He was the beginning of the 10-hour shift in this level two trauma center, and she the end.
I just clocked in and the e.r. charge nurse called me to trauma room two. I tossed my coat into a chair and rushed in to see the paramedics transferring a 19 year old young man to our bed. He was bleeding from an obvious gunshot wound, GSW, to the right flank. The "two dude brothers" had struck again. The notorious "two dudes" are in every city. And they are tough guys too. This patient, with his numerous gang tattoos and with the attitude that typically flows from his chosen profession related how he was minding his own business when these two dudes began to hassle him. In the end one pulled a gun and put a 9mm shell into his side. The patient was rude even cursing the people who were trying to help.
He was quickly stabilized with fluids and given medications for pain and a tetanus shot. Since he was stable, we ordered a CT scan prior to surgery. About this time his mother arrived. She, unlike her son, was gracious and treated the medical team with respect. She was afraid, as any mom would be. We comforted her and assured her he was getting the very best care possible. We felt sorry for her for the life her son had chosen. Despite his choices, this mother loved her son and even our best efforts to convince her that he would be ok, appropriately failed. She was scared and in our conversation I realized she had been scared for him for a long time. She was a single mom, living on little and raising a kid in a bad part of town. As we chatted the nurse came in with the radiologists interpretation of the CT scan. Unlike many other more unfortunate GSW victims, the scan showed no vital organ or vessel injury. He would be ok.
As I related the news to his mom, she wondered aloud how she would ever pay for his care. I assured her none of us worried about that. Truthfully we didn't. We never did. Patients with little intent to pay roll in to the "e.r." all the time and we never turn them away. And this kid, despite the choices he made that put him in my "e.r." got world-class healthcare that night.
It made me wonder throughout the rest of my shift if government run healthcare would solve the problem. At least the team would be compensated at a little for the effort to save this guys life.
My last patient brought me back to reality. She was a 44-year-old mother of four young children, all of whom accompanied her to the "e.r." that night. Three days prior she finished her last round of chemotherapy for breast cancer and now had developed the dreaded post chemo fever, or neutropenic fever. This is a condition caused by the side effects of the chemo. It kills off your infection fighting neutrophils, a type of white blood cell, rendering the person susceptible to infection and death. We placed her in isolation, started antibiotics and began to search for the cause of the infection with labs and x-rays.
It seemed she had no family history of breast cancer. The findings were discovered by a routine mammogram order by her by-the-book family practice physician. They caught the disease early and a resection of the tumor and surrounding lymph nodes gave a good prognosis. With the added protection of a few rounds of chemo, she had a better than 95 % chance of survival. Had the mammogram not been done, the diagnosis would certainly have been delayed; her prognosis much worse.
She too was rapidly stabilized, and with a few medications and fluids was feeling and looking much better. The kids, who had played quietly in a corner of our waiting room and their dad, were glad to hear we discovered the cause and were quickly killing the infection with antibiotics. As I finished her admission paperwork I realized my shift had ended 45 minutes prior. I gathered up my things and walked to the car.
Obamacare would clearly help me get paid for caring for both of these patients. And with its initial enactment my revenue would probably increase. The second order effects on how the government would then control price and in the end lower my reimbursement faded out of thought as I considered my last patient. She was a victim of a disease that struck her despite good health and life choices. She had a loving family who cared a great deal for her as much as the mother of the gangbanger who started my shift. But under a healthcare system where the government sets the price, shortages lead to postponement of screening procedures. This is the only explanation for why breast cancer mortality is 46% in the UK, a government run rationed healthcare system, and the US where the mortality rate is only 25%. Somehow, despite people's inability to pay, we save more lives than they do.
In both the current system and Obamacare, the gun shot victim gets care. But not so the breast cancer victim or the prostate cancer victim; their survival relies on early detection. When it comes to early detection, our current model works best. Our healthcare system is broken in many ways. But a complete government take over will not work. Patients like this young mother would die an early and unnecessary death. Obamacare is not the answer.
Mark Green MD
Dr. Green is the special operations flight surgeon that had a 5 and 1/2 hour conversation with Saddam Hussein on the night of his capture. Read Dr. Green's account of the experience, and the special operations missions, which led to their meeting in his recently published book, A Night with Saddam. He currently serves as the president of MD-Partners an emergency department management and leadership company.
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