Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Playing a game of Russian roulette with his life

Sarah E. Smith, MD
Physician
May 13, 2014
77 Shares
Share
Tweet
Share

Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician.

“Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face.  Vitals stable. Sugar fine. Oriented but postictal.  Didn’t take his meds.”

Approximately my age, the backboarded man’s chin bears a ribbon of red laces.

“Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, and I begin a cursory neurologic exam.

“Hello, sir, I am Dr. Smith, the resident working in the ER today.  It seems you have had a seizure, has this happened before?”

“Yes,” he groans. “I didn’t take my meds.  How could I let this happen?”

He raises his hands to his face, pulling them away to reveal blood from the laceration sustained on his chin.

“I am going to lose my job,” he says. “I have to work!”

His eyes are earnest and desperate.  I think of my father.

“When were you diagnosed with epilepsy?” I ask him.  A primary seizure disorder in early adolescence.  I learn further that he is uninsured and cannot afford his medications.

When he takes his medications his illness is controlled.  He does not seize in his employer’s store room. His startled co-workers do not call 911. He is not delivered by ambulance to an emergency department where evaluation and treatment incurs a bill several magnitudes greater than the cost of his preventive medication.

He understands that he is playing a game of Russian roulette with his life every day he doesn’t take his medications, but the money isn’t there.

I irrigate and drape the wound on his chin and lean over him, suture in hand, to repair the injury.  I reflect on several months prior, when my mother called me to tell me my father was in the intensive care unit back home, hundreds of miles away.

“He wouldn’t stop seizing.”

I was sick to my stomach as I arranged an emergent flight home.  I arrived at the hospital after the excruciatingly long trip and rushed to my father’s room to find him intubated and receiving a propofol infusion.

Two days later he was delirious, begging my younger brother and I to remove the restraints holding him to the bed.

Three days later he was ambulating slowly down the hall.  In a week he was in a skilled nursing facility, working with therapists to learn compensatory mechanisms for the memory deficits incurred.

Then the bills arrived.  My parents, with insurance that many would consider excellent, were still charged several thousands of dollars.  The focus on my father’s recovery was undermined by anxiety.  The retirement planning that had been underway was deferred — they both would need to work for a while longer.

I tied the last suture on the young patient in front of me and removed the drape.  He was suitable for discharge.  I arranged his prescriptions and set up an appointment in my clinic for follow-up.

“I will be there,” he said, absentmindedly tucking the paper into his pocket.

I surprised myself with the cynicism I felt in response.  I am far too young in my training to have my idealism threatened, but the system — as it is — fosters skepticism.

I want my patients to be able to afford the evaluations and treatments that will prevent undue physical, emotional, and financial morbidity.  I am about to embark on my career in primary care and will work earnestly to provide preventive and affordable care — work I hope our health care infrastructure will allow.

Sarah E. Smith is an internal medicine-pediatrics physician. 

costs_of_care_logo_small

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

Prev

How to stop losing primary care physicians to burnout

May 13, 2014 Kevin 78
…
Next

The covenant between physician and society is being broken

May 14, 2014 Kevin 20
…

Tagged as: Emergency Medicine, Neurology

Post navigation

< Previous Post
How to stop losing primary care physicians to burnout
Next Post >
The covenant between physician and society is being broken

More in Physician

  • Do residents deserve the title of physician?

    Anonymous
  • When an MBA degree meets medicine: an eye-opening experience

    Arthur Lazarus, MD, MBA
  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech
    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Healing the Damaged Nurse-Physician Dynamic
  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech
    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Playing a game of Russian roulette with his life
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...