Rights & Responsibilities

I have spent the last few days listening to and reading both sides of the arguments for and against the Affordable Care Act.  Every conversation that I’ve been a part of, read, or listened to brings my mind back to Joe (not his real name) a patient of mine in the not too recent past.

Joe was admitted to the ICU after a nightmare work accident and was fortunate enough to walk away almost unscathed: no broken bones, no brain or solid organ injuries, just a lot of abrasions and skin lacerations.

As he rolled into the ICU intubated it took a few hours to ensure that he hadn’t sustained any facial fractures or spinal cord injuries prior to being able to safely remove the breathing tube.  We weren’t expecting the curve ball we were thrown.  There on his admission labs: DKA, Diabetic Ketoacidosis. His blood glucose was over 800, he had an anion gap >20, a HCT >50, a severe acidosis, and for confirmation a Hgb A1C far over 12.  Our treatment turned rapidly from trauma to this serious diagnosis that is common in Medical ICU’s.  As care providers we had no idea if he knew he had diabetes or not and needed to wait to talk to him about it when breathing tube came out. Though the treatment; glucose management, electrolyte monitoring and fluid resuscitation started immediately.

When we extubated him, he confirmed for us that he had been diagnosed with Type 1 diabetes 5 years before and hasn’t had insurance to afford his insulin for the last 6 months- he felt lucky just to have a job.

The heath care organization that I work for had the responsibility to treat him regardless of his ability to pay and not just for the injuries sustained at work but for his DKA as well and by law he has the right to this treatment.

Without the admitting complications of DKA, he would have been able to be discharged that first day directly from the ICU.  However, DKA  treatment, monitoring, education, and the responsibility of the hospital to get him available resources to afford his insulin kept him in the ICU for 3 days.   The DKA could have caused the work accident with the potential for far worse outcomes for him and coworkers.

By day 2 his glucose came down, his fluid balance equalized, and his anion gap closed and he was discharged day 3 with available community and medication resources.

I greatly dislike that health care in the United States of America is political issue.  In my mind it is an issue of humanity.  Looking at my own life and health care costs, I don’t live with any chronic conditions or take any medication.  The more people who have access to primary care; the healthier my neighborhood, my community, and my city is.  Healthy neighborhoods and cities impacts all of us, directly and indirectly.

The Affordable Care Act brings us, as a nation, one step closer to making primary and preventative health care a right in our country and at the same it holds people responsible for the decisions they make and those decisions they decline to make related to their health.

I have been thinking about Joe a lot this week.  I hope he is able to find health resources that make controlling and treating his diabetes realistic as well as a major priority in his life.  I hope he is able to find a health insurer with reasonable costs and coverage for his pre-existing condition.  I hope he never again has to be admitted to the ICU for complications related to his diabetes.

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