its hard to stay healthy...

The health care reform movement appears to be stalling, choking on the unfortunately, partisan politics of Washington. And even as we debate the merits of providing millions of Americans with some basal level of healthcare coverage, another busy night in a crowded urban ER passes. Yesterday, as wait times soared, patients became increasingly restless. We announced that we were working as hard as we could to deal with the heavy volumes but that bought us little sympathy. I went out to the waiting room to try and see a few people that already had studies done. I called on a young man with abdominal pain, rectal bleeding, and hematemesis (vomiting blood), who had already had his bloodwork resulted. He had completely normal labs. I sat him in a triage bay, pulled a curtain, and said, Mr. C, "things look great!" He looked perplexed, but undetermined, I talked through his confusion. I had brought a copy of his labs and explained that his blood counts, kidney function, liver function, and all of his electrolytes were within normal limits. All I needed to do was a rectal exam to ensure that he did not, in fact, have active rectal bleeding. He asked about waiting to be seen in a proper room. I carefully drew the curtain back and pointed to a waiting room spilling over with patients. I didn't have to say another word. He bent over, dropped his shorts, and we proceeded. Sure enough, brown stool that had no occult blood. A few minutes later, with a prescription and a work note, he was on his way... Another life saved.

The night wore on without excitement. A nervous, young girl whose arm had fallen out of it's socket (shoulder dislocation). A paraplegic with a finger abscess (paronychia). A few elderly women, whose meager fixed-income diets of bread and canned soup had led to intractable cases of severe constipation (obstipation). Before I knew it, the night was over. On my way home, i listened intently to NPR as a primary care doctor who was being interviewed made a remarkably salient statement. "We don't have a healthcare system... We have a sick care system." How wonderfully succinct and to the point. Modern medicine really has evolved into an organized, parasitic field predominantly feeding off the disease and disability of the human body. After all, there is so little incentive in staying healthy. No colonoscopies or CAT scans. No MRIs. No dialysis or coronary artery bypass grafting. No chemotherapy. No cartloads of pharmaceuticals. No paid time off. No disability benefits. In a capitalistic society, there is no money in staying healthy... Instead, we continue to overeat, exercise less, work more, and drive our bodies to exhaustion. As our bodies crumble under the unfortunate rigors of our lives, we find ourselves weighing the purchase of our monthly pharmaceuticals against the purchase of fresh local, organic produce or renewable energies. And all the while, we become obsessed at a younger and younger age with cycles of disease and treatment. A 24 YO woman with recurrent miscarriages presented with vaginal bleeding. She was in the produce isle of the supermarket and began "gushing" blood. She was emotional and through tears streaming down her face, she mumbled "I saw bloody baby...i saw baby parts. an arm. a leg." Over and over during the course of her evaluation, she remained convinced of another miscarriage. After a thorough evaluation, I found that in fact, she had a health baby and that she had not miscarried. As I went through her medical history I asked, "Do you have any medical problems?" She replied with a list of a dozen including everything from arthritis and attention-deficit disorder to fibromyalgia. She read the incredulous look on my face and offered up, "i know its a lot, but it's hard to know which ones are real..." More confused, I had to ask, "i'm sorry? But what do you mean, which ones are real. Did you see a doctor for these issues?" She beamed like a scout with a new merit badge and stated, "I saw several doctors. Eventually, they told me that my mom had Munchausen's by proxy, so its hard to know..."