After Two A.M.

Rice paddies in Nepal - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

Climbing out of bed at two A.M. to drive to work brings a number of unrelated thoughts to mind:

Where am I?

What time is it?

Where are my clothes?

If I work all night, I’m going to be a zombie and may miss my kid’s game this evening.

What surprises lay in wait with this emergency surgery?

The IRS and State of California will get half of my pay.

What about the guy who is sleeping tonight with his pregnant girlfriend and won’t work tomorrow because he makes more on welfare than picking peaches on the farm?

If tonight’s patient doesn’t have any money, why is he entitled to sue a Good Samaritan for malpractice?

Perhaps I should feel guilty about these selfish thoughts, but as another tax season approaches I am reminded of people who perpetually take from the system and survive due to the generosity of those who are willing to get out of bed at two in the morning.

One wonders how many chances a heroin addict enrolled in a methadone rehabilitation program should receive, when he cannot resist the temptation to inject his beloved drug into a vein on his diabetic ankle. A life threatening infection ensues requiring multiple procedures which includes cardiac surgery when one of the heart valves is destroyed. The bill swells to hundreds of thousands of dollars and is paid by either the taxpayer or the hospital. It is difficult to envision any scenario where this is a prudent method to spend scarce health care dollars.

Personal injury lawyers dispute tort reform is an important part of health care reform, but personal experience teaches otherwise. Many years ago a neurosurgeon and I were called at two in the morning to care for a young man with massive head trauma. The patient suffered from a known seizure disorder but refused to take medication. He was standing high on a fifteen foot ladder while changing a light bulb. As luck would have it, he seized and fell head first on the cement floor beneath the ladder. He was found unconscious and transported to the hospital where he was diagnosed with a massive cerebral hemorrhage. Emergency surgery proceeded as well as could be expected, but the patient died two days later. Two months later the surgeon, the hospital, and I were sued for wrongful death. The case was meritless and eventually lapsed but not without wasting a lot of money and time.

With blood products in short supply, the two in the morning mind wonders if it appropriate to exhaust the blood bank to attempt to save the life of a gang banger shot in the chest by a rival. The dilemma intensifies if the patient shot a policeman and survived the aftermath long enough to reach the operating table. A cancer patient, a patient in shock from a bleeding colon, or a child injured in a motor vehicle accident have a more valid claim to finite, life saving resources.

Rule makers do not get out of bed at two in the morning. Their world is controlled, theoretical, and contemptuous of those who act under stressful conditions where risks and benefits must be considered. I wonder how they would react, if told there was no blood available for their son or daughter; the last pint was transfused to a convict stabbed in a knife fight, who despite the best efforts of the surgical team died in a pool of blood on the operating room table.