No More Empty Fortune Cookies!

Wednesday, April 30, 2008

Calling Dr. Fortune Cookies

I have a friend, we'll call her Snappy. Snappy was raised in the oh so affluent side of town. She went to the best of the best schools and drove a Mercedes when she was 16. Her daddy is a renowned neurologist at one of the leading teaching hospitals that happens to be located here, in Nashville, and her mother is a very successful interior designer with her own business in that already mentioned affluent side of town. If you ever watch The Real Housewives on Bravo, you'll have an idea of the type of family Snappy comes from. Snappy should have been an architect. She certainly has the intelligence and talent. She went to school in St.Louis to fulfill that dream, but due to her severe bipolar disorder and symptoms associated with it, she eventually came back to Nashville, abandoning hope of ever finishing school. Eventually, Snappy's symptoms escalated to a debilitating level in which she was unable to maintain any form of gainful employment, and now, she is just one of so many Americans, living off of Social Security/Disability Income, which, if you don't already know, is actually less than minimum wage. Snappy has it better than most, though, because she has her parents who really look out for her and help her out, and she knows that. I say all of this to set the stage for what I want to truly discuss about Snappy.

Three years ago, Snappy came to me with a sore under her arm. She said it had started as a pimple, but was not healing. She often comes to me with her "medical questions" since I have a background in nursing. I took a look, and, concerned about infection, asked Snappy if she had shown her Dr. this lesion. She assured me she would show her dermatologist next week. Next week she went to the dermatologist that her medicare allowed her to see, and he treated her armpit for cystic acne, injecting it with steroids. Months went by and the sore grew, the dermatologist continued on the same course of treatment, occasionally prescribing an antibiotic. Sometimes the sore would get a little bit better, but usually, it just stayed an open sore. Snappy, being who she is, would not ask her father to look at it. Would not even talk to him about it. After a few months, I told Snappy, I am afraid that this is a staph infection, and you need to be treated with IV antibiotics, has the dermatologist tested you for staph? "No," she replied. "They just inject me with cortisone and give me a Z-pack." "Well, I want you to ask them to test you for staph" I told her. That was two and a half years ago. My memory is a bit lame, but to the best of my memory, at that point, the dermatologist's response was that her insurance would not cover the cost of a staph test without reason to suspect staph and that they did not feel it needed to be tested, it was cystic acne, case closed.

This scenario played out for the course of three years. Snappy going on multiple antibiotics, none ridding her of this sore, which became a festering, open, oozing, nasty thing under her arm. And the dermatologist never testing her. Meanwhile, there have been numerous reports on the news over the past couple of years about the MRSA ( Methicillin-resistant Staphylococcus aureus ) outbreaks across the state of Tennessee.I advised Snappy to please go to a new doctor, but getting her insurance to approve of that has been a jumping through hoops task that she has not been able to follow through with.

Two weeks ago, Snappy went on vacation to her parents beach house in Florida. While there, she became ill. She knew her arm sore was most likely the source of the ailment, and the warning of staph infection rang once again in her head. She had been to the dermatologist the week prior to going to Florida, and he had continued with the same course of treatment as has been standard since he began treating it, but she knew she needed to see someone else. Snappy finally went to a different doctor. Maybe it was being in a different state that gave her the courage, or maybe it was just the necessity, who knows, who cares. The clinic that saw Snappy that day took one look and said this is staph, tested it, and yes, it indeed was staph. They started her on a course of IV antibiotics and within days, Snappy's three year infectious sore was healed. They sent her home with a pamphlet on Staph, the Super-bug. And asked her to take it to the dermatologist that had been treating her. They asked her to make the delivery of the pamphlet the last visit to him. Staph can kill you, and the only reason, I think, that it didn't kill Snappy, is because she was on just enough antibiotics to keep it from becoming a systemic infection or from spreading to a vital place like a lymph node or the heart or brain.

Snappy was looked at as an under-insured, low income, mentally ill person with limited funds. She was not given the same treatment she would have received if she had, say, my insurance and my job, the ability to speak up for herself and demand proper testing. Not to mention the foresight to say "Hey, dad, can you look at this for me? My doctor doesn't seem to be listening to my complaints." But that's a whooooole different issue. Sometimes, even when we don't want to be a "burdeon" on those we love, we need to speak up.

In my opinion, Snappy became a prime example of classicism. A saddening display, especially since it was exhibited by the medical community, those who are supposed to be sworn to heal. Snappy saw doctors, nurses, nurse practitioners alike at this office. None of which spoke up to her and said this isn't healing, lets try another course of treatment. And why is that? I'll tell you why, because her insurance would not pay for another, more costly course of treatment. But truth be known, Snappy's parents would have happily shelled out the bucks to cover any tests, medications, and treatments necessary that insurance may have declined to pay for. Only, Mr.Dermatology didn't even stop to ask, he only assumed.
I am infuriated for Snappy. I am appaled for Snappy, and I am disgusted with the health care system in general, because of cases, like Snappy's, and others, who aren't as lucky as her.
Snappy doesn't realize how lucky she is, but I certainly do.

6 cookies cracked:

Jay said...

Snappy's actually one of the lucky ones. Most people in her situation would have died and the doctor would have just shrugged his shoulders and said "oh, well that's too bad" and gone on.

Tink said...

And all these people talk about how horrible universal health care is. I think those people have ever been on Snappy's side of the spectrum. It's disturbing.

gr said...


Fortune Cookies said...

Jay, yes, she certainly is a lucky one. Some doctors wouldn't have given the patient a second thought or the effort of a shoulder shrug. But I guarantee that if they knew who her dad is, she'd of been treated and healed within days of first complaining.
I'm not saying it's right, just that's the way it is.

Tink, I think that the people who are afraid of universal health care are afraid that everyone will soon be treated like Snappy if it were to come to pass, not realizing that with the govt. putting real and effective limitations on the prices of health care, there would be no more inability to pay for treatment due to inflated prices, which in turn would create a position in which medical professionals could concentrate more on healing, and less on what the insurance company will cover. This is one of the main reasons I became so disenchanted with the health care system when I was a nurse.

you can say that again!

Reb said...

In spite of what the Insurance will or will not pay for, is there no Medical board that this Dermatologist can be reported too! That is outrageous! Of course, in Canada we have a different system for which I am extremely grateful, more so now!

Fortune Cookies said...

reb- yes, there are medical boards. Snappy would have to report it, she would have to be willing to commit herself to saying "I deserve to be treated better." and part of her illness is that she does not bring herself to that realization very ofter, if ever. If she would tell her parents, you better believe there would be some consequences for the dermatologist in question, but that is something that she will probably remain quiet about, not wanting to be a bother more so than she already feels she has been.