Wednesday, January 23, 2008

Make me a Saturday-night drunk, please.

She would have been a Hospital Hobbyist were it not for her late husband having donated ten gazillion dollars to the research center at the hospital. Because he had, she got the white-glove treatment (or as near as we can manage) from the minute she set foot in the door.

Food service dug up some real metal silverware from somewhere, and she got that rather than the disposable stuff everybody else gets. She got a newspaper every morning. And she thought she'd get to direct her own care to a degree commensurate with her husband's donations.

Two out of three ain't bad.

See, I have this philosophy: Everybody, when it comes to actual medical care, is on the same level as the poor bastard on charity care. In other words, it doesn't matter if your Secret Service agents get touchy or your personal assistants don't like it; I'm going to assess you head-to-toe at least twice during the day. I'm going to do those neuro checks every two or four hours, and I'm going to draw your blood even if it means getting you to delay that call to your broker.

Because, quite frankly, you are sick enough (or think you're sick enough) to be in the hospital. You are, therefore, a patient. Not a donor, not a politician, not a celebrity. You are a body in a bed (reductio ad absurdum) which needs diagnosis and intervention, just like the guy next door who speaks only broken English and is here by the grace of God and the indigent referral service.

So. She comes in, she lies down and begins to moan, and I get ready to assess her and fill up the paperwork that comes with an admission.

She didn't want to answer questions. She didn't want to let me check out the incision that was giving her problems. She refused a blood draw twice until I walked in with a needle and a face like grim death. She didn't want to talk to the residents.

What she wanted, and thought she would get, was a narcotic pain pump and plenty of Phenergan for the narcotic-induced nausea. Just enough, you know, to take the edge off and fill time between her Thursday admission and her Saturday discharge (in time for the boots-n-bows charity ball, or some such). Again, two out of three...

There's been a lot of debate here locally about how rich folks get better medical care than poor folks. To an extent, that's true: if you have decent insurance and the money to make up the difference, you have a wider range of choices and much better preventative care than the schlub who works four part-time jobs to barely make rent. But when you get into the realm of the Really Fucking Rich, the people who have buildings and sports fields named after themselves, things start to break down.

See, the problem with being Really Fucking Rich is that the people to whom you have donated money tend to take you at your word. If you say you don't want to be disturbed, they'll not disturb you. If you refuse blood draws, the phlebotomist will be encouraged (usually by someone connected with Patient Relations) not to press the issue. Tests will be delayed until you feel it's convenient for you to go to radiology. Residents will be so cowed by meeting Mrs. MRI Suite that they'll be too shy to do a full assessment.

I read somewhere that an ED attending training residents told them this: "If my wife comes in after a car wreck, I want you to treat her just like you would the Saturday-night drunk in the next bed." In other words, no special dispensation for rank or privilege--you get the same careful attention as the next guy.

The official position of the folks in the carpeted areas is that, while rich donors might get special perks like free parking, their level of medical care is the same as everybody else's. 

That's not true. Their level of care is *poorer*, because Those In The Nice Chairs allow them to pull rank and act like they themselves know best. And mostly, they don't.

The upshot of my three-day run with Mrs. Potsofcash was that I got to have a pleasant chat with the Patient Relations people. Mrs. Potsofcash was upset that I disturbed her afternoon naps to do things like assess her or clear her PCA pump or administer medications. She was unhappy that she didn't get to refused timed blood draws (to check things like drug levels; they're called "timed" because, well, they're sort of time-sensitive). She was peeved that she had to wear a hospital-issue gown to MRI and remove her jewelry for same.

What can you say to that? Her complaint wasn't with my demeanor or my language or my personality; it was with the fact that I was providing care to her as is necessary in a hospital setting.

My response to the Patient Relations person was this: "Um...she's mad because I treated her like a patient in a hospital, is that it?"

God save me from special treatment. And from Patient Relations. And from donors.


H said...

For the love of God please tell me the PR people understood your side of it. Or does the very occurrence of the "pleasant chat" mean that they didn't?

Jo said...

Lynn, here's how it went:

PR Person: "Mrs. Potsofcash is upset that her daily naps are being disturbed for blood draws and medication rounds. She also doesn't want any neurological checks or vitals between ten pm and six am. (Brilliant smile)"

Me: "Sorry. Mrs. Potsofcash is here for X diagnosis and requires Y treatment. Part of Y treatment is medication, and part of keeping her safe and healthy is being sure she hasn't had any neurological changes. She'll have to deal."

PRP: "Mrs. Potsofcash is a very influential donor. I think we can compromise on this, don't you?"

Me: "Right now, Mrs. Potsofcash is a person ill enough to be in a hospital bed. There will be no compromise on her care, as that would be medically unwise and unethical. If she has any further issues, I will refer her to the medical director. (a tough-as-nails former nurse and current surgeon)"

PRP: "We seem to have nothing more to discuss."

Me: "Damn straight."

For what they're worth, the PRPs didn't say anything more, and Mrs. P quit complaining. She did, though, check out the *very next day*, her intractable pain issues apparently resolved and her surgery cancelled.

Sure sucks when you check into a hospital and actually get *treated*, don't it?

Dr. Alice said...

I worship you. It's official.

Actually, I admire you, as I would have without doubt lost my temper during said pleasant chat, and you clearly did not.

And you nailed it when it comes to the care of the Really Fucking Rich - see also Howard Hughes. (He never got the mental health treatment he should have gotten because, well, he was too damn rich and nobody forced the issue.)

Anonymous said...

I haven't dealt with a "potsocash" lady yet (thank god) but I have dealt with family members of doctors and nurses that I work with whom end up as my patient - and I'm with you - I also feel that they should be treated the same and get the same kind of care as anyone else, regardless of who they know or who I work with. But that's just me.

Cuttlefish said...


I am seeing a surgeon for a consultation in a couple of weeks, and expect them to cut me open at some time after that, depending on their schedules.

Thank you for making me feel grateful that I don't have a lot of money or influence!

Jo said...

Squidfriend, best wishes to you in your upcoming surgical adventure.

woolywoman said...

You nailed it, Sister. Good for you.

shrimplate said...

Cuddlefish (sorry! I couldn't resist,) good lusk with that cutting-thingie.

I've met some poor bastards who thought they could put some sway on their care. But they rarely get the suits to pay attention.

H said...

So just today we had a lecture about nursing ethics, and our instructor told us: "I don't care if your patient is the president of the United States or a drunk rolled in to the ER on a Saturday night -- you give them care according to their needs and not their status." Direct quote. I think this means I can now count reading "Head Nurse" as studying. Score.

Anonymous said...

Can't wait to read your post regarding nurses who become patients and the problems that they present. Could be as tricky as Ms. Potsocash!!!

This is Sixty said...

We have a Potsofcash patient in our dialysis unit. With everyone else we get there needles in in about 30 seconds to a minute and get their treatment started in right around 5 minutes. With Ms. Potsofcash she needs extra special handling and it takes upwards of 15 minutes to just put her needles in. She refuses all meds because she decided she's allergic to all medication, even though she has never had an observable or reported reaction to anything. Her condition is in a continuous downward spiral because she ignores her doctor's suggestions and decides for herself how she will be treated.

We may not put tape on her table because she believes that germs will stick to it and she will get an infection, even though we do this for every other patient and none of them has an infection. We may not use the regular 2 x 2 gauze on her, but instead use sterile 4 x 4's because she will get an infection, even though none of the other patients get an infection from the non-sterile gauze.

She gets this treatment because she donated a bag of money to our clinic manager's church. Eventually she will be a very rich, very dead lady.

RehabNurse said...

I haven't had Mr/Mrs. Potsofcash, but I have had Mr. Relative of Staff MD (ROSMD). This is also a potentially precarious situation.

It never failed, Mr. ROSMD was a pain, but part of it was just his personality. I worked really hard with him, even getting his laundry done when he was incontinent. I stayed late. I showered him and washed his hair.

StaffMD, his relative was his MD and he was delightful. It was StaffMD's wife (and sister of Mr.ROSMD) an RN who was a special RPIA (Royal Pain In the Anatomy). She b*(tched all the time that we did not "do enough".

Hello, we work more than our eight or 12 hour shift to take care of your bro and you show up for a lousy half hour at a time, maybe once or twice a week and you work 2blocks away? Was it really necessary to yell at his nurse because Mr. ROSMD had his belt off when you arrived to pick him up at discharge?

I grew to enjoy Mr. ROSMD and his peculiarities, and his bro-in-law, StaffMD, too. It was just StaffMD's wife who was terrible.

We don't miss her. We just hope she doesn't kill anyone over something stupid.

Orthette said...

The hospital I work at is surrounded by an affluent community, and we get lots of Potsofcash patients. The director of anesthesia, we'll call him "James", goes out of his way to make sure these people receive special treatment. Enough so that when a handoff is done at shift change, the patient is simply described as a "FriendofJames" and no further description is necessary. (It's certainly not a term of endearment.)