Ouch!! is a Four Letter Word

I’ve broken my back twice, my neck once, had my shoulder ripped out of joint, my nose obliterated, my leg broken twice and any number of dislocations and broken fingers, elbows, knees and wrists; SO, you would think I am familiar with pain and the management thereof and, until yesterday you would have been correct. At five am yesterday morning I sat up in bed with a pain in my lower back that I was sure was going to kill me. I retched, the salvia filling my mouth faster than I could spit it out and the pain somehow just kept getting worse. By nine-thirty I was on my way to the emergency room after a FaceTime consult with my doctor. The wait seemed interminable but more on that in a minute. By eleven-thirty, the doctor had me in the CT scanner and by twelve-thirty, with the aid of a magic IV elixir (non-narcotic), I was pain free. I arrived back home at four-thirty with a new bag of medications and instructions for follow-up.

Now I know some of you have already guessed that this episode was caused by Acute Renal Colic, aka kidney stone. I have never had a kidney stone and my empathy is now with those who experience them on a more or less regular basis. My breathing techniques, number counting and dissociative techniques for managing pain may have had a little impact but, according to my wife, not much. While I may have said “ouch” once or twice I believe the four letter words I used were dredged up from my days as a fighter pilot and combat rescue pilot. I hope I held them under my breath but, once more according to my wife, not so.

Today I’m better although washed out from being in pain for seven hours but what I want to briefly discuss is not my pain but my experience with the medical system. I haven’t been to an emergency room for several years having the good luck to have found an on-call doctor’s office that will take me whenever and also having the good fortune to not need emergency care. Yesterday, although in pain and having lost temporarily the ability to use my God given skills at conversation, I had not lost my observations skills thus: When I arrived I was the third person in line for treatment, there was a sprained wrist and an unknown but stone-faced malady in front of me. But the ER waiting room filled quickly thereafter until there were few seats left. I assumed I would be seen fairly quickly but that was not the case for among those who arrived after I did but who went in before I did were: “My arm was numb when I woke up this morning; I think I’m having afib off and on; and a my nose won’t stop bleeding. These pushed me back in line and I admit to having uncharitable thoughts but I attribute that to the pain. Yet, this morning after some discussions, post magic elixir, with the nurses and doctors and overhearing some conversations in the Hospital cafeteria I may rekindle some of those uncharitable thoughts; although, I think my thoughts now are more “What have we wrought?” using a paraphrase from Samuel Morse.

In Tennessee we have Tenncare as well as Medicare and many of our older residents receive both which pretty much makes their medical care cost very little, if anything. Tenncare provides for low income non-Medicare patients making their costs again very little if anything. So, here’s what I observed and learned: Older people oft-times use emergency room visits to establish people to people contact and achieve attention. There are a variety of reasons for this behavior but it occurs several times a day in all the hospitals in this region. Each complaint must be taken seriously thus these complaints take time away from patients who are actually ill. People doing this have learned the symptoms of which to complain to ensure they receive prompt attention and thus you have the numb arms, I think I’m in afib and the nose had actually stopped bleeding although there were three blood stained Kleenex held in the lap as proof of the actual bleed.

I understand the need for human interaction so let’s give those people a pass for the moment. Now, of these and the others in the ER waiting room all but two or three were obese and their complaints all had something to do with their obesity: My knees won’t support me, I’m having breathing problems, and so on. I was amazed at how many sick people there were at 1000 on a Tuesday morning but what really amazed me was how obese the majority of them were. One man for whom they had to get a double-wide wheelchair complained of intestinal cramps and was afraid he had a bowel blockage but his continued flatulence and belching was a good indicator it was gastritis.

As they took me back to an examination room I noticed a line of people being pushed in on stretchers from arriving ambulances. Although I noticed it, I was in too much pain to care about the cause at the moment although I remember wondering if perhaps there had been an accident, but afterwards I remembered that trauma patients were taken to the University of Tennessee Hospital vice the local hospitals, one of which I was in. I also noticed that several of the people were obese and none seemed to have any apparent injury. As I sat in the exam room there were multiple announcements “reception EMS patient in hallway.” I would hear at least seven of these while I was waiting. Still, it seemed to take forever to see a doctor even after I was in the examination room, it was an hour and an episode of retching on my knees that got me attention. After the elixir worked its magic I lay on the bed waiting for the results of my tests and speaking with attendants and technicians as they came and went. Was there an accident I asked? “Oh no, these are just some of our regulars. They know if they come by ambulance they don’t have to wait in the waiting room to get seen. It’s a way of jumping the line.” Now, between my arriving and my getting the pain relief care I received, eleven ambulances had arrived causing the intake staff and doctors to be pulled away from the wheelchair and ambulatory patients in the waiting room.

According to one of my conversationalists, most of the patients who arrive by ambulance are often overweight and have difficulty moving and most are seeking pain killers from the doctors. She did note that while they arrive by ambulance, seeking admission to the hospital for a few days, they generally leave by private vehicle or an East Tennessee Handicapped Transport vehicle, which, for the price of a taxi ride could have brought them to the hospital in the first place.

All of these people need attention, but perhaps not in an emergency room or a doctor’s office. The draw on emergency response services is readily apparent and this behavior creates shortages for others in the system.

I know my doctor has established a protocol for some patients so that when they make their weekly or twice weekly call they are routed to a specific employee who can engage them in discussion and ascertain whether they really need to be seen or if they are just seeking human contact. The costs for this service are offset by not having to have the person come into the office and occupy time, space and personnel; although some don’t bother to call and just walk-in which requires they be processed the same as other patients.

Medicine is the single largest business in the United States. We have heated national discussions about providing health care for all. In Tennessee we pretty much have it but our medical staffs are overworked because they have to act as social workers for the elderly and investigators of opioid abuse plus Medicare and Tenncare fraud. Much of this abuse revolves around psychological problems whether it is loneliness, drug addition, anxiety and psychiatric disorders. Plus, when you are giving people things for free or little cost, will they overuse the benefits?

So, here’s the question of the day: Is there really a national answer to the problem of health care? Perhaps we should work backwards from care delivery to insurance instead of from insurance to care delivery. I know that Medicare has established a yearly medical review for Medicare patients which is a start, though perhaps not exactly what we need. Thoughts?

And, I’m just fine. Thanks for asking. No additional magic elixir has been required.