Will somebody please tell me how health care got so messed up? I don’t think there is a person in this country who doesn’t have a horror story to tell. Mine are no different; it’s just that I’m part of health care…..a registered nurse working in home health care. Here’s what I have been through in the last couple of days:

I was asked to do an admission evaluation on a gentleman with cirrhosis of the liver, post liver biopsy. I need to make sure he knows how to take care of his wound. Except for one minor detail: he is homeless and, after trying for 2 hours, I can’t find him.

Instead, I was sent on a 2-hour round trip to see a patient who has a home, but no medical insurance. I was told before I left the office that I was not, under any circumstances, to give him any wound care supplies. He has to get those at the Free Clinic. I am certainly glad that I have been a nurse for 30 years: I had to show his sister how to boil water, add the right amount of table salt, and make what we call “normal saline” solution. We needed it because we did not have the calcium alginate ordered by the surgeon for wound care, so we punted with a wet-to-dry dressing.

On the way to see the patient above, I received a telephone call from one of my patient’s wife: she was in a panic because she was unable to refill his prescriptions—the doctor’s office would not okay the refills. Nothing important: just the medications that keep this post-stroke patient from becoming agitated, plus the antibiotic that he takes to prevent a urinary tract infection. No wonder his wife was panicked! I got to sit on the side of the highway, on hold, for nearly 10 minutes. A medical assistant assured me that that was policy: if the patient has not been seen in the office in more than a year, they will not okay medication refills. I asked her if she had talked to the doctor: no, she hadn’t. I asked her to let me speak to him but, according to the MA, he was too busy to speak to me. It’s okay for me to sit on the side of the highway, trying to advocate for my patients, but not for the doctor to waste his time talking to me. I TOLD her to go speak to the doctor, mention the patient by name, and ask him if he really, really wanted to see him in the office. Thanks to 2 strokes, the patient not only cusses like a sailor, but he hits anyone who gets too close. He has never hit me but, I get told to “go to hell” on a regular basis! It took me 2 hours but I did manage to get the refills okayed by the doctor.

I have another patient whose insulin orders were all messed up when he came home from the hospital. The patient complained to me that he had his blood sugar under control before he was hospitalized, now it’s elevated and almost out of control. I faxed a request to his doctor for order clarification. I made a list of what meds the patient was on before, and what the hospital sent him home with, as well as vital information including his current blood sugar reading. I got the fax back today: no clarification; just the doctor’s signature. I guess that gives me carte blanche to do what is best for the patient—except I don’t particularly want to practice medicine without a license! But I did have to laugh: I now know that the words “stupid” and “doctor” are interchangeable! Not really, but it felt better to say that! I’ll send another request for orders; this time I will use monosyllabic words to help the poor doctor!

Another patient of mine has end-stage prostate cancer. He is on continuous bladder irrigation via foley catheter. The urologist sent orders for me to change the catheter. After talking to the patient’s son—also an MD—he and I decided that no way am I going to jeopardize this patient by removing and inserting a catheter: he is already bleeding heavily. Six phone calls later, we are about half-way through the red tape to get his catheter changed in the hospital where they can use a guide wire, and cauterize whatever bleeders they hit. Not much of a victory, but better than nothing. Because he is dying, I can’t get anybody to do anything of an interventional nature. What’s up with that? He has cancer, yes, but does he need to bleed to death?

We are about to be hit with another decrease in Medicare reimbursement for our services. We are trying to deliver good care to our patients in less time than we should have to, and with fewer supplies. These folks have been allowed to come home from the hospital because a registered nurse will be out to see them. We do “see” them but, I feel that patient advocacy is the more important part of my job. I am certainly no hero but, really, where would these people I mentioned be if I had not made so damn many phone calls?