Saturday, September 06, 2008

My Medical Holiday



Having been on the giving side of the medical equation 18 months longer than was good for my sanity I have decided to take a little back.

I just flew up to northern Montana where I went hiking and crossed into Canada. I then hired a 'coyote' to smuggle me back into the US. I dropped all my IDs and money in an envelope in Moose Jaw, Saskatchewan and mailed it back to my home address. I purchased a bottle of fine Canadian Mist whiskey and hit the road with my escort to Minot North Dakota. Wow, was I a drunk asshole.

As agreed upon when I hired my 'coyote' he dropped me just outside Minot and punched me in the face and called 911. In relatively short order the fine paramedics arrived and found me head- injured and slurring my speech. Without any ID and with me only being able to say, "It hurts, eh?" I was able to stay a few days in Minot General courtesy of the U.S. taxpayers.

Of course, since I kept having "seizures" and pain and remembered I was allergic to toradol, motrin, tylenol, phenergan, and reglan, they have been dosing me with dilaudid and valium and feeding me to my hearts content. They also went ahead and fixed my deviated septum which made me snore and has been bothering me for some time and which was made a bit worse by the well-delivered punch.

Since my case of amnesia is not resolving I'm working on getting the nice docs in Minot to airlift me to the Mayo for a thorough Neurology evaluation. I think I will be able to make my way back through the specialty hospitals (as I will continue to present protean manifestations of rare diseases requiring, again, lots of good drugs... Hell, maybe they will bring in 'House, MD'?) to near my hometown where I will leave AMA from the hospital around midnight, and walk home after two or three weeks of a fine holiday. Thank you all for paying for my vacation, and thanks, EMTALA.

38 comments:

  1. Ah, good to see you're feeling like yourself after a bit of a vacation.

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  2. Really, where was Homeland Security?

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  3. How did you get past the "minuteman" fence?

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  4. Nobody in Canada is fleeing their country for medical care in the US. The authorities would have detected you immediately. However, you could always do what most of my patients seem to do:
    adopt a forged identity, fake homelessness for treatment. You call 911 for chest pain, arrive drunk, get fed, then develop an amazing suicidal tendency.

    Having read Catch 22, you jokingly say, "I see everything twice!" and like in the novel, everyone takes you seriously for weeks.

    The joke is, after all, on them. And me, since I have a job and pay ultimately for your state-sponsored self-destruction.

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  5. I understand that this is fiction. What I really want to know is, are there people who actually do this? :O

    If every morphine addict / alcoholic was given so much respect by the US Government, then why the hell do people go vacationing to Amsterdam?!

    Where I come from, alcoholics often come to our Casualty Department (equivalent to your ER, just less equipped) invariably after 11pm. They are usually involved in drunken brawls and come with blood splattered all over their even otherwise soiled clothes. What do we do? We do treat them, no denying that. But we save money on the local anaesthetics, cause most of them are on the verge of respiratory depression when we see them. I've actually stitched up a large gash across the face of some drunk dude WITHOUT xylocaine.

    Others come with gastritis, and all we do is give them some Pantoprazole and ask them to shut up. Seriously, no respect whatsoever for these guys. Sometimes you actually feel sorry for them, if you can ignore the smell of booze and urine emanating from them, and the sight of the LGV which they have nurtured for much longer than their kids, most of whose names they can't remember.

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  6. Is this a "real" story of a patient you treated recently?

    It never ceases to be short of amazing the things people do.

    But, you gotta love it though, right?

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  7. We were in Seattle on our honeymoon, and Mr. Devo got it into his head that he wanted to go to a bike shop in Canada. Well, we had no passports, which was no problem for the Canadian border guard. Homeland Security considered this a big, huge, problem though. We waited in line for an hour just to get to the checkpoint, and we were then escorted from our vehicle, which we were to leave open for searching. I offered them two different drivers licenses, as I'd just changed my name, but they were unimpressed by my generosity. I asked my new husband if he thought it would be okay if I played Tetris on my iPhone while we waited, and he reminded me that there would be no Tetris in Guantanamo. Even worse, we were OFF THE GRID--that's right, no iPhone service. Eventually we were released when they figured out that we were actually just boring people from California.

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  8. Minot!?!!? You ARE a sick bastard.
    I'd head South before the Ice Age Snows come in a few weeks.

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  9. Sounds like a nice break, save some of those fentanyl lollys for me. I wonder if there is some kind of nice family the government will pay to watch my kids while Dr. House figures out my crazy esoteric dx?

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  10. You gave out the fact that is is imaginary right from the beginning: Canadians don't flee their country :-)
    I am glad though that you did not have to re-enter the US legally, US customs officers are the biggest pills. Pitbulls in uniforms.
    All others wish you a good stay.

    After a long flight and grueling work week overseas, I have found myself in the little room in the back a couple of times because I was too tired to put up with their stupidity gracefully.

    Anyway, now that we know where you have been, is there even a remote chance you are going to tell us what is in your future? (Question asked for the 256th time, if I am not mistaken).

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  11. I heard word that 911 is now a Victoria Secret salesman.

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  12. Really? Does he have any 'hands on' experience in that department?
    ;)

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  13. Sounds like a good time to me. If you do get to see Dr. House, could you give him my number please? I have a thing for old, stodgy doctors.

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  14. 911

    William S. Burroughs would be in awe of your ramblings, but your point is well taken.

    abacus,

    Do you have you answer to any higher ups when jerk off drunks/ass holes complain. I figure that the NHS hates it when they suck off the system as well. I remember a casualty dept. in the Midlands (Hanley or Stoke-on-Trent?, am I right- you are in the UK) and they didn't take shit from these guys, but you're right, they were less well equiped.

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  15. Please excuse me as I have a personal love-fest here.

    I *love* you guys. I always knew I was a conservative, but with the education I didn't receive, I was never very able to state why I believed what I did or put it to work for me.

    Ah, but now I can. I have learned so much from you guys. Thanks for the free education :-)

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  16. @cat

    I'm in India and I've just finished a 1 year compulsory rotatory internship (after which we receive our basic medical degrees). All mentioned cases that I've seen were in this magical period. All concepts of 'ethics' (or the sheer lack of them) are thanks to what I've learnt from my professors and residents. Don't get me wrong, I'm not blaming them.. that's the way our healthcare system functions.

    If you thought Dr. House was a maverick risk taker with no concept of ethics, check out every third doctor in our wards! Except they don't get a magical diagnosis everytime.. Its real life.

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  17. abacus

    Thanks for the reply and good luck.

    Cat

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  18. Please excuse me as I have a personal love-fest here.
    Careful, Amy. Last time I said that, some anonymous fartbag kicked my butt for brown nosing. Or maybe it's just me. Hmmm...

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  19. Lynn:
    Don't you have to go save somebody's life with Reiki or homeopathy?

    911:
    OK, time to put up. Your opinion of EMTALA, treating the uninsured/underinsured are obvious. How about suggesting some answers. Be specific, blathering about "market based" solutions is not go to answer the question of an uninsured trauma coming in the door at 03:00. Let's here it.

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  20. Yeah. I wanna here it, too. Let's here it.

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  21. dear anonymous,

    to repeat...

    1. make an ambulance ride cost more than a cab.
    2. make everyone pay something for the care they get (a city i just visited instituted a mandatory $2 co-pay for all ER visits and cut ER visits by 30%)
    3. if we treat illegal aliens send the bill to the government of same.
    4. people who default on medical bills should be punished in some way, and people who recieve free care should be made to make an effort to repay it... i have suggested community service.
    5. allow physicians to deduct the cost of the care they are mandated by federal law to give away.
    6. cap liability for care given under tha auspices of EMTALA just like liability is capped for government physicians.
    7. force all anonymous trolls to identify themselves and then put them in strait-jackets in the front row of an al gore speach, or, in the same fashion, have them watch 'an inconvenient truth' for 24 hours straight.

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  22. Interesting views..

    Except I actually found 'The Inconvenient Truth' quite informative! Take that back, you friggin' Republican! But I seriously wonder if Obama would do us IMGs any good..

    @anonymous
    Let us 'here' your views on this one, anonymous-being-with-bad-grammar-and-worse-punctuation.

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  23. This comment has been removed by the author.

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  24. Lynn:
    Don't you have to go save somebody's life with Reiki or homeopathy?


    Yes! Yes! There you are. Ah, so it is personal. I'm gonna chant around a pecan pie under a full moon...just for you, anon, because you're so brave to sign your real name. Easy to lob bombs while hiding behind a facade. Let's see how brave you are by signing your real name. What a gutless putz.

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  25. Anon jabs are awesome. Especially when their grasp of the English language outs them as a douche.

    :)

    GO LYNN!

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  26. Hey Lynne, can I have some of the pie? I *love* pecan pie :)

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  27. Hey Lynne, can I have some of the pie? I *love* pecan pie :)

    Pie for everyone. Well, except for the anon fartbag...

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  28. Douche eh. What a command of the english language. What are you going to type for an encore..."douchebag"? Maybe you can use some of this english language "proficiency" on the written portion of the MCAT. Been there done that, good luck.

    911:
    1,2, and 6 are spot on. But as you pointed it out yourself different localities are using varying mechanisms for the habitual offenders (as they should). The bigger issue is, have you talked with your state rep with any of your ideas. I have. I have also gone to the statehouse with other docs to demonstrate on reform issues. Being an active player in the current political system is something we docs are going to have to do to retake our own profession.

    3: " if we treat illegal aliens send the bill to the government of same."
    Though I agree in principle the mexican government is just going to ignore our bills. Period. Bush has no real leverage with Mexico. That was patently obvious in his last visit. Sure let's push the issue, maybe PEMEX will just refuse to sell us oil rather to China or Europe. A nice soundbite, but no real teeth to it.

    4: "people who default on medical bills should be punished in some way.."
    Medical bills can and are sent to collection like any other bills (I can't help if your former group was incompetent in this regard). Unpaid medical bills can and do ruin your credit. What do you propose, take the person out back and have him/her shot?

    "and people who recieve free care should be made to make an effort to repay it... i have suggested community service"

    Again, I don't disagree, but what about those who refuse. Refuse them ER visits, even in an emergency?

    5: "allow physicians to deduct the cost of the care they are mandated by federal law to give away"

    Heck, I am all for it. God only knows how much "free" (after the fact) care I give out. Again, have you talked to you rep? Frankly, I think this will be a harder sell. Because, then every other field will try the same thing and the feds will not open that can of worms.

    6: "cap liability for care given under tha auspices of EMTALA just like liability is capped for government physicians"

    Why stop at EMTALA? What about all those docs given "free care" not under the auspices of EMTALA? But the bigger issue is EMTALA itself. You see 911, though I am no big fan of EMTALA, I was in training pre-EMTALA. I saw the poor, uninsured, and unwanted get dumped on the county hospitals/teaching hospitals from the wealthy private towers. People died. It is all well documented from journals of the era for you to look at, as you evidently were not in practice back then. Look it up. Please do give an example of something that will work without the patient dumping pre mid 1980's. I am all ears. Also none of your "solutions" has really specifically addressed that uninsured 03:00 trauma. Just how much community service will that $$$300,000 hospitalization take?

    7: "force all anonymous trolls to identify themselves and then put them in strait-jackets..."

    Come now, we both know you can change this blog to an ID only blog at any time. You and your peanut gallery openly enjoy calling anons "douches", "fartbags", and "gutless putz". If you really want it to end just set up the ID only.

    Lynn Price: I am a physician. I have no tolerence for CAM or any other altie bullshit. Why? because some of my patients HAVE DIED listening to uneducated morons such as yourself. Reiki (or any other altie bullshit you believe in) is not going to save you in a code. It is not going to cure your lymphoma. In fact, the conclusion of the most recent systematic review of randomized trials involving Reiki (Int J Clin Pract 62(6):2008;947-954) concludes that "The evidence is insufficient to suggest that reiki is an effective treatment for any condition". Look it up. As far as my anon status, 911 can change that at any time. In the real world, I sign my name dozens of times per day. I take responsibility of patients EVERY DAY. To have someone who has not spent one minute practicing medicine call me "gutless" is laughable. I mean really Lynn just how indentifiable is 911 doc? He himself states he is an ER doc in "anytown USA". Jeez, you have him narrowed down to 100,000 docs or so Einstein. If you like, call me Joe the Doc. Happy now?

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  29. dear anon.,
    due to the net being down at this hotel i'm in I can't type a full respnse right now but a few points...

    1 i do not claim that any of my suggestions will square the books. what I KNOW however is that we do not, currently, insist that people be responsible for their own health. you talk of 'patient dumping' and evidently prefer the current situation to what existed prior to EMTALA. i can not speak to the extent that 'dumping' occurred but i can assure you that the solution as it stands is worse than the problem such as it was. i say this because it's hardbto get good medical care when quality physicians opt out of their profession because it is a ponzi scheme run by parasitic socialists. oldfart, tell us about 'patient dumping' prior to EMTALA.

    2. let's assume you are correct and that patient dumping was not an occasional event but one which cost many lives. please explain to me where it is written that a physician is, unlike every other professional, under a legal obligation to work for free for strangers who have often caused their own harm? notice, I am not saying we shouldn't do it... i'm simply asking why physicians are demonized for WANTING to avoid non paying patients. the answer is that we have unique life-saving skills and that this is 'too important to be left to the market'... to which I answervthat the free market is, will be, and always has been the most efficient way to distribute valuable resources and services. period.

    3. i make no claim that community service could pay hospital bills, merely that it would disincentivize abuse.

    4. Lynn is a big girl and can defend herself just fine. you do not know her position on CAM. having read her book i assure you that her position is hardly radicalv

    5. have I talked to my state rep? first, she's a lawyer. second, i would be happy to do so if I thought it would help. hell, tell me why you think this would help and what you think i should say and i'll do it.

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  30. and one more thing...

    just because the mexican government would not pay the bills is no reason not to send them. i experienced emergency medical care in the yucatan. the ambulance had a credit card machine in the back and if you did not pay you did not go to the hospital. somehow, this is not splashed across the international herald tribune headlines as an example of the heartless mexicans, it's 'just the way is is down there' right?

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  31. I have no tolerence for CAM or any other altie bullshit. Why? because some of my patients HAVE DIED listening to uneducated morons such as yourself. Reiki (or any other altie bullshit you believe in) is not going to save you in a code.

    Actually, Dr. Gutless, you're exactly like one of my main characters. And just like him, you see my Reiki practices as a bull to a red cape. Not once have you stopped to ask intelligent questions because you were too busy making asinine assumptions about me. I would like you to point out where I've ever advocated that Reiki or any other "altie" practice should take the place of evidence-based medicine. Good grief, grow up. If you're going to attack someone, have the evidence that reveals me to be a pancake-smoking lunatic. Read my book, and you'll see exactly who and what I am.

    As far as my anon status, 911 can change that at any time. In the real world, I sign my name dozens of times per day.

    Oh please, Dr. Gutless, in the real world do you attack people without foundation or do you maintain a semblance of decorum because, gosh, it would be horrible to assign such behavior to your grand self?

    This is 911's blog, and he can do whatever he pleases. You, on the other hand, troll your bad self over here and make personal attacks on me, yet you're too Chicken Little to identify yourself. Why don't you beat me up on my own blog and quit wasting space over here? You're little more than a schoolyard bully. I respect people who have the coconuts to put their face behind their words. You, sir, are without coconuts.


    To have someone who has not spent one minute practicing medicine call me "gutless" is laughable.
    What's laughable is that you hide behind anonymity while trying to pick a fight. At least I have the ovaries to stand up for what I believe in while using my real name.

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  32. Anon--I guess I didn't see the irony in me calling you a 'douche' for your random harassment of people with different viewpoints than yours. My bad. Clearly I do the same myself.

    But really....did you have to stoop so low and cut me with that MCAT remark???

    THAT was low. Ohhh...it still hurts.

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  33. I've been to Minot.

    I didn't think they were equipped to do facial surgery.

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  34. Okay we need MORE CONTENT here! Last post on the 6th? Come on, not like you guys have anything better to do.

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  35. 911
    Sorry about the lateness of the reply here but between work and a sick kid I've been busy. From your later replies you seem to be much happier at your moonlighting gig and realize some of your frustration was with you work environment...Good. A change of scenery can do wonders. I can assure you patient dumping was an issue that cost lives. Old fart may or may not agree based on what type of hospital he worked at the time (dumpee or dumper). I do think you suggestion that we allow to write off nonreimbursed care a reasonable one, I just don't know how it would be instituted. I disagree with you statement that your rep is a lawyer therefore aren't dealing with him/her. You may be surprised and you won't know until you try, also who ever said you have to talk to your own personal rep. Others from nearby districts who don't share your reps political persusion maybe more reasonable. Anyways good luck on your future.
    PS: Aside from all the insults about the size of ones reproductive organs and "bitch-slaping with respect to Lynn and Alternative medicine, please note who was the only one to site and reference the most recent "evidence based" analysis on the subject of Reiki. Believe it or not I am not totally AGAINST alternative medicine. I am FOR rigorous testing and analysis of all possible new therapies. Patients of mine have died because of alt BS tx. Very simply the proof is in the pudding. 200 years ago ASA was an alternative medicine from tree bark while the ancestors of us allopaths were bleeding George Washington to death with leaches. Look where it is now based on decades of studies. If Lynn want to throw out mindless insults based on my anon standing (remember flea or Dr. Wes) so be it. She is not actually responsible from anyone's care. I've cited the latest evidence on the subject...period.

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  36. dear anon,

    did you once maintain a blog?

    patient dumping did occur and it still does.

    the government, to me, is a large ship at sea. it makes corrections in course over long periods of time.

    when it tries to make sharp alterations quickly it is easy for the small boats to duck and dodge and that is all that EMTALA has done.

    physicians are simply more sneaky about dumping now AND many hospitals have closed along with many emergency departments because of it.

    EMTALA threw the baby out with the bathwater and then destroyed the bathtub.

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