Gall Bladder Emergency;

about a month ago a woman entered the clinic jaundiced and feverish. no abdominal pain, no vomiting. her vital signs were normal so we felt safe to order some lab tests and figure out what was going on. we did the usual liver and hepatitis tests. the results were very concerning for gall bladder disease. the patient was still relatively asymptomatic so we continued with an outpatient workup, ordered an ultrasound and results showed a markedly diseased gall bladder with a dilated common bile duct (indicating a stone stuck in the duct system). Even though she was still relatively asymptomatic, the reality of her labs and ultrasound demanded an immediate surgical consult.

at this point my stomach always lurches a bit because the usual reality is anything but pretty for uninsured patients, especially undocumented immigrants.

i called the publid hospital, and for those who have read my posts before, guess what the response was.

WE'd LOVE TO HELP, SOUNDS LIKE SHE NEEDS SURGERY BUT WE HAVE NO BEDS.

Okay. Texas is a big rich state, perhaps i will start sending my patients there... Another idea that crossed my mind was to buy her a ticket to Canada. Years ago i had a roommate who was doing a musical tour in Canada. He was in a car wreck, not too bad, but was brought to an ER and evaluated with x-ray and CT scans. On the way out the door he tried to pay and the doctor said, "don't sweat it, we have national health insurance here, it's basically paid for, there is no bill for you."

check out this irony. another roommate at the time was Canadian. she was here in the USA as a student. she got sick, abdominal pain, and wound up in the ER at our local public hospital. everyone assured her there would be no cost to her, she was savvy enough to ask before being seen. after a few weeks the bills started arriving and she had to pay $800 for the visit. guess how mucha round trip ticket to Canada is. under $800. she could have flown home, gotten free healthcare in Canada and taken two weeks of vacation and come out about even.

okay, so it might be difficult to put a very sick undocumented immigrant on a plane to Canada. i assume it breaks alot of governmental laws, even though it honors human rights and the laws of ecnomics and free trade, but that's another story.

so lately i've been offering the option to my patients to go to other hospitals in albuquerque, names Presbyterian, which is the only other non-profit hospital in town. they have been known to disocunt bills significantly for working poor uninsured patients.

i called the surgeon at Pres and was treated a rare medical miracle. The surgeon was amazing on the phone. respectful, thoughtful, supportive and eager to see the patient. Most times docs ask the insurance status of the patient. She didn't. when i offered to her the social and financial issues, she shrugged her shoulders and said to send the patient right over.

the hospitalization turned out to be fairly complex with a 9 hour surgery. while the patient didn't look sick by her symptoms, she was actually on death's doorstep. this surgeon saved the patients life. i have already written a letter of gratitude to the surgeon because i was so touched by her compassion and perspective and desire to help someone who needed help.

while the patient is also super appreciative, and has already started to pay her bill, the total came to about $50,000. gulp. out of the frying pan, into debtors prison. perhaps Canada wouldn't be such a bad place after all for this patient and her entire family... Pres is a non profit and offers some discounts so my volunteers are helping her fill out the paper work. we'll keep you posted.

andru