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.
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.
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.
Diabetes doesn't spread to rich people but fires can :very-smart:
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.
Once again stating my belief that people who greet others with tedious questions deserve to break rocks in Siberia.
Ironically, what made me a leftist was working on the business side of health care. You can have all the nicest people in the world running your hospital/practice, but at the end of the day, they will get fired of they don't deliver money to investors. Whether anyone actually gets treated appropriately and affordably is tangential.
The admin at my hospitals has always tried to treat it like a normal corporation. We'd have HR come to emergency, pull night shifters in at like 2pm for a mandatory meeting, only to be told that our comment cards weren't reflecting 𝑔𝑜𝑜𝒹 𝒸𝓊𝓈𝓉𝑜𝓂𝑒𝓇 𝓈𝑒𝓇𝓋𝒾𝒸𝑒 and that "in medicine we can have no bad days". The work was watching children die and the bad days were because children died. HR wasn't helping then. They were the ones who turned me against limited reformism like Medicare4All being the end-game. Without a nationalised health service, healthcare existing as a commodity will mean it's ruled by the same mentality and structures as any other industry. That middle-man kills so many people for pennies.
That's the takeaway I got from Scrubs, lol. It's kind of surreal that everyone is acutely aware of what a failure the American Healthcare system is, and has been for at least 3 decades, and the most that's been done about it is the ACA.
Idk about people being aware, I see a lot of people insist that we couldn't possibly spend any less on healthcare otherwise the quality will go down
Seeing patents I was involved with routinely not recive care for want of small ammountd of resources is what flipped me. Solidarity comrade
Working the billing side of health care was insane. You had a price ledger that was a complete joke and insurance companies that would fight tooth and nail before paying anything on a policy.
The hospital insurance department had 6 people handling Medicare/Medicaid billing - over half their business - and another 50 to handle private policies.
I keep forgetting that the reason why so many of these so called zoomer/millennial neoliberals are so smug and self assured is because their careers are so far detached from the average person. When you work in some tower laundering money, writing very epic and important opinions in some newspaper or substack article, summarize policy for politicians, or sell and buy imaginary numbers on a screen, you don’t realize the suffering going on around you. or you do, and you just don’t care.
Dude, it's even weirder. They don't need VR and AR, the well to do and impoverished live coterminous lives yet they're totally disconnected. People in flashy dresses drift pass the homeless downtown and the homeless don't even look up anymore, it's like 2 worlds on top of each other.
Blue collar work kills your body but office work kills your soul. I've worked data entry for a regional retail chain for about a year, after about 7 years of working in kitchens and customer-facing retail. It pays pretty well, but I can feel myself becoming a worse person. You get lost in your own little bubble of personal comfort, the memory of living on the outs always pushing you further in.
I definitely got sucked in to the creature comforts, it doesn't make you a bad person. Eventually it got to be too much for me, though. I quit an easy six figure job to go back to school to become a nurse. Some days I wish I was a man, so that my mid life crisis would have gotten me a fancy sports car, instead of trying to learn anatomy and organic chemistry in my mid 40s.
I don't know if my theory is correct or an overly simplistic reading of the science. However the human brain calculates problems in chunks around one lunar year. Dunno how the brain actually measure the time but it is't relevant. However the point is that you brain searches back to determin what the worst problem it can remember is in that window and sets your perspective accordingly. Ao if you are so materially successful someone getting your starbucks order wrong is the worst thing it can remember that becaome your 10/10 red alert point. So in that way money buys easier access to sadness. The better your life the less access to input to accurately calibrate your perspective is.
I'd still take it (if it paid ok), but I haven't been working for so long that I don't think that even data entry would hire me
Me traveling note there’s good services and folks available to help in say Massachusetts, NY, all of NE I’ve seen but outside cities in middle and southern states it’s difficult. Life expectancy has about 20 year difference from surveys up to 2018 from southern states and northern (except reservations in Montana, Nebraska).
Problem is not many resources available down in those areas where many people don’t want to live (high rates of cancer, poor sanitation, unusable water, ect). Also the corruption (Politicians redirected millions in welfare money to rich folks in Mississippi where it’s needed the most). I wish I had better answers.
When I travel there I work my ass off finding help for those folks. After a 6 month stay though I need to go to east or west coast for a break from the blight.
american traveling nurses are basically for-profit Doctors Without Borders (and not doctors) just doing fucking triage in America's ongoing devastation
Before the pandemic there was an article about rural healthcare. It was about some psychiatrist in a state like New Mexico with a low population density in its rural counties. They were the only provider serving multiple counties and had like 300 patients, the maximum their clinic could regularly schedule, with a huge wait list. COVID has only amplified this crisis with the general exodus and especially a rural exodus of providers. Urban hospitals pay better and there are fewer plague rats. When travel nurses stop being able to fill those gaps it's going to get really dark fast. Each additional patient for an RN means a 7% greater chance of death.
