As an under-employed, semi-retired surgeon, my father is now running into the frustrations we all face and that until now he avoided or took for granted. Most recently he commented anecdotally that in the northern climes where he abides spring is closely followed by the “road construction” season, which precludes time effective intra-metropolitan automotive travel. Therefore, local denizens often resort to more arboreal pursuits, as respite from the week’s travails. Such is the scenario by which a neighbor in attacking her hedge with a new, electric trimmer tried to turn Debby into Lefty. Fortunately, he has a hospital literally across the street and with towel compression, hemorrhage was stemmed as they proceeded to navigate the emergency room, substation, trauma sector.
First in harm’s way was the triage administrator. This individual is uniquely skilled at that most important medical procedure, the wallet biopsy. In a staccato monotone name, address, date of birth, and insurance coverage were elicited. Then an affidavit was presented affirming fiscal responsibility to the signee for any services or procedures not covered by insurance. Fortunately, the patient was right-handed so I could maintain hemostatic pressure on the injured left extremity during signature affixation. We were asked, any questions? Well, there is a pain issue so when do you think she will be seen? We were rewarded with the comforting response that this ER had a policy of seeing patients within thirty minutes of arrival, that in fact we had just been seen and please have a seat in the waiting room.
This Clintonian parsing of credibility segued into the next rampart to be scaled, the triage nurse. When was your last period, are you immunosuppressed, undergoing chemotherapy, have kidney failure, participate in risky sexual or recreational drug practices, and do you feel safe at home? Are there that many poxed, menstruating, terminally-ill cancer patients out there masquerading as sixty-year-old, overtly-robust women? And if she was the victim of domestic violence, would she admit it in the presence of an apparent significant other? Any questions? Yes, do you have any clean bandages, this dirty towel is soaked with blood? No response, but we were escorted to a cubicle where we met the third opponent.
Hello, I am Mike, the physician’s associate. I am going to be treating you today (at least we established a time reference). There is an on-call physician available and if warranted, he can be paged. Any questions? Given we are talking about response time to an emergency situation, do you happen to know whether his doctorship is on the front nine or back nine and if he is carrying his own clubs or using a motorized golf cart?
Services rendered can be grouped into history, evaluation of wound, and actual suture of laceration. Are there any foreign bodies in the wound? Granted our borders are not secure, but we did not think Al Qaida had crossed the Detroit River from Canada and implanted miniaturized weapons of mass destruction in trimmer belts. We could get an ultrasound of the finger to rule out foreign particles, although they are not always visualized and a CT scan would be more accurate. Want to look at the wound first? Then we got to the real action, the irrigation and inspection of the wound. Old Mike got out the sterile saline and bulb syringe and like a gladiator of old donned combat attire of gown, gloves, head cover, full face protector shield and proceeded to wash out the wound. Any questions? Yeh, when do you numb it up?
Now comes the truly interesting part. After inflicting sufficient pain to make a grown woman cry, our Halstedian surrogate proceeds to remove his total body barricade, paint the digit with iodine, only reglove and then sweating and snorting over the open wound suture it with six stitches. The theatrical surgical getup was solely for self-protection from potential exposure to patient-born pathogens, there was no Listerian concern for contaminating the operative field. However, one thing our healthcare provider excelled at was disclaimers, possibility of infection, non-healing, scarring, tendon injury, loss of sensation, bleeding, and deformity. Any questions? Does she need a tetanus shot?
Anyway, the wound healed perfectly, I took out the stitches (another encounter with this cohort was not to be) and there were no complications. What does it all mean? I’m not sure, but I certainly dread the possibility that healthcare reform will lead to socialized medicine and violate the sacred patient/doctor relationship our present system inculcates. Peace, good health, fair seas, and the wind from abaft o’ abeam.