Thursday, March 05, 2009

Not Freddy Kreuger

So on a warm day after a snowstorm a nice sled ride would have been a great thing, but, not appreciating the degree or direction of the slope, a young lady, wearing jeans and a t-shirt, went rocketing into the trees and raised her left arm to protect her face from the trees. Good thing too or this injury would have been absorbed by the facial tissue.

Twenty years ago a plastic surgeon would have been called and would have been happy to come in and fix this as, on first blush, it looked like this might have needed a skin graft. However, there are no plastic surgeons outside academia now who will take ER call because if they did they would lose money with every call.

An Orthopedic surgeon would have been obligated to fix this were there an underlying fracture or tendon injury, but there was not such an injury.

A Vascular Surgeon or Hand Surgeon would have been obligated to fix this if there had been a major vessel injury or a laceration involving any of the hand or finger extensors, but there was no such injury.

Enter meatball surgeon, your local ER doc. I did not want to fix this myself because I knew that if I did I would be out of the game for at least an hour and that the wound would likely get infected from all the foreign debris in it, but I was the only one who would touch it.

We numbed the area widely and used a mechanical lavage device (a glorified 'squirt gun' called a 'pulsevac') to get as much crap out of the wound as we could. Then I cut out a bunch of dead tissue and dead skin (debridement) and did the best I could. Not pretty.

The patient did not fill their antibiotic prescription and the wound did get infected. I heard this from the plastic surgeon who was kind enough to follow up this injury. But all that happened was that he had to pull a few sutures and drain some pus.

Insurance? No.
Money? Apparently only enough for a sled.
Sutures? I don't know, about 100.
Bill? To you! Thanks.


  1. Thanks, 911, I feel so much better knowing I've paid for a slug patient who can't be concerned with her welfare and is happy to let us foot the bill. My day is made, my life complete.

  2. Couldn't you have at least appropriated the sled?

  3. I don't know anything about suturing, but it looks like a nice job considering what you had to work with.

  4. Mad ER doc's skillz plus

    One tough dood's scar story equals

    Priceless face when my daughter tries to run with a monster plantar wart on her toe because our 1000.00 per month insurance premium precludes us from using said insurance.

    Fuck Me

  5. well thanks amy, i left much of the wound open specifically to allow it to drain. the initial hole in the skin was so big i didn't think i would get it together but we were lucky. she may still need a graft but hopefully not.

    pink, not to worry, a bailout for your daughter is on the way!

  6. Here's a sob story for you. In July of 2008 I went out on my own and stated a company, the first thing I did before ordering supplies or hiring staff was to secure health insurance. I shopped around and got a good policy for a reasonable monthly premium. The payments were paid what I believed to be on time, however the bank where the payments were coming from was/is using a practice in banking that seems to be unethical and what we may find out to be illegal. This is relevant because I was under the impression the premium payments were paid to the insurance company on time, when in reality the payments were arriving two weeks after they were authorized. The result: my insurance was canceled for non-payment. After receiving the letter instinctively I knew something "bad" was going to happen. First thing the next day i called the insurance co and provided proof of payment and a week after receiving the letter I fell, broke the fibula in my right leg, tore all the ligaments and chipped the talus bone.

    There was a 3.5 day hospital stay with surgery, tests and other various procedures. There have been appeals to insurance, calls to the bank, all to no avail. The stress level I felt was overwhelming when the bills came in as not paying is not an option. A suit was in the process against insurance for breach of contract and to the bank for the same, however all has been resolved with the liability insurance for the building where I fell is covering the medical.

    A very long story short; insurance isnt a panacea to cover medical bills. I was responsible and got health insurance that I pay wholly out of pocket and it failed me.

  7. C.
    I do not doubt your story and i have know there are asswipes everywhere. sorry you got on the wrong end of a few of them. you tried to do the right thing and got screwed. i'm sorry that happened to you.

  8. Since the young lady didn't have insurance and didn't take the antibiotic you prescribed after injury, the least she can do is take BCPs paid for by your taxpayers so she doesn't pop out any more geniuses during her child-bearing years.

    You said she was wearing a shortsleeved tee shirt and jeans WHILE SLEDDING!?

  9. Hey is DRX still alive? If so, do ya have a recipe for Russian Black Bread? I'm makin some and I'm not sure how this one's going to turn out.

  10. Is there any way a patient could get a plastic surgeon to come in without him getting so pissy he'd write his initials in the stitches?

    Like, say to the nurse, "please tell him I'll pay him up front, $2k to stich me up nicely, please" ?

    Although, this line of thought seems like a can of worms. Maybe say, "is there any way I could negotiate a PS or PS resident in to here tonight?" Ugh, there is probably no way to do this. One could only hope to get a good ER doc stitcher like you!

  11. Thanks 911. I think I'm going to go to Cat's clinic instead. Fuck the insurance companies. He can have my 1000.00 per month.