Let's Get Her Out

Last week I started my second Medicine rotation at a hospital near Flushing, Queens. For those who aren’t familiar, Queens is the most ethnically diverse urban area in the world. Pretty insane to think about.

I picked to come here, because I wanted to see a different world of medicine. Cornell, being in the Upper East Side (which apparently has the most expensive zip code in the world? Also pretty insane to think about [fact-check me tho]), anyway, you can imagine what the population is like here at the Cornell hospital.

So, Upper East Side --> Queens. Nuff said.

Here’s a story from my first week at Queens, which plucked me out of my shiny marble cocoon, and dumped me in a big pile of reality, at least for many.

“Let’s get her out of here this afternoon.”

The attending physician said one of his favorite phrases, as we presented the patient during morning rounds. Maybe because he is sick of this lady, or, more likely because there are 100 sick people in the Emergency Room of 60 beds, all waiting for days to get a bed upstairs.

The patient we’re talking about here is a 30-year-old, Spanish-speaking woman from Ecuador. She was actually the first patient I read about on my first morning at Queens. “Poor lady!” I had thought. She has had this mysterious abdominal bleed for a few years now, never bad enough to get her hospitalized, but also never obvious enough to be successfully diagnosed.

When we saw her, it became clear that she was suffering from more than just the puzzling bleed – she had patches of scaly, red, clustered rashes all over her chest, back, and leg. She did not look healthy. But there she was, quiet and cooperative, politely nodding and smiling as we asked her questions through the phone translator (she didn’t speak a word of English).

That was Monday.

Now it’s Tuesday. As in one day after she was admitted. We’re at morning rounds, where interns, residents, and attending physicians put their heads together to make plans for each patient for that day.

So the update is, yesterday we did an upper endoscopy on her (where we stick a camera on a long flexible rod down her throat into her stomach), and found that her entire esophagus (the tube that connects your mouth and stomach) is literally lined with actively bleeding, broken capillaries.

Found the culprit! I did an internal cheer.

“So yes, she can go, her blood tests are stable, let’s get her out of here this afternoon.”

I looked up, alarmed.

“Wait, but did we even figure out what caused all this bleeding to start?” I was confused – at Cornell, we would have kept the patient for at least one more week, running all different kinds of tests and consulting 30 different specialists.

The attending looked surprised.   

“Well you’re absolutely right.” He finally said, in a ‘let me see how I can explain to this naïve med student’ kind of tone. “we are going to discharge her without a diagnosis, because she’s medically stable, and she does not need to stay in the hospital. She can go home and follow-up outpatient at our clinics.”

That’s reasonable, I guess.

“Okay, although how do we know if she’s going to be able to come to follow-up? Do we know if she’ll have any barriers?”

On hindsight, I probably came off pretty annoying on my second day. They had a lot to do, and I was taking up time.

“Good point,” the attending clicked around on the computer. “I guess we could check what insurance she has.”

What a cool function. So we looked. And were silent for a quick second – Self Pay.

“Hmm. This doesn’t tell me anything. She might be undocumented for all I know.”

There was a moment of uncomfortable silence.

"This mean she'll have to pay full price on her clinic visits?" I was scared of the answer. That would mean hundreds of dollars per visit.

"Well, our clinic offers one complimentary visit after each hospitalization..." The attending replied. He sounded unsure himself. "well, we tried our best. This is unfortunate, but at least she’s here. In a year, we might not even be able to treat patients like her. We might be required to report them…with this new administration.”

We chuckled bitterly.

“Anyway, we’ll help make these follow-up appointments and tell her the time and location. Maybe for our own scientific interest we can send a few more panels of tests.”

“But she’ll still have to go today?”

“Yeah. Okay, send her labs, let her eat, and send her home on with antacids. Who's next?”