The Cruel and Stupid Politics of Hospital Discharge

Careful readers of my last post – the one on my little Tiger’s accident – might have picked up on one aspect of the night that really messed with my mind: the circumstances under which we were discharged.

Here are the bald facts.

The Tiger and I were in Columbus. Our home in Athens is an hour and 45 minutes away. My husband returned to said home, with our one and only car, on the understanding that surgery was a virtual certainty, and knowing that our older son, the Bear, would need reassurance.

There is no public transportation between Columbus and Athens, unless you count the highway-robbery airport van (available by pre-order) or, well, hitchhiking.

Since surgery didn’t happen, we were discharged at 4:30 a.m. The Tiger was about two and a half hours out from being fully sedated. His arm hurt. A lot. We would have taken a cab to a hotel, assuming we could 1) get a cab at that hours (probable) and 2) pay for it via credit card (somewhat dicier).

Fortunately, a very kind and determined social worker persuaded the Ronald McDonald House across the street to take us in for the night’s remaining few hours.

But this posed another problem: How was I supposed to cash in the Tiger’s prescription for pain relievers? The ER doc had written it for Lortab (Vicodin syrup – definitely superior to codeine), but even heroin wouldn’t have helped without a place to fill it. I asked if the ER could give us a sample to get us through to morning. Nope! Their internal pharmacy closed at 11 p.m.! Their advice? I should take a cab to one of the 24-hour pharmacies. They handed me a list.

Children’s Hospital is in the sort of neighborhood where all the windows are boarded up. I’d be very wary there as a woman alone anytime after dark, and probably in broad daylight, too. And I was supposed to go to a Walgreen’s in the midst of this blight, at 5 a.m., with a groggy, frightened, pain-ridden six-year-old. Um, yeah.

We went to the Ronald McDonald House and the Tiger slept for all of three hours before the pain roused him. A couple hours later, his dad scooped us up and we got him the medicine he needed. I was FURIOUS that he had to suffer needlessly. No one is going to convince me that pain builds character. Especially not in a six-year-old.

Our experience isn’t an anomaly. You’ve surely heard about women discharged within hours of giving birth (laws have been changed to prevent this) or with mastectomy wounds still oozing and bleeding. Men often get one measly night in the hospital after prostate surgery and are sent home on the assumption that their partner will know how to deal with catheters and potential blood clots.

I was venting my rage to a friend of mine, and she had an even more harrowing story to tell. Her husband suffered some severe burns a few years ago. The hospital discharged him at 10 p.m. – though he’d been an inpatient – and he was still running a fever. The nurses measured it once at 99.8, and that was it for him – even though his fever rose again. She had four little kids at home and had to make the trek up to Columbus to rescue him from prowling the streets with third-degree burns and a fever!

I’m not sure exactly what’s behind this systematic cruelty. Insurance policies often drive patients out the door before they’re ready. My friend’s husband was likely displaced to make room for an incoming patient. Conversely, my husband once spent a full weekend hospitalized after his chest pains had been determined to be completely benign – just because no physician was available to run one final test, and they evidently didn’t need the bed.

In the Tiger’s case, no long-term harm was done. I’m still irate that in the short term, his pain was not humanely controlled. Beyond that, though, we may have gotten lucky. One possible complication of his particular injury (a supracondylar fracture of the humerus) is compartment syndrome. Basically, swelling disrupts circulation and nerves to such an extent that muscles and nerves may suffer permanent damage. One medical source (Orthopaedia) recommends observation overnight to ensure that compartment syndrome isn’t developing, and adds:

Casting these injuries as means of definitive treatment carries risk of compartment syndrome, as swelling is not allowed in the cast…this is especially true with the greater amount of flexion used to maintain the reduction [reduction = replacement of bone into its proper position].

So, while I didn’t know it at 4:30 a.m. in the ER, early discharge posed a real risk. I knew to look for additional swelling of fingers, tingling, poor blood flow, etc. I didn’t know that the Tiger was at greater risk due to being discharged. I didn’t know that having a hard cast upped his risk. I only knew that he was in pain.

Cruelty merges seamlessly with shortsightedness.

And this is the world’s greatest health system? I’ve gotta figure out Rush Limbaugh’s trick.

Mind you, we have good insurance.