The
Rational Argumentator
Setback! Further Adventures in a Teaching Hospital
“So Mr. d’Acier, you remember we told you that after your surgery you’d taking warfarin, a blood thinner, to avoid clotting?” I had just awakened, and Karolina, my favorite morning shift nurse, had entered my room.
“Yes, I do.”
“Well, it worked. In fact, it worked too well. It appears you are overly sensitive to it, and we can’t release you today as planned. You’ll have to stay until your PT/INR returns to safe levels. As things stand now, you’re too susceptible to uncontrolled bleeding.”
I wasn’t sure what a PT/INR was, but this was a disappointing turn of events. The sole consolation was that, as it was explained to me, my blood was currently identical to that of Crown Prince Alexey. In my half-asleep, half-drugged state, I began imagining their might be ways in which I might try to parlay this into a claim on the Russian Imperial Throne, but a cup of black coffee led me to abandon that notion.
Thanks to the accident with the SOC HLTH 101 school bus returning to campus, Boomer and Derek had been regular visitors in my room, as had numerous other students. Amy, the girl who had tweaked my nose, often wheeled herself down the hall for a visit. “I just can’t believe it, I’m a patient myself,” she kept repeating incredulously.
Boomer and Derek seemed to take it in stride. Boomer was already quite familiar with crutches from his high school football days, and Derek took readily to his walker. They were young and would heal fast. We were all somewhat amused that Professor Smudgeon had elected to spend a small portion of his multimillion-dollar family inheritance to isolate himself in an expensive and exclusive private sanitarium. On the other hand, he was the worst-injured and was in a full body cast, so perhaps it was understandable he wanted to remove himself from the presence of mere commoners.
Karolina was very supportive of all of us, and when we’d gather in my room she’d bring us cold drinks, and we’d sit and shoot the breeze. I would explain how rising health care expenditures stem from increased use of technology, the status of health care with high income elasticity of demand, and government interference in markets. Of these, the first two could not sensibly be called problems, since the additional dollars spent result in even greater benefits. But the third cause, of course, is certainly a problem. The Keefauver-Harris amendments alone may have increased pharmaceutical prices by 700%, and killed millions of Americans as well.
For their part, the students told me about their classes, their lives, their homes and families, their dreams for the future. It was interesting stuff. It did not fully make up for my extra days in the hospital, but I was making the best of it.
One bright morning I lay propped up in bed, talking to Amy in her wheelchair. “And so as I see it, by cutting the discount rate another half point, Bernanke showed he doesn’t understand the situation at all. Loose monetary policy was the problem in the first place, and more of it will do nothing to liquidate the malinvestments of the asset bubble. And his comment about core inflation being softened by weakness in fashionwear and mortgage services only confirms his disconnect.” Amy nodded, although it wasn’t clear she was actually listening.
Boomer and Derek hobbled breathlessly into the room. “They won’t let Derek leave! He’s a prisoner!”
“Derek, too? What’s the problem, thin blood, like me?”
“No,” replied Derek. The discharge nurse says I cannot leave because I’m going home to Idaho. She says it’s impossible, and I have to stay.”
The semester had ended, so the students were excused from finals, and were simply to be sent home once discharged. Most lived in-state, but not all. Boomer and Derek seemed upset about what they’d just heard, but couldn’t give a clear account of it. “Look guys, that doesn’t make sense. I think you’ve simply misunderstood. Here, how about if I go talk to Nurse Klebb for you and get this straightened out.” Rosa Klebb was the discharge nurse, and spent most of her time in front of a computer at the nurses’ station down the hall. Mounted on my trusty walker, with Boomer, Derek, and Amy in tow, I shuffled off to the nurses’ station.
We found Nurse Klebb at her computer, reading a Wikipedia page on gangrene. “Yuk,” she said, and shuddered.
“Hello, Nurse Klebb,” I smiled. “I hope you are well this morning. I came down here with my friend Derek, just wanted to make sure he understands his situation. “
“Patient confidentiality prevents me from discussing any patient’s case without explicit consent.”
“I consent. You can tell him anything,” Derek blurted.
“Explicit written consent.”
“Oh cripes.” Dutch peeled a post-it note from the desk, scrawled out a consent, and handed it to her.
She stared at me. “Now you’ll have to provide me some form of official photo ID to verify that you are indeed the person described on this form.”
“Oh for pete’s sake, Nurse Klebb. You know who I am. And I was told not to store any valuables, including IDs, in my hospital room. Here, look at my hospital bracelet, that will be enough.” I glared at her with as much authority as I could muster.
She glared back over her heavy plastic framed glasses. Her henna-tinted gray-streaked hair quivered, but she began “Well, all right then. Here’s the situation. We can only release a patient if we know he has a primary care physician for followup. And so, because Mr. Jones wishes to travel to Idaho, I cannot release him.”
“What? Why not?”
“Because it is Idaho. It is another state. They have different medcial licenses than we do.”
“So what?”
“So I cannot order a doctor in Idaho to do anything.”
I was pretty sure Nurse Klebb couldn’t order a doctor anywhere to do anything. “What orders? What are you talking about?”
“What I mean is, I simply cannot call a doctor in another state.”
“Why not?” I wondered if she realized they have phones in Idaho.
“Because it is a different state. It’s a different medical system. They have different licenses. And therefore Mr. Jones cannot be discharged, since we cannot assure proper post-hospitalization care.”
“So you mean to say that simply because state lines are involved, you can’t send medical records, discharge recommendations, and can’t call to see how it might be arranged?
“If you wish to put it that way. I mean, it is another state.”
“I see,” I snorted, not seeing at all. I spun smartly on my walker and returned to my room, Boomer, Derek, and Amy following. Karolina was there with Esmerelda, the cheery aide, changing my bed linens. As I hobbled into my bed, I told them the story. Esmerelda rolled her eyes. Karolina laughed a little and shook her head.
“I’m sorry. You know, this is really a very good hospital. We provide world class health care. But bureaucrats anywhere are always bureaucrats. And the only thing they are good at is creating bureaucracy. But I guess you know what to do.”
“Yes, I do.” I handed Derek my cell phone. “Call your parents in Idaho. Have them call your doctor, give him Nurse Klebb’s number, and have him call and read her the riot act.”
Twenty minutes later, Nurse Klebb arrived at my door. “They said I’d find Derek Smith here?” Derek waved from his chair. “Mr. Smith, it was very difficult, but I’ve managed to arrange for your discharge. You’ll be ready to leave, once we’ve completed the necessary paperwork.” She smiled unconvincingly at us all, and then turned and left.
“Tough luck, Derek,” smirked Boomer. “’Necessary paperwork.’ You may be here for a very long time.”
James d’Acier is an economist and writer who currently lives in the Midwest. He recently underwent surgery in a major university teaching hospital, and wrote this story while hospitalized. He assures us that while his discharge was indeed briefly delayed by overthinned blood, and he did meet a “Nurse Klebb” who claimed he could not be discharged for the reasons given here, this is purely a work of fiction.
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