August 8, 2009, 11:38 am

A Tail of Health Care…Reformed? puh-lease!

Like the number one reason any woman took Midol was a guy!

We took Midol so our uterus didn’t burst into flames while tearing our guts apart and we didn’t  develop four-plus pitting edema of our earlobes.

This ad is from the ’70s, the era of Women’s Liberation! Who needs a guy – we can take care of ourselves!

I am woman, hear me roar!!!

And had I not taken Midol, you would have heard me.

But it had nothing to do with a dude.

(H/T to Advertising Is Good For You, where I found this ugly guy delightful ad!)


She didn’t eat her dinner Friday night.

By 4: 30 am Saturday, the previously healthy 65-year-old female had a fever and lower extremity weakness. A family member heard her repetitive moaning. The patient got up to void, but could barely negotiate the one step up to the hallway. As she negotiated the hallway, she staggered.

By 5:00 am she was in the ER.


The patient was taken to an exam room. Vital signs were taken and it was noted that the patient’s fever was “extremely high”. The doctor came into the room and the temp was re-taken.  Extremely high.  The patient had no insurance and was not verbal; the doctor discussed options with the family member.

The goal: find the source of the fever and begin treatment. A CBC, Chem 14, a urinalysis, an IV and hydration would be started. No lactate level would be done; the doctor stated it would be pointless to run a test that she already knew would be elevated based on clinical presentation.  Blood cultures would be drawn, but not sent immediately. As the doctor explained, they are expensive and it would take days before the test results would be back.

In this facility, payment was expected at the time of treatment and a detailed estimate was provided to the family. The low end of the estimate was the deposit.


By 8:30 am Saturday, the fever was still raging; the lab tests were normal. The patient was in ice packs with a fan in an attempt to lower the fever. An IV antibiotic was initiated; hydration was on-going. An internist and a neurosurgeon were consulted as the patient was experiencing lower back pain in addition to the profound weakness. The patient was admitted.

Further tests were proposed:  lumbar x-ray to rule out spondylitis and, given the patient’s age, a chest x-ray to rule out occult pneumonia. The pros and cons of each test were fully explained along with rationale and the cost.


The radiographic exams were normal. A loose bowel movement that morning had been blood-tinged. The patient had been medicated for pain. A second antibiotic was started. The next step would be an abdominal ultrasound, as no obvious source for the fever had been found. The rationale for the test and the cost were discussed and the family gave the go-ahead.

The spleen. Enlarged and mottled on ultrasound. A call was made to the family to discuss needle aspiration to rule out lymphoma.


Monday morning the patient’s fever was down. She was eating.  She was voiding. She was still weak, still moved slowly and awkwardly. She would be discharged home on oral antibiotics with the results of her spleen aspirate pending.


It’s been a week now and the patient is acting 100% normally.

The patient was my dog, a 10-year-old, 70 pound Shepherd mix. We still don’t know what nearly killed her last weekend. The spleen aspirate was abnormal, but not lymphoma. The fact that the fever responded to antibiotics (as did the weakness) leaves us with the feeling that it was an infection in such an early stage that the source was not obvious.

I realize veterinary medicine is not human medicine, and a million holes can be found in my attempt to draw a parallel between them. But a few things crossed my mind during this experience:

(a) Tests were not done just for the sake of testing or because a printed standard said they should be. This was not template medicine dictated by any outside organization or government regulations.

(b) The doctor/patient relationship was unencumbered by insurance company approvals, government regulations, billing, coding or the number of patients that had to be seen in a certain time frame.

(c) there was full transparency regarding what each test would cost.

Maybe the human health care system can take a few pointers from what the veterinary world has been doing all along.

(P.S.  I just realized you can read this story from the vantage point of ME being the third-party payer standing between the vet and my dog, deciding what would be “covered”  – i.e. paid for.  Interesting either way….)


  • Twitted by Emergiblog

    August 8, 2009 at 11:51 am

    […] This post was Twitted by Emergiblog […]

  • Duncan Cross

    August 8, 2009 at 12:24 pm

    I have a post on this subject:

    We kill 4 million pets every year because nobody wants them. We kill or let die who knows how many more simply because their medical bills are too expensive.

    What makes veterinary medicine so straightforward is that pets are ultimately just pets. There are tough choices, sure – but no morally complex issues at stake. When pets get too old or sick, we kill them. Dealing with people is much more complicated – thank God.

  • Reality Rounds

    August 8, 2009 at 6:44 pm

    On the other hand, Duncan, we often treat human beings worse than animals in the health care system, especially at the end of life. Also, I have never, ever experienced anyone “killing” a patient because they could not afford the bills. My guess is Kim has not either. I assume you are just being dramatic. I will admit that people who can’t afford health care and insurance will delay care/treatment until it is to late. But when they do come in, we treat, but it is usually futile at that emergent point.

  • geena

    August 8, 2009 at 7:10 pm

    At first I wondered what kind of facility you were in!!

    My cat spent almost a week in Kitty ICU (KICU!) quite a few years ago with an infection. He had to have surgery to figure out where it was coming from.

    After he finally came home and was on the mend, my other cat got sick and needed biopsies and some time at the vet. He now needs special “prescription” food.

    That month, between the two of them, I spent enough money to buy a small car.


    At every step of the way, it was just like you described, Kim – the vet would give us the facts, including the price, and just let us decide. It was great.

    As a side note – I do believe we treat humans MUCH worse than animals at “end of life.” I’d never put an animal what we put some poor old people through!!!

  • kmom

    August 8, 2009 at 9:09 pm

    And sorry to say, some of us could be in that situation with our loved one—choosing whether to treat based on the expense and whether we can afford it. In moments of stress, trying to make a wise decison about things we don’t really understand and trusting the experts we may or may not know. Do we commit only to treatment we can pay out of pocket for, or decide to treat no matter what or somewhere in between? It adds another layer of agony.

  • Melody

    August 8, 2009 at 9:21 pm

    This is very interesting to me, as I just went through the experience of putting my 16 yr old dog to sleep. She was not acutely sick, just chronically ill and withering. Had lost her hearing, and her sight was failing rapidly. She was incontinent of urine, which required BID meds. And the arthritis in her hips was obviously more painful by the day. (Sounds like many of our elderly patients.) The last few months her appetite was withering as well. Even the cheese burgers and omelets my husband cooked her were no longer appealing. After she stopped eating for a few days, we made the painful decision to put her down.

    The experience was peaceful and pleasant. So pleasant that my own father has asked me to take him to the vet when “his time comes”.

    After seeing many elderly waste away on life-support day after day in the ICU. I wish I could take my dad to the vet when his time comes.

  • […] A Tail of Health Care…Reformed? ( […]

  • aqua

    August 9, 2009 at 2:23 pm

    I am sorry to hear your dog was so ill. It saddens me to know so many beings of all persuasions miss out on the right care because of money.

    Since he was born, my 1 yr old boxer, Skookum, has had numerous illnesses that sound similar to what your dog went throught . The 2nd to last time his temperature became so high, and he became so sick and dehydrated he had to be hospitalized and rehydrated.

    Tons of tests were done, and they showed his white blood cell count extremely high, but no dignosis could be made again. That visit alone was $1000.00, the other 6 or so times the bills ranged from $250.00 to $450.00. Last time I could not afford another vet bill, Luckily I had the bright idea to “force hydrate” him with children’s pediolyte and a turkey baster…it worked very well and he became well over 4 or 5 days…but not without me feeling intensely guilty and stressed out for not taking him to the vet.

    I bought pet insurance at $95.00 a month (which, being on disability, I cannot afford, but he is like a child to me and I cannot let him die because I can’t afford to take him to the vet.

    Of course, since buying insurance he has not been sick…go figure

  • Ken O

    August 10, 2009 at 2:27 am

    I’m another one who wondered where this was going at first.

    I see how in some ways pets are easier, mostly because most people are prepared to accept that there comes a time (say a dog with arthritic hips) when you need to “let them go” because doing anything else is effectively torturing them.

  • […] a fantastic post from Kim at Emergiblog on the wonders we might achieve with healthcare reform – while saving money – if we were willing to […]

  • Am Ang Zhang

    August 11, 2009 at 1:17 pm

    Good “tail” indeed.

    The Cockroach Catcher

  • whitecap nurse

    August 11, 2009 at 7:22 pm

    I figured it was a pet as soon as you got to “payment up front.” I have had 2 very sick cats both end up in ER recently and have had good experiences (but dead cats) both times. However, it is very easy for me to say no to kitty chemo, kitty neurology consult etc. It would be unspeakably difficult to have to make those decisions for a parent or child. As far as diagnostic testing – I would love to have the same transparency about cost/benefit/need discussed for human ER care as we do at the vets.

  • Karin RN

    August 12, 2009 at 7:54 am

    LOL. You got me there. I almost thought you’re talking about a human patient. On a sad note, hospitals in the Philippines still require deposit up front before critical tests and treatments are done.

  • Jill Rey

    August 12, 2009 at 4:37 pm

    I just got a colonoscopy and had to put down 50% of the fee up front. Health care has become so expensive and rushed, I can’t help but get frustrated. The Doctor I worked with actually ordered extra blood tests that I had already gotten at another hospital and I had to pay twice! I can see how most people wouldn’t care because their health insurance would pay it, but I had to pay out of pocket. My
    Registered Nurse: Registered Nurse was great though.

  • janis

    August 19, 2009 at 12:41 pm

    I couldn’t agree more. As a paramedic with a best friend who’s a veterinarian, you can imagine we often exchange rants. Like the patient who told me they called 911 instead of a cab because “I have to PAY for a taxi.”, or, the client who read my friend the riot act about her bill: “I can go to my doctor and get xrays and blood drawn and only pay $10!”
    When she diagnosed my Shepherd with Addison’s disease (a very difficult condition to diagnose), she was careful to order only the most relevant tests and helped cut costs by letting me administer IV fluids at home. I think part of the difference is that vets don’t have to practice as much CYA medicine as human doctors do.

  • Becky

    September 2, 2009 at 7:43 am

    One great online resource you should check out for travel nurse advice is the Cirrus Medical LinkedIn Group (name: The Traveling Nurse). The Traveling Nurse posts a variety of job opportunities in tons of U.S. cities and provides members with information on the most recent trends in the nursing field. Join today at

  • […] A Tail of Health Care…Reformed? ( […]

  • Justin

    November 11, 2010 at 2:17 am

    I agree that the medical industry could learn some things from the pet health care industry. I hate when I have no idea what a test or exam will cost until I receive the bill several weeks later.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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