 46% of Americans who are actually paying any, because that'll really play well in Peoria. That'll be great news to the 91 million American unemployed at the moment, because it means folks like you, Anny, are going to get three new Mcjobs to help pony up all that cash. All for someone else's kids! Thanks, dude!

Gosh, sign me up, I can't wait to give Uncle Sam another 20% or more of my annual take-home, because I'm not eating enough PB&J and bologna sandwiches now, I can look forward to adding ketchup sandwiches to the menu! Thanks for the suggestion, Anny!
And then to contain costs, we'll cut staff and facililties, so that in a few years, procedures will be shoved down to lower and less-qualified staff, if they're performed at all, and in un-updated facilities with more antiquated equipment and technology. Welcome to U.S. Medicine 2015 1935.

If your message is that we should first helpfully eject all non-whites, and enforce a level of ethnic and social diversity - like you find in Sweden, Denmark, and Norway - that would do a Klan rally proud, you'll have to get your own blog. Good luck with that. I think they tried it in Western Europe starting around 1933.
We experimented with socialism in this country. But adhering to it almost caused the Pilgrims to starve to death, until they threw it out entirely, switched over to unrestrained capitalism, and were so inundated with bounty as a result that they paid off all their debts to their English sponsors, and had enough left over to hold a huge feast, and even invite their neighbors over. We call the remembrance of that "Thanksgiving". As Casey Stengel used to say, you could look it up.

The only subsidizing that's going on is at gunpoint, as healthy people are coerced under threat of growing fines to buy healthcare they don't need for exorbitant prices, in order to help cover the cost for those who get it for nothing. Try that at the interpersonal level, and see what the local District Attorney calls it.

I would have been all for government just letting anyone who wanted it sign-up for Medicare. But then, when they saw the exorbitant price they'd be asked for, and the substandard care they'd receive, if they could find a doctor worthy of the name who'd actually take that card, they'd run from government care like scalded cats. The idea would have been crib-strangled by everyone who experienced it firsthand in weeks. Pretty much the exact same response you're seeing now for HopeyDopeyCare, even from media talking heads who usually can't get their lips off his buttcheeks long enough to cover actual news.

But don't worry, I understand how socialism-philes love to chirp about "organizing things to be more efficient", because they're sooooooo good at making the trains run on time. Perhaps you could Google "Soviet health care" and get back to us. Unfortunately for your ilk, some of us also studied history, and we remember where the train tracks in your Worker's Paradise always lead: glorious barbed wire enclaves sitting beyond signs that promise all who enter, "Work Makes You Free". Right after a helpful post-train ride shower, eh? Last I looked, overt Socialism only killed - as in personally murdered, we're not even including the wartime casualty lists - about 65,000,000 people worldwide in just the last century alone, courtesy of Hitler, Stalin, Mao, Fidel, and Pol Pot. It would actually be less harmful to disseminate bubonic plague in grade schools.

So pretty much all your assumptions are wrong, the lack of familiarity with the basic differences is breathtaking in its totality, and the conclusions you draw, from the dearth of information about...well, anything you brought up, are almost totally wrong. Other than the fact there there are three Scandanavian countries named Sweden, Denmark, and Norway. Which probably puts you barely ahead of most current 12th graders in geography.
Sorry if reality stings when it smacks you where you sit. Maybe try an ice pack?
So seriously Sparky, as Bill Murray said to the innkeeper in Groundhog Day, "Did you really want to discuss the weather, or just make chit-chat?"