Today, I was too busy to see a patient who came to the office in desperation and pain.
That was because I was seeing other patients in more desperation with more pain. In fact, I was doing a little operation on a 17 year old blind boy who had been hobbling around with a piece of glass embedded in his right foot for the past 2 years.
He had seen at least 4 Physicians for his probem and had undergone at least two exploratory procedures. His Physicians had no luck sending him to a plastic surgeon because of an over 2 year wait in Calgary to be assessed - and the difficulty in accessing a Specialist that "does feet".
So - the poor fellow hobbled in pain through most of his highschool years. He was sent to me by his Physician after his Physician learned that I do "things like this" (I don't really - but I suppose that I do now because it seems that I get a lot of referrals like this).
I had just removed a large tennis-ball sized benign vascular tumor from the left buttock of another fellow who had been unable to sit for the past two years. His tumor had recently become necrotic and intensely painful, and he had been advised by the E.R. that they would arrange for him to be seen by a surgeon - the arrangement never happened....twice.
The poor lady in the waiting room went home.....scared at having lost 20lb in the past 3 months and at the intense pain with any bowel movement or passing of gas.....and even more scared that she could feel a mass protruding through her rectal area.
My next two weeks were booked solid with increasingly desperate people. Some of them were returning to ask why their colonoscopy screening tests were taking over 18 months to get booked.....others wanted to know why they had to wait 12-18 months to see a neurosurgeon for their incredible back pain that required surgery.
After a dizzying day of little, but significant surgical procedures; I recalled that I forgot to eat again.....it had been 20 hours since my last meal. When I woke up this morning, I got up from the bed to walk to the bathroom - and distantly heard a loud thump that scared my wife to death and had the kids running into the room......I stared up at them in confusion - not remembering losing consciousness.
I seemed fine (except for a sore left wrist), but for the first time in my life - felt the cumulative effects of rountinely 3 hours a night of sleep, chronic dehydration, stress and probably malnutrition ganging up on me.
The strain of a College Complaint from a patient being charged for surgical supplies that I had to pay for, but Alberta Health wouldn't pay for - and to which the patient felt entitled, combined with the mounds of paperwork for everything from Blue Cross drug authorizations to Handicap parking forms and demanding letters from various insurance companies, employers and various patients that wanted notes for "time off from work".......had finally started to affect me in a way that I have never felt before.
I thought that I was handling this all pretty well; with a generally good mood and an increasingly strained cheerful outlook......however, I'd never fainted before.
The rest of the day had me quite thoughtful about my predicament. I need to see my 40 patients per day - they are desperate to get in for their appointments with my current 3 week wait....but I am also handling about 10-12 emergencies per day that keep me at the office at least 2-3 more hours than I am scheduled for....this adds at least another 2 hours of paperwork to my day and keeps me up later and later at night.
And I am working harder than I ever have in my life while making less than I ever have. Alberta Health, for example, has refused to pay for various surgical procedures that I have done since last May. They grudgingly agreed to pay about 30% of my actual costs of doing the procedure (never mind my income) - and didn't care a rat's ass that I was going to be personally in the hole about it. They simply disagreed that the procedures had been performed. The surgical pathology reports, the patient testimony and my surgical notes complete with digital photos did not appear to matter to them in the least. They simply refused to pay. It's not a battle that I will win with them - and is reminiscent of the deservedly and ubiquitously despised HMO's in the USA.
One of the best, brightest and smartest Physicians I have ever known told me last week that he has had enough of the same sort of strain. The constant pressure to attend to impossible demands from an ever increasingly desperate patient population and decreasing payments from the Government, were just too much to handle for him any longer. He's pulling the plug on his 5000 patients. This is, in part, because Alberta Health fixes our rates to something below our operational costs - and they state that they will charge us as criminals if we charge any rates in addition to what they are willing to pay - even if we just want to make our costs and earn nothing. It is an untenable situation that our increasingly disconnected Government is unwilling to address.
So, for this reason; out of about 36 Docs that have worked in my Medical building about three years ago - there will be only about 4 left starting this July.
Many of them have left to go to private medicine or the USA - shunning Alberta Health....and they're all ecstatic with their decisions. But I am not prepared to abandon my patient population yet.......yet......
And so, after a day of doing these surgical procedures....I got home and listened in awe as my wife skillfully helped my eldest teenaged daughter successfully manage an episode of serious "Facebook bullying" by another grade 8 girl. I may have done some pretty neato surgeries today (the blind boy is walking fine now....I found the damned glass) - but what my wife did today to help our daughter REALLY blew me away. After 20 years, she is still teaching me a hell of a lot. I am soooo lucky to be married to this hottie!
And so, as I FINALLY sat down at the table to FINALLY eat something....my thoughts drifted to that poor elderly lady that I was too busy to see today. I put down my fork, looked up her number in my compter (at the table) and called her. And listened. And sympathized. And became embarrassed at how dreadfully our Health Care System has failed her.
So I watched my meal get cold as I called the Gastroenterologist on call at the hospital.
He listened for a few minutes in sympathy. I had referred this lady "urgently" about 4 months ago, but my referral - like every other referral I have made to G.I. in the past year - went essentially ignored, even after I called twice.
He then told me that he could not really see her soon, as that he was busy scrambling with more urgent cases and that she really had no hope to be seen as an outpatient. He told me that I should just send her to the E.R. as "an emergency" and to tell her to expect to wait at least 15-25 hours to be seen.
I have taken this approach before - and they often just tell these patients to see their Family Physicians because the issue "is not really an emergency" (very true). So I opened my laptop again and wrote an "urgent consult note" to the E.R. Doc and then called the E.R. triage nurse to inform her that the patient was going to arrive soon in the E.R. and that I wanted a call from the E.R. Doc to explain the situation.
As my meal went from cold to arctic - I called the patient back at home to advise her to go to the E.R. She told me that she could not afford a taxi, couldn't drive and didn't know if the bus was operating this time of night. She lived only a few blocks away from my house and I briefly entertained thoughts of driving her to the hospital.....but by this point, I didn't know if I could make it upstairs safely to bed - never mind driving anybody to the hospital. We talked some more, and she agreed to phone a friend for a ride.
Pushed my plate away.....It's time to get some sleep. I hope that she gets to the hospital and gets seen......
Hope the pager doesn't wake me up.....last night I got a call from the ICU about another patient (85 years old) of mine that was frustrated with his cough - so he took a whole bottle of tylenol and ativan in the hope of dying. ICU wanted him sent to Psych after "forming" the patient (taking his rights away). He is very clear about his intention to go home and kill himself. He isn't crazy - he just doesn't want to live anymore with his COPD and mild cognitive impairment.
So - do I let him go home to kill himself, or do I continue to take away his human rights at a cost of $3000 per day to the tax payer because "I know what's better for him".
They didn't teach the wrangling of this stuff in Med School.........
Thank God for my family!
It's the long weekend.........time to recharge (it's going to snow).....