#673
Long day. Running on very little sleep, ending up taking friday as well, so it’s going to be a 6-day stretch of duty time. 144 hours….I’m a boss like that. It’s that others want to be off to do things for the holidays and I don’t give a damn when I’m on. I had almost all last week off, I suspect I’ll have a ton off next week too, but I haven’t actually looked yet. Last two calls were nose bleed calls. One was legit, an older lady with some mental issues going on who was a chronic nose picker. Hers was bleeding pretty bad, like actively bleeding in streams. Nawt gewd. The other one was just an older lady who had had a nose bleed off and on that was just…a nose bleed. Not serious at all, nothing like the previous woman, but she wanted transport and by law we must give transport if requested. Just another paranoid older woman….they amount for some fifty percent of our calls and it’s irritating to be called to look at nosebleeds (way more common than you probably think) for some 50+ female. And I banged the shit out of my knee on that call and now I have a dent in my shin and an ugly bruise. I’m at least moderately rageful over this. I don’t mind hurting myself for patients who actually need our services and I don’t mind busting my ass for them either. However, people who abuse the system SEVERELY irritate me.
Another call I had earlier was another older lady who was reaching for the railing at her house and fell and they had paving blocks for a little setup for plants and she hit it and busted her hip. We got her suited up nice and tight in a vacuum splint, but the angle she had was really bad and I couldn’t get into the position I needed to be in to lift her. So I was half over her until we lifted and turned her. We had to be really careful because hips hurt like hell and we don’t want to hurt the patient and like….so we go down to get her ready to rock and roll. I lift in that awkward position and riiiip. I probably need to take a second here and explain something very important about me. I work hard, much harder than most people my age I’ve worked with. I’m a good deal lazier when it comes to working for myself because my happiness standards are lower, but when I do a job for work I do it well. Whatever it is, I do it RIGHT. So. I didn’t just tear my pants a little bit. Oh no. I tore all the way from the center-crotch area where all the fabric comes together + is stitched all the way up to the hem of my pants. Oh yes. All the way, a solid 6 inches of fabric, BAM. So my ass is hanging out and OF COURSE this is the day I’m not wearing black boxers like I normally do. In fact, I’m not even wearing boxers which would be passable. I’m wearing somewhat tight super-sexy white boxer-briefs, the end effect looking like a rare zebra-ass escaped from the Milwaukee Zoo. You can’t help BUT notice it even if you aren’t paying much attention. So. We lifted her and that happened. To my credit I didn’t fucking move. I did NOT drop the patient, I did not even jiggle the patient. I manned the HELL out of that because I know how much breaking your hip hurts. She didn’t even know about it til a little bit later, that’s how professional I was. *pats self on back for great success* However, she did find out a bit later. That turned out for the better though, because you know this woman was in serious, serious pain and she found time to laugh and make fun of me a bit. She was a tiny little thing, MAYBE 110 lbs soaking wet. She told us her blood pressure was normally low and not to be alarmed, which makes sense considering her size. But…..her BP was 130/90, which is some 40 points higher than her normal. Yeah, that tells you she wasn’t joking about the pain. But still. Comments about wardrobe malfunction, equipment malfunction and my coloration may or may not have been said. ;P Whatever, it worked for her, s’all good. So we call a paramedic intercept for pain control. We get a king douchebag paramedic who won’t give her pain medication because she had drank some alcohol earlier in the evening. Except….we know he CAN give pain medication even to alcoholics, just not some of the big guns. And this woman is not drunk. She isn’t even tipsy, like, she just got back from hosting a fundraiser, a fundraiser for the fire department and ambulance service for the town down the road no less. She WASN’T EVEN MILDLY DRUNK. And the asshole won’t help her out, not even with a light analgesic. Then when we get there he just walks off even though when we meet our intercept we transfer care, it is HIS patient at that point. Total prick. Then his partner who was driving their ambulance behind us walks in and Sheri (my partner) asks her if she could help bring the patient in because I had an equipment malfunction. And she does this cute little hip move and points mouthing like a "this?" pointing to her pants. Sheri goes yeah, and they laugh and I get to stay in the ambulance and not show off my bits to the ER nurses. Har. Final kicker is when we get back to the station Sheri is having a tiny fit because she’s pretty anal about how the ambulances are stocked and someone screwed up the stocking and so we’re going through everything taking out extras, putting in things we’re low on, etc. And my chief comes in to pick up paperwork and I’m just doing my thing, organizing this and that, not even worrying about anything. And he looks at me and just busts out laughing. Sheri was like, "DON’T LAUGH AT HIM." And he just keeps laughing and tells me we’ve all been there, then does his thing and takes off. Yeah. I’d be surprised if everyone *doesn’t* know about that by now.
I saw an article about outrage over a doctor talking about females and males and the cost of health care. Here:
http://shine.yahoo.com/healthy-living/fox-s-sexist-comments-on-women-s-healthcare-spark-outrage-172914267.html
As a medical professional and someone who does bump up against a great many more nurses and doctors than the average bear, the article kind ticked me off. People are misconstruing what the doctor was saying in a great way, acting like he’s talking down to women and that he’s incredibly sexist etc. Unfortunately for the knee-jerkers, what the doctor is saying is extremely true. This very topic was discussed back when I was still in class training for my job, the fact that women are far, FAR more likely to use medical services than men and that often when men go it’s because the women are pushing them to. It’s even present in EMS. I think my professor said 75% of medical services are for women or driven by women, which is a pretty big number. It was something like that anyway. Fact is, a guy is way more likely to just drive himself in if he has a nosebleed that won’t stop than he is to call 911 like the lady I previously mentioned. And actually, he’s way more likely to just sit it out too. For whatever reason, men just don’t use medical services anywhere near as often as women. The doctor is right about the organ systems too; a woman is much more complex and deals with a huge range of things that men will never have to. Even taking the prostate into account, the difference is just staggering. There’s a reason why almost everyone has heard ofa gynecologist or an OB/GYN and not andrologists; the female reproductive system is way more complex than us males is. Field test: ask the women you know if they know what a gynecologist is and if they see one. Then ask the men if they know what an andrologist is and if they see one.
So yeah, reading the article where the writer criticizes the doctors remark "We only have the prostate, women have the breasts, they have the ovaries, they have the uterus, they get checked in every part." as surreal irritates me. Yes, they do have more reason to see the doctor more often, and thus, should pay for that extra care. We aren’t even talking pregnancy, which is a whole ‘nother ballpark of huge extra costs. To say that women use more care is not sexism. I think that where a lot of the conversation is lost is that people don’t realize that a LOT of the debate is *really* about a different economic point of view. A lot of people, people like me, don’t think that I should be paying for other people’s problems. I don’t think it’s particularly right for me to pay for your sunglasses, your children’s clothes, your food, your car etc, (or for you to be paying mine) so why should I be paying for your health care? If you choose to take risks and skimp on heath care, that’s on you. That’s where I’m coming from and how I see the issue. On a more personal level, I *know* that I take risks by not seeing the doctor regularly. I *know* I take risks by not keeping up on my medication. And if I get burned for that, I don’t think ANYONE should pay for my decisions unless they tacitly choose to do so. Of course, not everyone feels that way. A lot of people really truly believe that health care should be free (or at least really cheap) and that everyone should be able to get it at no cost. I don’t understand this point of view and I won’t pretend to. The equipment is god damn expensive. Even if you were to take away the nasty markup that american companies put on medical equipment, it’s still grossly expensive and to maintain the level of care we give, it has to be that way. It’s easy to understand that we can’t just reuse needles, but it’s easy to forget how many other ways a patient can contaminate the equipment around him. There are a good deal of very nasty diseases out there that jump from person to person just by skin contact…and that they are highly contagious. MRSA anyone? C-DIFF? To keep patients safe we can’t reuse a lot of equipment, from tubing to gloves to masks to….a great deal of things. We will be going through it one way or another and it will be replaced. Then take into account tort law….that’s another huge thing. Bigger than equipment and the actual care, honestly. *Shakes head* Anyway, we’re not bringing the cost of health care down in a big way in any reality that I see as possible, so to me the idea that health care should be free/very cheap is not even worth considering.
Then there’s the last bit about preventative measures. As per the national woman’s law center:
"Yes, women access more preventive services, as the commentators point out. But shouldn’t all of us get the preventive care we need to get and stay healthy? Why should women be discriminated against for simply going to the doctor?"
Starting with the last sentence….it is not discrimination for you to pay more for purchasing more services. If I go to mcdonalds and buy a cheeseburger but you buy two cheeseburgers, a fry and a large drink, is it discrimination that you pay more than I do? No it is not. You purchased more services, therefore you pay more. Sec, I’ll get back to the preventative measures thing.
However, the very first bit the NWLC put out, this:
"We did the research and the fact is that women are charged more for health coverage simply because they are women,"
This intrigues me. On one hand you could say it’s sexist to differentiate between the sexes. By proxy, then, it would be also be bigoted to differentiate insurance costs for an 18 year old vs. a 70 year old, not to mention to differentiate between socio-economic status, etc. So do away with all of it and treat everyone the same. I could generally accept this sort of proposal. On the other hand, the way things stand now insurance companies make bets on potential and likelihood, not necessarily the actual. They know that an 18 male is not very likely to get seriously sick and that a 70 year old female has a whole host of potential issues that are both extremely common (arthritis, osteoporosis, various bendings of the spine), common (bowel issues, heart disease, diabetes and all it’s long term effects) as well as the uncommon and rare diseases out there. They also know that a very minor issue to an 18 year old, things like colds and the flu, can easily become very serious ones for an older person. Therefore it makes more sense for them to either charge the 70 year old much more or outright deny her. So, too with women vs. men. So I can get and support that too generally. What I don’t support is the idea that it’s sexist to make any differentiation between male and female despite there being many, MANY differences. But that’s a rant I’ve made many times; we go way too far in our striving for tolerance. There’s a dif between a legitimate difference and discrimination.
Back to preventative measures and america’s obsession with them. They aren’t the magic bullet to all things, but rather, they’re a bullet for certain things that we have good tests for as well as good answers for. Like they’re great for breast cancer. Checking for lumps in the breasts saves lives. However, they do NOT work for many other conditions, including some other forms of cancer. Like prostate cancer, we have a test for it but it false positives somewhat often. Second, lets say you do have prostate cancer. Most forms of prostate cancer grow slowly, very slowly, and thus they don’t effectively metastasize like more well-known forms of cancer. Because of this, in a great deal of cases it’s better to just watch the cancer and see if it does anything. This confuses a lot of people. Why do you just ignore it if you suspect or know that you have cancer? The issue comes from the fact that misdiagnosis, overdiagnosis and treatment damage outweighs the damage of the cancer itself because most forms of prostate cancer aren’t very damaging at all. They just sit there doing not much of anything. Here’s some links supporting the conclusion that preventative screening is NOT worth it because it is more damaging than it is not:
Focused study on prostate cancer stating it’s better to not screen:
http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatecancerscript.pdf
CDC agreeing with the above study:
http://www.cdc.gov/cancer/Prostate/basic_info/screening.htm
So does the american college of physicians:
http://annals.org/article.aspx?articleid=1676183
The american urology association agrees too with the caveat that during ages 55-69, the risks of misdiagnosis/overdiagnosis/treatment damage are roughly equal to the benefits of preventative screening. Thus it should be up to the patient to decide based on the patients value during that age range and that age range only. After 70 it goes back to not recommending the procedure.
http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm
So on and so forth. By no means is prostate cancer the only disease out there where preventative screening and preventative care actually does more damage than it helps. It all depends on what the problem is, what the test is, how good the test is and what the preventative/response measures are.
Which leads into another idea that’s been being looked into. Preventative measures make up a huge part of the medical procedures out there. Some studies are saying it holds the goal of being healthy back with the side-effects. Hum. *Shrug* I’m sure it’s like prostate cancer screening, it’s a case-by-case deal. Some will be great, like breast feeding is a great preventative measure for keeping infants healthy. Some will be pretty dangerous, like saroten for migraines. Others will be more harmful than beneficial, as with prostate cancer screening/treatment.
My point is, we need to stop looking at preventative measures as a magic pill that will eventually fix all our issues. It is not a magic pill. Rather, it’s just one more tool in the modern doctors toolkit. Sometimes it will be called for, other times it is not. We shouldn’t insist on it being used in every case and we shouldn’t assume it’s always the best thing to do. Thus my irritation at the idea at ‘needing’ preventative care and it being a huge issue if one can’t always get it.
Anyway. I just got waylaid by two more calls that we needed to call for mutual aid on, we don’t have a full crew to take em. First was an older lady who I’m pretty sure is dying very soon, other was a young, super obese girl who fell and broke her hip. I first responded to the one, did lift assist on the second and now after all that, and all this writing, I am tired. Time for a nap. Baibai.
In the spirit of the general direction of this entry:
You know it got someone.