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children by the millions sing for alex chilton
By | April 13, 2010
alex chilton (age 59) postponed going to the emergency room because he didn’t have insurance. he died.
a patient i know, who has terrible swelling and pain in her legs and feet, got a 102-degree fever last week and was having a hard time staying awake. one leg turned red from ankle to groin. she called me up (she lives an hour away), and i talked her into going to the emergency room.
another lady called me on a sunday morning, to tell me her husband, who has intractable vertigo and vomiting, was very lethargic and not making sense, and he wasn’t eating or drinking. i told her to take him to the emergency room.
i saw a guy in my office. he’d been off his oxygen for the past four hours, his wife explained, because he doesn’t have a portable oxygen cylinder to come see me, and he figured he’d be okay without it (they live out in the country, 90 minutes away). he was having these bad coughing spells, and kept falling asleep while i was talking to him. he didn’t have a fever, but he looked a little blue around the mouth (pulse ox 80%), and i sent him to the emergency room.
these folks don’t have insurance. (in the great american tradition of ironic humor, they’re too sick to have insurance.) two of them were admitted to the hospital, one to the intensive-care unit. the other one got “tanked up” in the emergency department – got IV fluids to reverse the dehydration. each of them apologized for bothering me.
when you’re an american, and you don’t have health insurance, or your insurance is worthless, you wait and see. the last few times you saw a doctor, it’s only been for ten minutes at a time and strictly business; plus, you slept through health class in high school. so you don’t really know how to decide when you’re sick enough to risk entering a health care establishment. you might think you know – but you probably don’t. a lot of folks think they have terrible illnesses that they don’t actually have (and spend more than they can afford on colloidal silver and “liquid oxygen” – don’t worry, not real liquid oxygen), because the basic true facts of human health and illness remain this mysterious arcana in our culture.
the flip side is that when we have symptoms that in fact are very ominous, we hope they’ll go away, because we can’t afford to be sick. alex chilton had chills and shortness of breath whenever he tried to cut the grass. to most of us, sounds like allergies. what a doctor hears in that statement is “whenever he tried to cut the grass.” breathlessness on exertion? i want to see you in my office.
in fact, any doctor wants to see you in their office, when you can’t breathe, can’t walk, can’t pee. but the doctor isn’t likely to even know you have these problems.
a woman i know had shortness of breath and chest pain. it hurt real bad, but she’d also had recent chest surgery, so it kind of hurt all the time anyway. now it was suddenly worse. (doctors prick up their ears at “recent surgery,” “shortness of breath,” and “suddenly worse.”)
she has insurance. she has a doctor. she likes her doctor. however, when she calls during office hours, she’s not permitted to speak to the doctor, and if the nurse hears the words “chest pain,” she ends the conversation, saying, just go to the emergency room. (if she calls after office hours, she gets an answering service advising her to dial 911.)
because of this, the woman doesn’t call the doctor anymore (unless i make her do it). neither does she go to the emergency room (unless i make her do it… okay, the woman’s my mom), because she can’t tell whether it’s bad enough, this time.
“going to the emergency room,” for most of us, signifies this huge humiliating hassle.
when you go to the emergency room, you have to wait there for hours and hours, worrying; the staff is snippy to you, they don’t explain what they’re doing, and most of the time they tell you you’re fine and send you home.
at least, that’s your experience. the ER doctor may feel certain he’s just saved your life, but he doesn’t tell you that, because he’s already moved on to the next acute crisis.
the “discharge paper” is a preprinted handout instructing you to “follow up with your primary physician.” the diagnosis line is blank, or a scribbled acronym.
since you don’t know whether you had something terribly wrong with you or not, and you don’t have a primary physician anyway (or you’re pretty sure your doctor’s next available appointment is three months from now), the main thing you’ve learned is: don’t go to the emergency room.
if you have to pay cash for this, it’s a disaster that will affect you and the rest of your family for months.
you were going to buy your kid a bike?
you were going to get the phone reconnected so you could get a job?
you promised your doctor you’d take your epilepsy medicine every day?
not any more. it literally costs a thousand dollars (at least), to “go to the emergency room.” and maybe if you had stayed home, it would have gone away by itself.
alex chilton wasn’t able to mow the grass one day, so he waited and tried again another day. same thing. he tried again a third time, and ended up dying in the car on the way to the emergency room, begging his wife to run the red lights. i think the saddest thing is that a lot of americans aren’t going to find this strange, or sad, or worrisome in any way. it’s amazing what you can get used to.
there’s a lot of consternation in the medical world these days, about folks having unassisted home births. it’s become a movement.
each woman, each family has their own individual specific reasons for deciding to give birth by themselves, without medical attendants or midwives. not having insurance, or having insurance that is worthless, might play a role, for some individuals. but mainly it’s part of an ideology.
but on the sociological level, on the big-historical-picture level, i am suspicious as to why this is happening now. why today? why not back in the seventies, when hippies were having babies in schoolbuses, just to avoid anesthesia? those days produced a midwifery renaissance, not a “freebirth” movement.
i think it’s because it’s been a few decades, now, if not a couple generations, that americans have been obliged to make their own decisions about whether they could afford to enter the “health care arena.”
they’ve been obliged to make their own decisions, because the basic facts about human health and illness have been treated like classified information for professional eyes only.
they’ve been obliged to make their own decisions, because they’ve been disenfranchised from health care by employer-based insurance rationing.
when they’ve chosen to patronize a health care establishment, they’ve gotten too little and paid too much, and told themselves, “well, i could have done that by myself at home.”
and now, especially through the magic of the internets, the masses have created a lively DIY marketplace of ideas, of what to try when you don’t think it’s bad enough to deal with the health care system. (not so lively a marketplace of ideas for how to tell what’s bad and what’s not, hence the colloidal-silver and liquid oxygen [don't worry! it's not real liquid oxygen!] industries.)
the start of michael moore’s movie “sicko” shows a guy stitching up a deep cut in his own hand, using a needle and thread. (there’s actually bunches of youtubes showing similar events.) i’ve often mentioned this scene to my patients. a few of them say, “ew! gross!” but most of them look kind of thoughtful and say, “gosh, i wish i’d thought of that.”
it’s just more of an ordeal, in these united states, to go to the emergency room, or even try to call the doctor, than it is to try to stitch your own laceration at the kitchen table, to give birth “unassisted” without “prenatal care” (sorry for the scare-quotes, but this phenomenon’s destabilized the metanarrative of american childbearing), or to decide whether you are, in fact, about to die from a heart attack.
like alex chilton.
…and that’s why i’m moving to canada!
– just kidding! actually, it’s why i give my patients my cellphone number, and tell them, and all my family and friends, please call me. quit apologizing for bugging me. just call me.
and that’s what your doctor would say, too, if the overhead expenses of their large group practice didn’t require them to hustle you in and out in record time, and if they weren’t continually warned that they have to preserve the clinical distance between doctor and patient or they’d be inundated and their lives would be ruined. they’d say: here’s my number; please call me, before you decide to go to the emergency room – or more importantly, before you decide not to go – call me.
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