Healthcare Failure

I am an RN, and I work for a temp agency so I go a lot of places and see a lot of things. On my last shift I saw one of the most horrendous things I’ve ever seen. Here’s a hint: it wasn’t anything gory.

Out of my comfort zone

I always say I am not a peds (pediatric) nurse because I can’t deal with it emotionally. I don’t even like giving kids simple shots-when they start to scream my instinct is to say “Ok I’ll stop!” It’s stressful to have to overcome that and hurt them anyway, even if it is for their own good. There are so many other things to do in nursing that I really try to avoid kids if I can.

Over the weekend I worked in a facility that cares for children who are beyond special needs; they often have feeding tubes so formula can be pumped directly into their bellies and tracheostomies in their necks so they can breathe. They are sometimes limited mentally as well, and with multiple complicated issues they need constant care. They are there because they are too much for their parents to take care of, and it is heartbreaking.

Near the end of the shift another nurse asked me to help her change her patient’s brief (most of these kids are incontinent.) I went in and saw a girl that I guessed to be around ten years old sprawled on the bed, snoring loudly due to old facial fractures that make it hard for her to breathe or swallow. One leg was bent slightly, the other curled up and turned out at the hip. Her fingers jutted in different directions, contractures making them stiffen into unnatural positions over time. One arm was stiff as well and sticking out from the shoulder at an odd angle.

There were pictures of a normal, athletic blond posted all around her bed, but I could not find a resemblance to the child lying there. I was shocked at her condition.

I started to pull out one of the pillows that supported her leg so we could change her brief. The other nurse gasped “No!” but it was too late. I had moved her leg a couple of inches which caused her to grimace and screech in pain. Her hip was dislocated and unable to be put back in place, making any movement excruciating. One of her shoulders was the same, meaning she couldn’t be turned over or shifted at all without pain.

She continued to wail without words, reminding me of a wounded animal. We lifted her bottom the slightest bit and switched the wet brief for a clean one trying not to move her more than we had to. Her nurse asked a few questions but I couldn’t discern any response, definitely no words. Her distorted face reminded me of the grotesque Sloth character from the movie “The Goonies.” Terrible, I know, but it’s true.

Seeing all this I wondered what I would do if this was my child. Her quality of life seemed so terrible, what benefit was there to saving her life if this was how she lived? It’s something that we don’t think about when we are concerned about keeping a loved one alive. What kind of life will they have?

But that’s not the horrendous part.

When we left the room I asked her nurse what happened to her. She was in a crash that caused a lot of damage, required multiple surgeries and months of physical therapy (PT.) She had improved over time, and in the hospital PT even had her up and walking….when the insurance money ran out.

That’s right. Therapy had to be stopped because insurance said they wouldn’t pay for any more. Instead of getting stronger and being rehabilitated she weakened and declined and became the tortured child I had just seen. Because her family’s health insurance company wouldn’t allow her to continue to get the care she needed. It makes me want to throw up.

Whose fault is it?

You may think I’m placing blame in the wrong place, but remember hospitals are businesses too. If you can’t show an ability to pay, they are not required to keep providing treatment once you’re stable and there is no longer any life-threatening emergency.

This is not the first time I’ve seen bad things happen because of crappy health insurance. We have a family member who lost their house because of long term illness and medical bills; to pay for her care they had to choose whether to pay for their health insurance or bills. They got more and more behind, and putting insurance first eventually meant they couldn’t pay the mortgage. They still ran up hundreds of thousands in medical bills over just a few years. How did putting insurance first help them if they still ended up drowning in debt? It meant that the hospital would agree to treat her because insurance means they will get paid.

Another recent example: one of my best friends has Rhumatoid Arthritis, an auto-immune disease that involves your body attacking all connective tissue. It causes tremendous pain, her joints swell and will become contorted over time, and sometimes it’s almost impossible for her to move but she never gives up-she’s a dance teacher and refuses to stop moving. It never gets better, so to treat it she takes immunosuppressants as a monthly IV infusion; a lifetime of chemo to keep her body from eating itself. This makes her slow to heal and quick to catch every passing bug, but she can function most of the time.

A few months ago her insurance company decided it didn’t want to pay for her medication. They wanted her to use one that had already been shown not to work for her because it was cheaper. When she called to see what she needed to do to get her medicine approved she couldn’t even get a human being on the phone.

She was forced to jump through hoops and negotiations for two months while on no meds at all. She became bed bound and her wonderful husband had to take off from work to care for her while they waited. Finally she did get her infusions approved again, and she started treatment last week, but it never should have happened. She was a cost cutting experiment of the insurance company.

Best Health Care in the World?

Yes, we have amazing health care in the U.S., but what good is that if we can’t access it? If you can’t afford the drugs, the treatment, the surgery, the physical therapy, what happens to you then? You are left to suffer.

As a nurse I take care of a lot of people who can’t focus on what they need to do to get better because they are so worried about what it’s going to cost and how they’re going to pay for it. Their options are limited by their coverage or lack of it instead of being tailored to help them recover. That goes against everything I believe as a healer, and I hate it.

Insurance is a business. They want to make money, not take care of you. It can help if you are using it for occasional illness and minor care, but when something big happens it becomes less of a safety net and more a series of twisted hoops to jump through. Insurance is a profit focused scam, and they’re good at what they do.

What about the Affordable Care Act? Well Obamacare’s fatal flaw is simple; it mandated insurance, which already doesn’t work. No one would come together to support anything more radical, though, so at this point it’s all we’ve got.

We live in a country that is so obsessed with having private rights that we aren’t willing to help each other. That’s what’s holding back universal health care, that “I don’t want to pay for maternity care since I’m a guy” attitude. We don’t look at it as a communal safety net that protects us all, we just look at what it means for us as individuals; how will it affect me, what do I need? If I don’t need chemo or surgery or rehab, why should I pay into a fund for it? Because someday you might, and because someone you care about almost certainly will.

Healthcare while traveling

Taking care of a girl who was crippled not by her medical care but by her insurance company made me think about what options we might gain (or lose) by moving to another country. In our first destination, Mexico, health care is less expensive than in the U.S. with a comparable quality in many places. However from stories I’ve read I know we’ll need good travel insurance and possibly cash up from if we ever find ourselves in an emergency there, which makes me nervous.

It makes me want to plan our travels around the health care systems of the countries we visit, to make sure that if (when) we have a catastrophic event-cancer, heart attack, major trauma-it won’t destroy us financially or leave one of us lying contorted and suffering in a bed somewhere because we couldn’t afford rehab. Finding the best system we can and taking part in that seems a lot better than hoping that the fine print of my policy works in my favor.

I’m no expert on the health systems of other countries, but I’m looking into it and judging from this coverage on National Public Radio I’m not the only one. We’ve all heard the stories about going to a hospital without ever seeing a bill, and that probably falls in the too-good-to-be-true categorty. However Greg Dobbs, a co-founder of the digital magazine BoomerCafé was pleasantly surprised to find that the UK’s National Health Service was not only capable of saving him from a serious bout of internal bleeding, but there was no charge for the emergency services. He became ill as he was flying in, so he had barely arrived but they took care of him just the same. They choose to take care of those in need first and worry about the cost second, and to me that’s the right way to go about it.

As we travel I’m curious about and want to get an up close look at medical tourism as it’s taking off in many places around the world, including Cozumel. More and more people are traveling for health care because even out of pocket it’s cheaper to have major procedures done in Indian or Mexico and many of the doctors there are just as well trained. They even speak perfect English.

I may not be working overseas as a nurse, but I will be paying attention to what kind of care is available and how it’s done. Maybe I’ll learn something that I can bring back to help people here.

What do you think about the health care you have? Would you support a “socialist” universal health care system that takes care of everyone? Why or why not?