100 Words a Minute Tuesday, Jan 19 2010 

I met with a young  woman who had questions about insurance. Four months ago she started feeling a little dizzy and her ability to think clearly slowed down. This worried her because she was a part-time, but mostly unemployed computer consultant whose job was to fix complex problems for corporate clients. She proudly confided she typed 100 hundred words a minute with 98 percent accuracy. The morning she couldn’t type 20 words in two was the day she knew something was terribly wrong. She couldn’t get words out of her mouth. Her husband commented, “Honey, the left side of your face is drooping.” They rushed to the nearest emergency room. The doctors thought she was having a transient ischemic attack (TIA), but weren’t sure because she was so young, exceedingly healthy, didn’t smoke or drink and wasn’t overweight. The ER docs needed to do a CAT scan. She was asked if she had insurance. That would be no. My patient was then informed the charge for the scan would be about $3000. The urgent, potentially life saving CAT scan was politely refused. 

At home the couple did an exhaustive computer search for the cheapest CAT scan. They did exactly as some health care reformers had advised: shop around for the best health care deal. For gods sake go to the website “Price Grabber” and compare prices. They might even have a coupon. Come on! Get a deal on that brain scan! Why pay more? No matter the arteries in your brain might be about to blow or bleed out, or you may lose the ability to use half of your body – find the least expensive CAT scan in the metro Chicago area. Don’t contribute to the high cost of health care in this country. 

The woman’s husband drove her to the County ER a few days later. You see –  there is no affordable CAT scan for the uninsured.

The patient said with gratitude in her voice: “I came to County because I knew they would take care of me.”

I hear these exact words consistently from my uninsured patients: “I came to County because I knew they would take care of me.”

This story has a happy ending. The patient suffered minimal, short-term effects from the TIA and the delay in care, and is on her way back to typing 100 words a minute.

Blue Line Sunday, Jan 10 2010 

It never ceases to amaze me what patients risk to get to County for health care because they’re uninsured and don’t want to incur thousands of dollars in medical bills. The emergency response system works this way: An ambulance by law must take a patient to the closest ER. No exceptions. But that doesn’t work for people who are uninsured and County isn’t the closest ER. So they argue with 911 operators and plead to be taken to County. When the ambulance arrives they beg the EMT’s to take them to County. They refuse to get in the ambulance if it won’t take them to County. An ambulance ride is safe and quick but to avoid medical bankruptcy some choose to drive or take public transportation which is dangerous because care is delayed.

My middle-aged, uninsured patient with diabetic retinopathy and peripheral neuropathies lived far away. He was legally blind. In an emergency he would never be brought to County but instead to the hospital a few short blocks from his home.  He started experiencing stroke symptoms and told his wife. They didn’t even bother to call an ambulance. They jumped on a bus that dropped them at the Blue Line train and came to County. That took almost 2 hours. The patient waited in the ER for 5 more hours until doctors diagnosed him. 

There is a golden window for stroke patients: 3 hours. If they get to the ER within that window and receive a powerful clot busting drug called T-PA (Activase), the chances are good they’ll survive with little to no deficits in brain function. Doctors can even insert the drug directly into the affected artery which is even more effective.

3 hours and the window closes. 7 hours, SOL, shit-outta-luck. The doctors told the patient he would probably suffer residual disabilities from the stroke. And he did. According to his wife his memory was now poor, he was often confused, and he had more falls. The man could never be left alone.     

Over 300 patients are seen every day in the County ER. That’s 10,000 patients a month.

There are over 1 million people uninsured in Cook County.

Add it up: Blue Line, stroke, uninsured, overcrowded ER, 7 hours.  

7 hours too late.