As in Dead

Let us start with this little bit, from a local rag that offered plenty of words of support for the incompetent psychopath in two "elections":

"Enter President Bush's 2007 budget, which inexplicably proposes $36 billion in cuts to Medicare and Medicaid over the next five years, including more than $8 billion in reimbursements to hospitals. And this comes on the heels of the deficit reduction act, signed by the president in early February, which will already cut more than $13 billion from Medicare and Medicaid."

The article is basically about Bush's plan to help local communities hit by an outbreak of avian flu. It's a simple plan, really, elegant in its brevity and, indeed, wit.

"Sorry, there's nothing I can do for you."

I know what I will be doing if avian flu makes the jump and spreads to my little berg. I'll be sick myself, most likely, and as a health-care worker in a hospital already short of nurses, I'll be showing up to work anyway so I can spread the noxious germs around to patients who are already weak and vulnerable.

Patient "D" was in a skilled nursing facility getting months' worth of intravenous antibiotics, through a PICC line, to treat resistant strains of bugs that had grown fond of them. "D" had a long history of alcohol and drug abuse, hepatitis, HIV-AIDS, seizure disorder, and was oriented only to self. At one point they'd eloped from the skilled nursing facility and they were found out on the streets having a seizure. Then they came to us.

The PICC line was infected so they had to remove that for a while at least. Getting a peripheral line in wasn't so easy. They had the specialty nurse come up with their little IV ECHO machine to scope out a vein in the patients' shoulder, a delicate little 22-guage.

The patient would try to wander about aimlessly, or they would be in their room removing their clothing, telemetry wires, and urinating on the floor. Someone had given them a phone book, and the patient tore out pages, spread these on the floor, urinated on them, and then wadded these up into a wet ball and placed it by the door. It somehow belonged there.

On my day off, "D" was sent to get another PICC, and while in that department they got up off the stretcher and fell causing a laceration on their head.

A patient has to be restraint-free for twenty-four hours before most skilled nursing facilities will accept them, so we basically couldn't tie them down, or we'd never get them out of here.

The next day the patient was in my dutiful hands. I checked on them four or five times an hour but still couldn't keep up. Mid-afternoon I saw that they had pulled out their PICC line but there wasn't much blood on the floor so it couldn't have been out for long.

We got an order to place another PICC, and in the meantime I got a peripheral line into their wrist.

Before doing that I asked the charge nurse to help me by praying to The Great Buddha of Difficult IV Sticks, and I asked if she, presumably Catholic because of her country of origin, knew if there were any Catholic saints earmarked for prayer concerning IV insertions, and she laughed and told me she didn't really know, but to go with the Buddha.

So I did. It worked. Believe me. First time lucky.

The guy from the special department where they did the patient's PICC yesterday called. When I asked him how things were going, he said, and I quote, "I feel like I've been shot at and missed and shit at and hit," with a laugh.

"But seriously," he asked, "What are we doing? Putting another one in, just for them to pull out again?"

I let a semi-dramatic moment go by and then replied, "Well, yes. Duh." He said it wasn't the first time and wouldn't be the last.

Then I promised that we'd try to chemically restrain the patient, but I had been giving them a couple milligrams of Ativan every two hours or so all day long, which probably saved them from seizing on me but it didn't always ease up their general restlessness and bleary-eyed curiousity.

So Bush is proposing a budget that includes cuts to hospitals.

Guess what will soon start happening to people like "D"?

They will be triaged out.

They will be left on the streets or sent home to anyone and anything that will take them in. Or not.

It won't matter. And it probably won't really matter to a lot of our fellow red-state Americans. If they are forced to choose between serving uninsured "D" with their HIV, seizures, impaired mentation, alcoholism, and crystal addiction as opposed to say Their Own Sweet Dying Mother, then "D" gets the boot.

City services will come to include bring out your dead wagons.