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What a Mess
CDC has recommended to doctors across the country that any “non-emergency” health care is to be postponed. There are a lot of problems with this, of course, not the least of which is defining “non-emergency” in my line of work. Treating somebody’s blood pressure is not an emergency unless she strokes out tomorrow, in which case it apparently was an emergency after all. Oh, well. But anyway, I’m doing a lot of video-call medicine, which is the government’s idea of, um, I’m not sure what. But this is what we’re supposed to be doing. For now. Until they change their minds. Again.
I had an interesting video call with a patient of mine this morning. He’s a retired physician from New York City. Brilliant guy, but he can come across as abrasive and arrogant at times. I think it’s just his New York City mannerisms, coarse language, and his extremely frank approach to conversation which can be off-putting. I think he’s fundamentally a good person and he can be really funny if you can get past his gruff exterior. He’s also a very vocal and frequently hostile Democrat. He hates Republicans. But hey, he’s a wealthy New Yorker. What do you expect? And come to think of it, he hates lots of other people too. So whatever. He’s in his early 80s now and lives in an assisted living facility with his wife. I called him this morning because his recent labs showed some problems with his diabetes. He likes his gin and his ice cream, and glycemic control is a challenge for him. Particularly because he doesn’t listen to a gosh darn word his doctor says. Or his wife. Or anyone else.
The best I can remember from our video call:
Me: “Good morning Dr. Smith! Good to see you!”
Dr. Smith: “Good to be seen! You know what they say here in God’s waiting room – better to be seen than to be viewed! Ha!”
His wife Florence in the background somewhere: “Harold!”
Me: “Thanks for taking the time to talk with me, Dr. Smith. I just wanted to go over your recent labs here. Your glucose is a bit of a problem again, and I thought we could…”
Dr. Smith: “Hang on, let me put down my ice cream so I can take notes.”
Me: “Dr. Smith, it’s 8:15 in the morning.”
Dr. Smith: “Ha! I’m not eating ice cream! I just like pissing you off!”
Me: “So you’re not eating ice cream. And you’re not listening to me, either, are you?”
Dr. Smith: “Of course I am! Glucose! By the way, my daughter says hello!”
Me: “Um, ok, great. Ok, about your glucose…”
Dr. Smith: “She’s a nurse in a hospital outside of the city, and she’s been laid off, so she’s got lots of time to call and annoy her dear old Dad about meaningless $#!% like his glucose.”
Me: “Um…”
Dr. Smith: “She’s an orthopedic surgery nurse, and most of their elective knees and hips have been rescheduled, so she just sits around the house and thinks of ways to annoy me about…”
Florence: “Harold!”
Dr. Smith: “What’s bad is that her husband is a nurse anesthetist. Which I never understood. What the #$%& does he do all day, anesthetize nurses? Does he sneak around and hide propofol in donuts or something? I mean, what kind of #%$&…”
Florence: “Harold!”
Me: “Um, about your glucose…”
Dr. Smith: “I mean, if you want to be an anesthesiologist, go to $@#!ing medical school, right? What the…”
Florence: “Harold!”
Dr. Smith: “Anyway, what’s bad is that he’s been laid off, too, because they’ve rescheduled most of the vascular cases that he works on. So he…”
Me: “Are you even taking your insulin shots? Because your labs look like…”
Dr. Smith: “They’ve moved a big ship into New York Harbor to act as an overflow for the overcrowded hospitals. They’re supposedly refitting some of the closed schools into makeshift hospitals to handle overflow from overcrowded hospitals. They’re mobilizing the $#@%ing National Guard, now that they’re done shooting kids at Kent State, apparently. What a bunch of…”
Florence: “Harold!”
Me: “Look, I…”
Dr. Smith: “But they’re laying off all the #$%&ing nurses because the @#$%ing hospitals are empty because the #@$%ing politicians are %#&$ing around with…”
Florence: “HAROLD!!! Keep your voice down!”
Me: “And if you don’t keep your sugar down, you’re going to…”
Dr. Smith: “I mean, if this is a serious pandemic, why are they laying off nurses? Huh? How can you have a proper pandemic with empty hospitals?!? What a $#@%ing mess! It’s like Trump scheduled a plague and nobody showed up! I mean…”
Me: “Look, why don’t we…”
Dr. Smith: “And the doctors these days are even worse! They haven’t been laid off – they’re just not even bothering to show up! If there are so many sick people out there, why aren’t the doctors out there taking care of them? They’re all just sitting behind their computers doing video crap like they’re scared of some disease! Aren’t they supposed to be treating disease? What a bunch of panty-waists!”
Me: “Look, Dr. Smith, with utmost respect, why don’t you go #$@% yourself?”
Florence: “HAROLD!”
Dr. Smith: “See?!? That’s what I’m talking about! Where is that kind of spirit? When are today’s doctors going to stand up and take care of some sick people? Be a man! In my day, we wouldn’t have been hiding behind our computers and our charts!”
Me: “That’s because in your day, you had oil lamps and papyrus rolls, and you sent all your sick people to leper colonies.”
Dr. Smith: “#$%& you. I retired twelve years ago.”
Florence: “Harold!”
Me: “Look, we’re being told to do things like this. I don’t like it either. But I don’t see how…”
Dr. Smith: “Wait – hey that’s my daughter calling in. Gotta go. We’ll talk later.”
Me: “We?!? We’ll talk later? We haven’t even gotten to your diabetes yet! I haven’t said a #$%@ word since you’ve…”
Florence: “Harold, shouldn’t you…”
Me: “I thought you said all your daughter did was annoy you? Why are you…”
Dr. Smith: “Take it easy doc! I’ll get right on that sugar stuff. Great to talk to you! See you later.”
Me: “Right. Ok.”
This is a rough transcript of our call, partially because that entire conversation took about two and a half minutes – he talks really fast. Especially when he’s pissed off. Which he usually is, until he has enough gin and ice cream. And he never has enough.
But he’s really angry about how we’re handling this virus. To be fair, he’s generally really angry about all sorts of things. But in this case, he may have a point. Possibly for all the wrong reasons. But he may have a point. Hard to say.
I don’t know how far outside the city his daughter and son-in-law work, although he says they go to lots of Mets games (Another really classy Dr. Smith joke from a previous conversation: “Why do they call the hospital oncology ward Shea Stadium? Because that’s where the Mets win! Ha!”).
And I don’t know what the real situation is in NYC hospitals, and how much of this is a dad that’s just pissed off that his daughter and his apparently very patient son-in-law have been laid off.
But what he describes is similar to our situation in my area. Our hospital census is way, way down. And elective surgeries are one of the few things that hospitals actually make money on. They often lose money on each case of pneumonia or whatever, but they make it up with cardiac caths and hip replacements. I don’t understand how the hospitals are staying open, until I think about how much stimulus money is flowing down the streets of every city in the country right now.
But he probably has a point about all the elective surgeries. What happens when we start to reschedule all those elective knees, hips, carotids, aneurysms, and God knows what else? Some of those are typically booked a few weeks to a few months in advance. And then we don’t do any of them for three months. And then everybody wants all of them done at once. How is that going to work? In medicine, like in anything else, when you try to do too much, too fast, sometimes things go wrong.
My guess is that our rate of surgical complications will be unusually high for the second half of 2020. Blood clots, staph infections, pneumonias, and so on – many of which didn’t have to happen.
Of course, if they had been doing elective surgeries during this time, how many of those patients would have developed coronavirus? Probably some. Which would turn out worse? Hard to say.
Well, it’s hard for me to say. I suspect that Dr. Smith would declare which is worse, with absolute certainty. And maybe he’d be right. Hard to say.
But the longer we wait, the worse this is going to get.
I don’t envy whoever is planning all this.
Again, I don’t know how much of Dr. Smith’s tirade is correct, although I have no reason to doubt any of it, since I’m seeing the same thing here. But for once, he and I agree about something:
What a $#@%ing mess…
Published in General
My daughter is living in Manhattan. It’s a mess.
I don’t know how we get back to normal from this point. It will take at least two months just for people to get over their fear of hospitals and doctors’ offices as sources of disease.
And knowing that the virus will be back in November will give a lot of people looking at elective or nonemergency surgery a “Why bother?” attitude.
I suspect the medical care system will be slow to restart for many reasons.
I always thought “elective” surgery meant you wanted a smaller nose or bigger boobs. Apparently not.
I rely on 3 to 4 shots in my spine per year, just so that I can walk around without looking like the Tin Man deprived of oil. And without being in agony. That’s elective. Ooookay.
I’m hearing now, maybe July. That’s awesome. But I take surcease in the fact that this plan was generated by top men. Top. Men.
Dr. Smith is hilarious. He has the most boring name for someone who is not boring. The Shea Stadium joke is pretty good.
It sounds like you’re suggesting that hospitals will be ‘overwhelmed’ with elective surgeries from July to Dec which would be the ultimate irony.
It’s personal for me: our grandson has a hole in his left ear from when his tube fell out and the ear didn’t heal. He has zero hearing in that ear and the surgery to fix it was deferred – and not rescheduled – earlier this month. It’s been interfering with learning to read and other listening kinds of skills in 1st grade. He needs that ear, and I imagine a lot of other patients need their “thing” fixed too. For him it’s a day in outpatient and a couple of weeks out of the pool and off wrestling but it’s also hearing when he starts 2nd grade.
In places where many/most of the formerly private practices have been absorbed by large hospitals, this kind of help isn’t happening because… It’s the example I used when writing our governor to advocate for eliminating economic restrictions in our state. I also reminded him that our “curve” is as flat as a pancake so that justification for lockup is over.
I used “Smith” to provide anonymity. Not his real name.
I have a question: Is it really possible to disinfect hospitals at this point? Aren’t they going to be contaminated with this virus for a long time to come?
The main reason I wouldn’t have any surgery right now or in the foreseeable future is that I just can’t believe that I’d get out of there without pneumonia. I look around my house and try to imagine disinfecting it completely. It just doesn’t seem possible. A hospital filled with people and equipment seems seems impossible to disinfect too.
I am so dumb sometimes
update: I also realized the Mets don’t play in Shea Stadium anymore.
I am so sorry… I don’t understand the reason for deferring his surgery – it sounds serious and not elective – thoroughly illogical and inhumane. I thought the first rule of medicine was ‘do no harm’.
Why do you feel sorry for the people who are planning all this? Their jobs are not at stake. Whatever they do, they will have a job.
That’s a good one.
But I didn’t get the Mets joke.
Doctors refer to metastatic tumors as “mets.”
“The pt has lung cancer with brain mets.”
Or something like that.
You know, if I make it to my early 80s, I’m going to have pizza and beer for breakfast, lunch, and dinner. When you make it to that age, every meal is a celebration . . .
Dr. Bastiat, you should consider a career in writing if you ever get tired of this doctoring thing. That was hilarious! I would pay money to read stuff like that. Actually, I think I am………..I did fork over money to sign up for Ricochet.
You are on a roll lately – Keep them coming!!!
For breakfast I eat sugar-filled pastries or donuts and wash it down with soda pop or fruit juices, and a Reese’s Cup for dessert.
Well of course he hates people: He’s 80+, living in an assisted living facility which HAS to remind him his days are numbered, he’s probably well aware the vast majority of those alive are gonna outlive him even without WuFlu – and enjoy life while they do it – his friend the Dr. keeps calling to tell him to stop partaking of his two favorite things (gin & ice cream) or he’s going to die.
Well, duh! And worst of all, he lives in NY!
I think he should write murder mysteries solved by a doctor. Hey @drbastiat, I’m here if you need advice (over 4600 books sold on Amazon) . . .
I have heard that about 50% of hospital work is scheduled (non-emergency) work and those items are the most profitable. Without them, the business model is out of wack and costs need to be cut (layoffs). But, somebody needs the gloves, right? right!!?!
Don’t be too sure of that. When I turned 82, with the space of a few months, I developed allergies to three of my favorite foods — chocolate, pizza (cheese!) and peanuts. Fortunately, I still have beer and wine.
Enjoy them while you can (in moderation, of course).
Why do you think he writes on Ricochet :-)
I doubt it’s a coincidence
He can do both
How many times do hear about people going to the doctor thinking they have one thing only to find out they have something else? I guess if you have anything, act like it’s an emergency . . . “I hurt my back playing golf, pretty sure it’s a heart attack, or maybe a stroke. Can you get me in on Tuesday?”
My wife’s father was on hospice and even then my mother-in-law was nagging him about what he ate. At some point, just do what you want.
A law school classmate (40 years ago) did consume DingDongs and a diet Coke for breakfast every morning in the library.
I keep hearing of people who are blocked from medical care (to keep everything for Wuhan virus cases) or who choose not to seek medical care (for fear of Wuhan virus or because the Wuhan virus protection process makes seeking medical care so complicated and lonely). There are going to be in the near future a lot of medical complications due to medical care delayed.
I was at Target today, grabbing a few things (isopropyl alcohol AND hydrogen peroxide in stock? Yay!), and there was a lady at the pharmacy counter. Apparently, her dad (in his late 80s) needed his meds, and she needed her meds, and the doctor sent the prescriptions in, but she was having some minor complications.
The doctor won’t see her in person, so… she was trying to get the pharmacist to tell her what she should take, and could he give her a prescription “just in case.”
Riiiiight.
Needless to say, he wasn’t going for it.
Are we playing Clue?
And?
He was drinking Diet Coke, what more do you want?
I don’t understand preemptively canceling elective procedures at all. Why not just take it week to week or even day to day and cancel if the @#$& hits the fan? Why not do the ones you can do during the calm before the (alleged) storm?
I am in the same boat. My injection scheduled for last Monday got canceled the Friday before. I go to a dedicated orthopedic hospital too. As in NOT a general acute care hospital. There’s no ER attached. There’s nothing but scheduled orthopedic procedures. All canceled.