Before and After

There was occasional yelling and screaming coming from one of the patient rooms near the first station. Whenever I strolled down to take a look-see things settled before I got there. It was Dani's post-op patient. I asked her if she needed any help with anything and she said "No. They just don't want to pay."

One of the hospital insurance-coverage specialists entered the room and a moment later the cursing and raised voices started up again. The rest of us went back to doing whatever...

I was getting a bite to eat when Dani came into the lounge to do the same. She explained that the woman just had a mitral valve replacement, but she was not a citizen and her family, which owned several restaurants, strip malls, and other commercial properties, did not carry health insurance.

They had assured the cardiac surgeons that they would pay cash for the procedure and it sure seemed as if this was not unaffordable for them, so she got her new valve.



Whenever she was approached by case management, administration, or even the surgeon, the patient would suddenly develop crushing chest pain, the family would have fits, and all hell broke loose. Dani said she just kept her head down and avoided the room as much as possible. But post-ops do need a little attention once in a while.

"So how's your bunch?" Dani asked me as I finished off an apple.

"OK," I said, "But I've got a patient with a tumor bursting out of her breast."

This woman had come in for a complaint of chest pain. She had infarcted, with a Troponin level several decimal points above normal, so she got stented. Along the way somebody took notice of a two-inch-diameter indurated hard brown raw sore on her breast.

It had been there for months but she was uninsured; a waitress when she was healthy enough to work. So she ignored it.

Thankfully her bone scan was negative.

"That's good," said Dani.

She had a cough though. That cough.

Lunch over.