Our healthcare system is broken.
Dec. 29th, 2024 06:27 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
which_chickSo my friend went roller skating with her kids and her friend and her friend's kids today. While skating, she fell and hit her head in a fairly solid sort of way. She does not have health insurance.
I am not a doctor. Her sister is not a doctor. But here we are with two delightful realities.
Reality 1: getting actual medical attention is going to cost a bloody fortune that she does not have.
Reality 2: we need to know if this is a necessary ER visit.
I love doing Dr. Google of a Sunday evening when what is on the line is "Is my friend going to die?" I mean, thrills and spills and high stakes poker, am I right? Thing is, subdural hematoma is one of them things where you can go to sleep and just... not wake the fuck up. Some folks might think falling and hitting your head during skating is not a thing you can die from but those folks are wrong.
But she doesn't have healthcare. So we're not going to the ER for no reason. That's what Dr. Google is for. "Is this serious enough that we need to spend at least 1K on an ER visit?"
And because we're in Greater Rednecklandia, Local Hospital (a step up from an urgent care facility) is not a great choice for "Do I have a subdural hematoma or not?" because they're farm team doctors. They do have an MRI machine but they cannot actually fix you if you DO have a brain bleed. If they admit you and do the MRI and you need Something To Be Done, they will put you in the wee-woo wagon and drive you to Regional Hospital. They will not fix you at Local Hospital and they will not let you discharge yourself and drive your own ass to Regional Hospital even if you are not currently in danger of dying.
I reiterate: If you get admitted at Local Hospital and have some need for legit medical care that you can only get at Regional Hospital, you are already locked into a pricey fucking ride in the wee-woo wagon. The wee-woo wagon is not optional at that point.
Since riding in the wee-woo wagon jacks the cost of your adventure in uninsurance by like 10K, if you're not actually dying imminently but might be in need of legit medical care, prolly you ought to just have someone drive your damn ass up to Regional Hospital in the first place. It's a 40 minute trip by car but you won't get there any faster in the wee-woo wagon. The alternative to pro-se commuting is to go to Local Hospital and roll the dice on needing a 10K ride in the wee-woo wagon. That's not a bet you want to take when you are uninsured.
My personal feeling is that the Sprawling Hospital Complex (with its far-flung mets lighting up the western half of my state in a constellation of "care" like a chemo patient failing a PET scan) is going to claim that the Local Hospital "is not economically feasible to keep open" in the next five years and shut it down so that the only damn option is schlepping up to the Regional Hospital. And you do get, relatively speaking, better care at Regional Hospital but that's also because Sprawling Hospital Complex has bled off services and stuff from Local Hospital to gut it so that it's basically an Urgent Care Center With A Helipad and an MRI. And they're going to close it down as "unprofitable and underused with empty beds all over" and "not doing enough business to justify keeping it open".
Mark my words. Anyway, so I'm on the cellphone with a laptop open, evaluating the patient with her sister on-site:
Her pupils are equal sized and light reactive. That's good. One blown pupil or non-reactive pupil is VERY BAD and needs immediate medical attention. (Mostly. If you're my old 4-H leader who got hit in the face with a baseball at her kid's game and has one pupil that is permanently blown and has been for like ten years now, it's nothing to worry about. She looks concussed all the time but is otherwise fine.)
Her motor skills are even on both sides and she's reasonably coordinated (as much as she ever is, see "fell while rollerskating and bonked her head"). We did "grip my hands with your hands and squeeze hard" (judging grip strength for bilateral differences) and "close eyes and stretch out each arm one at a time, bring it in to touch index finger to nose like a fake sobriety check at a DUI stop" (looking to see if response is bilaterally symmetric, plus coordination check, plus following directions) and "stand on one leg for a slow count of ten" (coordination, balance, bilateral skills). Again, we're not doctors, but these are things that would show up any motor skills impairment on one side of her body, like you'd get with a stroke or a one-side brain bleed. I get that they're not high-tech or super fancy, but they're quick and dirty checks that can be informative on the "do we need to go to the ER immediately?" front. And she can do those things in a not-obviously-fucked-up way.
She's not dizzy or nauseous. She has a pretty solid headache but she's not slurring words or feeling sleepy. She seems alert and can follow a conversation. So she's good, right? Sorta?
No.
She's got no short term memory. Like, none. She's fuzzy on recent events of the day: "Why am I driving mom's car?" (Because you brought your truck and trailer over to load the pig to take to the butcher and you needed something else to drive the kids to the rollerrink) and "I thought I was going rollerskating with April?" (You did. You fell down and bonked your head pretty hard, so we came home after that. She does not remember falling or coming home from rollerskating or even GOING rollerskating.)
And, since she has two young children and is in her early forties with no known mental deficits, probably she needs to be checked out by someone OTHER than "her friend with google chops" since it's been a flipping hour since she bonked her head and she STILL cannot remember being asked to recite the names of her (current pets) three cats, dog, and horse after an interval of five minutes.
She completely and totally failed the "five random words" test and so we re-checked with "what are the names of your animals?" remembering task. "Trys, can you name your animals? (yes. She did.) Good. In five minutes, I'm going to ask you to tell me them again. I'm going to say "Tell me those names again," okay? (She did not remember being asked to remember the names. "You didn't ask me to remember anything. What are you talking about?") She has a fucking neuro deficit. I don't CARE if she can grip both hands with equal strength, she doesn't remember shit that happened five minutes ago. An ER visit is a good idea.
I'm doing a very gentle *headdesk* that will not cause a brain bleed in my brain. Lala is driving Trys to Regional Hospital to get checked out.
I am not a doctor. Her sister is not a doctor. But here we are with two delightful realities.
Reality 1: getting actual medical attention is going to cost a bloody fortune that she does not have.
Reality 2: we need to know if this is a necessary ER visit.
I love doing Dr. Google of a Sunday evening when what is on the line is "Is my friend going to die?" I mean, thrills and spills and high stakes poker, am I right? Thing is, subdural hematoma is one of them things where you can go to sleep and just... not wake the fuck up. Some folks might think falling and hitting your head during skating is not a thing you can die from but those folks are wrong.
But she doesn't have healthcare. So we're not going to the ER for no reason. That's what Dr. Google is for. "Is this serious enough that we need to spend at least 1K on an ER visit?"
And because we're in Greater Rednecklandia, Local Hospital (a step up from an urgent care facility) is not a great choice for "Do I have a subdural hematoma or not?" because they're farm team doctors. They do have an MRI machine but they cannot actually fix you if you DO have a brain bleed. If they admit you and do the MRI and you need Something To Be Done, they will put you in the wee-woo wagon and drive you to Regional Hospital. They will not fix you at Local Hospital and they will not let you discharge yourself and drive your own ass to Regional Hospital even if you are not currently in danger of dying.
I reiterate: If you get admitted at Local Hospital and have some need for legit medical care that you can only get at Regional Hospital, you are already locked into a pricey fucking ride in the wee-woo wagon. The wee-woo wagon is not optional at that point.
Since riding in the wee-woo wagon jacks the cost of your adventure in uninsurance by like 10K, if you're not actually dying imminently but might be in need of legit medical care, prolly you ought to just have someone drive your damn ass up to Regional Hospital in the first place. It's a 40 minute trip by car but you won't get there any faster in the wee-woo wagon. The alternative to pro-se commuting is to go to Local Hospital and roll the dice on needing a 10K ride in the wee-woo wagon. That's not a bet you want to take when you are uninsured.
My personal feeling is that the Sprawling Hospital Complex (with its far-flung mets lighting up the western half of my state in a constellation of "care" like a chemo patient failing a PET scan) is going to claim that the Local Hospital "is not economically feasible to keep open" in the next five years and shut it down so that the only damn option is schlepping up to the Regional Hospital. And you do get, relatively speaking, better care at Regional Hospital but that's also because Sprawling Hospital Complex has bled off services and stuff from Local Hospital to gut it so that it's basically an Urgent Care Center With A Helipad and an MRI. And they're going to close it down as "unprofitable and underused with empty beds all over" and "not doing enough business to justify keeping it open".
Mark my words. Anyway, so I'm on the cellphone with a laptop open, evaluating the patient with her sister on-site:
Her pupils are equal sized and light reactive. That's good. One blown pupil or non-reactive pupil is VERY BAD and needs immediate medical attention. (Mostly. If you're my old 4-H leader who got hit in the face with a baseball at her kid's game and has one pupil that is permanently blown and has been for like ten years now, it's nothing to worry about. She looks concussed all the time but is otherwise fine.)
Her motor skills are even on both sides and she's reasonably coordinated (as much as she ever is, see "fell while rollerskating and bonked her head"). We did "grip my hands with your hands and squeeze hard" (judging grip strength for bilateral differences) and "close eyes and stretch out each arm one at a time, bring it in to touch index finger to nose like a fake sobriety check at a DUI stop" (looking to see if response is bilaterally symmetric, plus coordination check, plus following directions) and "stand on one leg for a slow count of ten" (coordination, balance, bilateral skills). Again, we're not doctors, but these are things that would show up any motor skills impairment on one side of her body, like you'd get with a stroke or a one-side brain bleed. I get that they're not high-tech or super fancy, but they're quick and dirty checks that can be informative on the "do we need to go to the ER immediately?" front. And she can do those things in a not-obviously-fucked-up way.
She's not dizzy or nauseous. She has a pretty solid headache but she's not slurring words or feeling sleepy. She seems alert and can follow a conversation. So she's good, right? Sorta?
No.
She's got no short term memory. Like, none. She's fuzzy on recent events of the day: "Why am I driving mom's car?" (Because you brought your truck and trailer over to load the pig to take to the butcher and you needed something else to drive the kids to the rollerrink) and "I thought I was going rollerskating with April?" (You did. You fell down and bonked your head pretty hard, so we came home after that. She does not remember falling or coming home from rollerskating or even GOING rollerskating.)
And, since she has two young children and is in her early forties with no known mental deficits, probably she needs to be checked out by someone OTHER than "her friend with google chops" since it's been a flipping hour since she bonked her head and she STILL cannot remember being asked to recite the names of her (current pets) three cats, dog, and horse after an interval of five minutes.
She completely and totally failed the "five random words" test and so we re-checked with "what are the names of your animals?" remembering task. "Trys, can you name your animals? (yes. She did.) Good. In five minutes, I'm going to ask you to tell me them again. I'm going to say "Tell me those names again," okay? (She did not remember being asked to remember the names. "You didn't ask me to remember anything. What are you talking about?") She has a fucking neuro deficit. I don't CARE if she can grip both hands with equal strength, she doesn't remember shit that happened five minutes ago. An ER visit is a good idea.
I'm doing a very gentle *headdesk* that will not cause a brain bleed in my brain. Lala is driving Trys to Regional Hospital to get checked out.
no subject
Date: 2024-12-30 02:46 am (UTC)