I'm five years deep as an emergency room RN at an inner city hospital. Not sure if this is relatable at all, but I wouldn't describe the last few years working as a nurse to be like the most fun years. This appears to have had some sort of impact on me. For instance, I was recently made aware by my manager that "dead inside" is not an appropriate response when the regional president and hospital CEO asks how you are.

Today was another beautiful day of ED holds, 12 hour wait times, and traumas being ran in the hall beds. Towards the end of my shift I do the impossible and discharge two of my six patients back to back. I'm immediately rewarded with an obvious deformity patient requiring conscious sedation and a DKA patient from the local shelter. Skip to the first patient waking up from their little medically induced power nap. "Where is my shirt and sweater?" I apologize and explain we had cut them off during the procedure. Patient immediately started sobbing. Well, clearly the special K cocktail hasn't completely worn off yet. As they are wiping away tears, "I'm sorry, that was just literally the only shirt and sweater I owned right now. Is it okay if I take the gown when I leave?" Suddenly this indescribable, yet somehow vaguely familiar sensation hits me. Weird... whelp onto this DKA patient. I walk in that patient room and inform them I will be their human nurse for the evening. Patient begins to apologize for coming in and that they didn't want to bother anyone, but couldn't stop throwing up. I ask if they have been checking their glucose and taking their insulin as directed. "I'm trying, but I only have one vial right now and don't know when I'll be able to afford more. I'm sorry, but i didn't know what else to do, so I've been taking less and skipping doses... it's hard to get financial assistance without a permanent address or phone and I don't have either of those right now. I'm sorry to bother you guys."

Goddamnit. Who do these people think they are? I didn't spend the last several years building this facade of mental toughness and emotional stability for these two patient's to come into MY EMERGENCY DEPARTMENT and make me feel a genuine human emotion again.

Now begins the involuntary journey to apathy and numbness that our healthcare system mandates in order to survive a second time around.

In the US, any hospital which receives federal funding through Medicaid (most if not all) are under a law called EMTALA- Emergency Medicine Treatment and Labour Act. Legally Emergency has to treat anyone who comes through the door regardless of their ability to pay. That's good. But they only have to treat the patient until stable. After that, they can ship them to any other facility which is legally mandated to accept them or let them go back to the circumstances that repeatedly cause their illness/injury.

So you get patients like these who are just a revolving door of suffering for the sake of shareholder value. They can't afford insulin for their diabetes, their blood sugar goes so high their blood turns acidic and starts killing them, we lower their blood sugar, and they go back to homelessness. At some point their leg will rot off and they might qualify for the single medicaid bed in a rehabilitative nursing home ward. If they're connected to social services in the hospital, they might qualify to get put on a wait list in a month which might give them affordable housing in a year.

No compassion, no compassion, no excuses.

  • Nephy [he/him]
    ·
    2 years ago

    My experience working on the ambulance the last few years:

    You know who calls 911? Poor people.

    It's so, so rare that we go to a nice house. It's constantly the worst neighborhoods, the shittiest houses with no heat and no insulation, with people sleeping 4 to a room . People get sick from living in conditions like this. If you grew up and had a room in a warm house to yourself and food in the kitchen you had it better than like 30% of the population.

    And it's always that they are calling for things they needed to see a doctor for a week ago but they can't afford it, and now whatever they have is so bad that now they need the ED.

    5 dollars worth of antibiotics or insulin or pain medication could have solved this problem a week ago but no, poor people have to suffer.

    • happybadger [he/him]
      ·
      2 years ago

      The lack of preventative medicine is the real barbarism of the healthcare industry in my opinion. DKA is a terrible way to go and a massive use of resources, in this case purely the result of price-gouging for a drug that costs almost nothing to produce. In my ED that night they take up one of 12 beds in an AO covering 250k people, one ICU bed out of 8, one ambulance out of six in my fleet for an hour, and diverting any stage costs the next patient half an hour for no benefit to anyone. That unmanaged diabetes is going to needlessly kill them in the one medicaid bed at the nursing home with a wait list of 80 people. Most of them wouldn't need that bed if not for socioeconomic factors and a system that discourages low-grade/inexpensive care their entire life.

      That was probably like half my cases too. Some trauma and illness is acute but so much of it is systemically chronic and not recognised as such.