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What If You’re Having A Heart Attack? - The Watchtower of Destruction: The Ferrett's Journal
December 26th, 2013
09:03 am

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What If You’re Having A Heart Attack?

On Christmas Eve, I took the dogses for a walk around the block.  Precisely halfway around, I got sharp icy pains in my chest.

When you had a triple-bypass earlier that year, that’s a cause for sheer terror.

I wasn’t quite sure what to do, as the icy pain was not entirely unfamiliar.  The cardiac rehab folks had informed me that my lungs had likely collapsed during surgery, and the nerves that controlled reinflation had been slightly damaged.  Plus, the beta blocker I’m on has a known side effect of shortness of breath; they cannot give it to patients with emphysema.  As a result, any time I’ve walked outside in cold air, I’ve had icy pain and an instant asthma attack.

Maybe this was an asthma attack.

But this was bad.

But it was very cold.

I got back to the house, and of course the immediate snap-call is “GO TO THE EMERGENCY ROOM.”  Right?  Well, except that if you’re a heart patient and you complain of chest pains, you get kept in the hospital for two days while they monitor you.  And if it turns out to be wrong, well, we just finished paying off $5,000 in ER charges from a false alert earlier.  And I have no sick days left at work thanks to two and a half months of sick leave.

If I’m wrong about what’s happening, we fuck our finances and my job security.

If I’m right about what’s happening, I’m dead.

That’s one hell of a tense discussion to have, but it needs to be had – that balance between “What you should do” and “What you can afford to do.”  And if you’re a heart patient, you deal with chest pains all the time – every time you have gas or an ache in your arm, you wonder, is that the end?  And you catalog that pain against the pain of the one time you had a for-real heart attack and try to determine if it’s the same thing.

Of course you should go to the ER.

Of course you don’t have $5,000 sitting around every time you have pain.

And you panic, which doesn’t help, so you’re sitting there thinking, “My heart is beating so fast,” which of course it is, you idiot, you’re terrified something really bad is happening, and your wife gets you a warm cloth to breathe through so your lungs warm up a little, chiding you gently that you should have worn a scarf, which of course you should have but in 44 years you’ve never needed a scarf, it’s a habit you need to develop before walking outside, but you had all summer to feel like you’re a healthy human being which of course you’re not.

And she gets you an Ativan, which is in itself a danger because what if you feel so good that you overlook The Big One, and you both agree that you will lie down for fifteen minutes with your wife cuddling you and if the pain subsides then it’s probably not worth $5,000 just to verify.

And I have decent insurance, mind you.  It’s just that they run an awful lot of tests on you, if you complain about this sort of thing.  They don’t fuck around.  And the bill has to go somewhere.

And after a half an hour, we decide that it’s probably just the cold, and sure enough when we go to church the next day on Christmas morning, it’s fifteen degrees out and the same icy pain manifests in my chest when I step outside.  That’s a new kind of pain.  That’s the asthma pain.  I’ll have to ask the cardiac rehab folks about that on Friday.

This is what I think of when people talk about “the health care system works!” and I want to punch them.  Yes, I have access to the BEST CARE IN THE WORLD.  Literally.  The Cleveland Clinic is world-class, and the surgeon I got was one of the masters at bypasses.

But I have to pay for it.

And I’m well-off, man.  We’re both professionals in this house.  We’re not rich, but with a lawyer and a computer programmer at the helm of La Casa McJuddMetz, we’re above the curve… and we balk at making decisions that could cost us our lives because the bills are a lot.  I have a good job that is understanding of massive problems, who were pretty wonderful about not just giving me time off to recuperate but then let me go to Hawaii.  (Admittedly, the Hawaii trip had been planned well in advance, but still.)

And I wonder what it’s like for the guy with the $10 an hour job down at the loading dock, or the minimum-wage clerk at 7-11.  People with employers who see them as slots to fill.  There are people in America who are dying because they have to choose between “Is this pain serious enough to risk getting fired?” and that is a real risk.

Obamacare is a step in some better direction – maybe not the best, but certainly better than the current Republican solutions of, “Well, preexisting conditions and medical bankruptcies aren’t that big a problem.”  Yet it’s still too small.  The bills still pile up.  The jobs can still fire you if you’re too inconveniently sick.  And when you have no job, those bills snowball.

I want socialized medicine because I’m one of the supposedly privileged class, and I have to balance risk versus expense.  I made it; no worries, I’m fine.  But somewhere, there’s a guy who has less ability to pay those bills, and a suckier job, and a real heart attack.  And he just died because he made a judgment call that he had to make, and it didn’t quite work out.

That guy deserved to live.  Call me a dreamer, but in a country like America with all of our wealth and know-how, I think we should be able to find a way to help that guy.  The Republicans keep telling me that guy is the salt of the earth, the kind of real American who keeps us going, the laborer who works twelve-hour days and never asks for help.

I agree.

I think he deserves better choices.

Cross-posted from Ferrett's Real Blog.

This entry has also been posted at http://theferrett.dreamwidth.org/363867.html. You can comment here, or comment there; makes no never-mind by me.

(52 shouts of denial | Tell me I'm full of it)

Comments
 
From:anonymousalex
Date:December 26th, 2013 02:13 pm (UTC)
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So glad you're okay, and without disagreeing with you on principle, I do have a question/quibble: Doesn't your insurance have a maximum out-of-pocket amount per year? I know mine did (back in 2009, the last time I even got close to my annual deductible), and it meant that once you've paid for the first $5,000 trip to the E.R., you're done--the next trip is, to you, free. Provided it happens this week and not next week, of course.

-Alex
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From:theferrett
Date:December 26th, 2013 02:20 pm (UTC)
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A quibble people will notoriously make, and my point is that it doesn't matter.

My point is that I go through this "How bad is this pain?" judgment call on a regular basis, and I'll be in the ER for at least a day afterwards if not two while they diligently monitor my vitals... and if I keep calling out sick like this every time, I will eventually lose the insurance.

So even if it's free, it's not free.
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From:anda
Date:December 26th, 2013 09:05 pm (UTC)
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Micro-quibble with the quibble - in some cases that is counted by policy year rather than calendar year.

For too many people, though, that amount is high enough that they can't afford that first trip, and thus with the dying ... or, more often, the long-term suffering of things which could be relatively readily solved/treated if only they could scrape up that first several thousand bucks. :(

If I win the lottery, several friends are getting an email of "what's your yearly out-of-pocket for the doctor" followed by a check.
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From:cakmpls
Date:December 26th, 2013 02:19 pm (UTC)
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Well said.
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From:ecosopher
Date:December 26th, 2013 03:02 pm (UTC)
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I'm really glad it wasn't a heart attack! Yay for being alive!!

There is no logic to the healthcare debate. One method of arguing against universal healthcare, I recall, was to point out the failings of universal healthcare systems in other countries. My answer to that is: 'Some of your facilities are the best in the world. People from other countries travel to the US, to be seen by medical professionals who can work miracles with technology which is simply not available to them in their own countires. You can provide healthcare which is second to none, so you're telling me, you can't do better than the NHS? DO BETTER. You're supposed to be the greatest country in the world. Create the greatest healthcare then. Show us how it's done, please! Because we're not saying that we're perfect. But what we have is better than what you have, both before Obamacare, and now. And simply bitching about how 'socialised medicine' is 'taking away choices' is fucking bullshit.'

Ahem. I *may* feel rather strongly on this issue.
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From:wolflady26
Date:December 26th, 2013 05:36 pm (UTC)
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It makes me so angry when people compare to the rumors they've heard about other countries' healthcare. I heard some pundit on a talk show slam France's healthcare, which WHO rates as the best in the world. I have healthcare in Germany, which is more than fantastic. I rarely ever have to wait for a doctor's appointment, far less often than I did with American health insurance. It's ignorant and aggravating to assume that universal healthcare can't be done well.
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From:driocanthe
Date:December 26th, 2013 04:43 pm (UTC)
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I'd like to tattoo this inside the eyelids of a few politicians...
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From:anais_pf
Date:December 26th, 2013 05:36 pm (UTC)
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Scary. Very scary.

Back in the olden days, this sort of situation was one where my parents would call our doctor and ask what they should do. The default was not "go to the emergency room." The doctor would ask some questions, make some suggestions, and advise on what to do if certain things happened. It strikes me that I never hear about anyone calling their doctor anymore. Maybe doctors aren't receptive to that? But that's a question you should ask your doctors: can you call them (or whoever is on call for them) in a situation like this one?
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From:libco
Date:December 26th, 2013 09:09 pm (UTC)
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Doctors usually default to if its bad enough for you to call them, go to the ER.
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From:naamah_darling
Date:December 27th, 2013 12:39 am (UTC)
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Well, first, it helps to have a doctor. One who knows you and has access to your file. Poor people can bounce from clinic to clinic, hardly seeing the same person twice. Without a rapport between a doctor and patient, it's hard to have trust on either side. For someone like me who has suffered physical and psychological abuse at the hands of the medical establishment, being tossed from person to person is deeply inhumane.

Second, no, you can't just call your doctor. I've only JUST found a doctor whose assistant I can reach same day. I'm 36. Previously, I sometimes had to wait for days, calling back twice a day to remind people. Because until recently I had to go to poor people clinics where turnover is high, care is cheap and impersonal and predicated upon the least possible treatment for the most treatable symptom, and actual care doesn't happen unless I fight very, very hard for it. Even now at a GOOD clinic, I don't have my doctor's personal number. All I have is the clinic number. I read about people who call or email their doctor personally, and I'm just like . . . what world do they live in? There were times when my doctor moved clinic and even though they are SUPPOSED to send you notification, they don't, so I had to wait months to have him crop up again, seeing people who didn't know or trust me.

Basically, it sucks and everything is broken.
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From:vvvexation
Date:December 27th, 2013 04:25 am (UTC)
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Some years ago, my doctor's clinic stopped having an advice nurse on call. Prior to that change, you'd been able to call them up, describe your symptoms, and they'd tell you whether you should see a doctor; afterward, you had to drag your ass down to Urgent Care in person, and pay the associated costs, just to find out whether you needed a doctor in the first place. I got the impression that the change was made due to liability issues, and that it was happening all over.
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From:caudelac
Date:December 27th, 2013 06:27 pm (UTC)
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I have no reasonable expectation that my doctor would be available to talk to, except in the case of my natal care folks, where someone (probably a midwife or RN), is typically around to take questions.
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From:wolflady26
Date:December 26th, 2013 05:37 pm (UTC)
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I'm so sorry you have to make that decision.
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From:gythiawulfie
Date:December 26th, 2013 06:26 pm (UTC)

As an asthmatic.....

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Invest in a humidifier. While breathing through a warm washcloth will work in a pinch, during colder weather spending a few minutes each day either in a steam filled bathroom or a small personal humidifier works WONDERS.

As for the rest I hear you loud and clear and no it isn't an easy choice to make and it shouldn't have to be one
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From:jenk
Date:December 26th, 2013 06:58 pm (UTC)

Also an asthmatic

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Are you able to get a "rescue" inhaler for asthma attacks?

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From:mouser
Date:December 26th, 2013 11:03 pm (UTC)
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When you've a $10/hour job, you go to the E.R. and rack up the bills and lose the job because you don't care that much about a $10/hour job and you'll never pay the bills off anyway.

This is one of the reasons that our healthcare is so expensive - when you're poor you don't have any other option.
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From:naamah_darling
Date:December 27th, 2013 12:51 am (UTC)
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I'm sorry you're having to make that call. That truly, truly sucks.

I've been having heart palpitations for a week now, really super-frequently. I am seeing my doc on Monday, the soonest I could get in, but if she orders a bunch of tests, I'm not sure I'll be able to afford that even with Medicaid, because just having insurance doesn't mean they will actually do what they are supposed to do and cover what they are supposed to cover. I mean, I have no other symptoms and everything seems okay otherwise, so it probably isn't anything immediately life-threatening, which means it will probably get ignored.

People hammer on "you should get it checked out anyway, be safe be safe be safe" and it makes me want to scream. If it's probably nothing, then I can't afford to "just" get it checked out. And when you're poor, the percent needed to reach "probably" shrinks alarmingly. "Four out of ten chance it's nothing? Ehhh, I'll take an ibuprofen and a nap and wait a month."

Not to mention how years of truly shitty medical care and not being able to afford office visits conditions you to avoid doctor's offices like dark alleys full of angry bears. I still have panic attacks going to see anyone but my regular doc. I never know when they're going to try to fuck me over.
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From:gabyrippling
Date:December 27th, 2013 04:18 am (UTC)
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I have decent insurance and I had the problem that my freaking doctor's office sent my labs to a lab that didn't take my insurance, so I got sent a huge bill (I think it got worked out after I complained at the office, but ugh). The idea we somehow have more control over our healthcare in this country is such a freaking myth.
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From:anonymousalex
Date:December 27th, 2013 02:31 pm (UTC)
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What bugs me is that it's a myth that anyone believes, given the enormous weight of evidence against it.

-Alex
From:noumignon
Date:December 27th, 2013 06:07 am (UTC)
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You saved five thousand dollars. I think the system worked. I have to balance life and death with money whenever I drive to work in a snowstorm, it's my life and my money and I can make that decision. Guess how often I'd go to work if someone else was paying for my snow day.

I think the real sin is that the medical system is set up for only high-cost options. There should really be the option for some nurse to go over a checklist with you for $100 and give you an opinion, but they know you'd sue if they got it wrong.
From:anonymousalex
Date:December 27th, 2013 02:39 pm (UTC)
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Bullshit. You can make a reasonably informed decision about the risk-benefit calculus in driving to work in the snow. You know how much you'll lose if you skip work, and (within a reasonable delta) how likely you'll get in an accident if you drive in.

That analysis doesn't hold in the medical example given. If you don't know how big a risk you have, you can't properly analyze how to proceed (setting aside, also, that when you can't breathe isn't the best time to make calm, rational decisions).

If he had that advice nurse that others mentioned, and he gave him an opinion that it's most likely an asthma attack and he's fine staying home, that would be different. But in the absence of knowledge, you can't really say whether the right call was made, except by luck.

-Alex
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From:ilgreven
Date:December 27th, 2013 05:22 pm (UTC)
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If he was wrong in his decision, that five thousand dollars would be covering his funeral.
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From:breenwood
Date:December 30th, 2013 10:09 am (UTC)
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It scares me that you're sincere here. The system under no stretch of the imagination worked. How is "I'm too scared to go the doctor because I, an untrained amateur, have no idea if this will kill me, and if it might not I can't afford to make that mistake"? How is any system that urges its users to err against the side of caution one that works?

Caveat - I am Australian, and I pay for healthcare that I don't use properly (I don't claim what I should). But if I feel like I may be having a heart attack, I'm on the damn phone immediately.
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From:bill_sheehan
Date:December 29th, 2013 02:43 pm (UTC)
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Hear! Hear!

I have what they're now calling Platinum insurance - my recent ambulance ride, hospitalization, and tests are all covered, no deductible.

Giving everybody this kind of coverage will bankrupt the nation, I'm told. And it's too complicated. And socialism.

Fuck it. Bankrupt the country and let's see where our priorities truly are. Personally, I think we can live with a few less wars.



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