Determining Severity

I’ll keep this short. The emergency room is not a fucking deli. You don’t take a number, and are then seen when a room becomes available. Don’t come bitching to me that people who arrived after you are being seen first. Patients are seen in order that they need to be seen. Your tooth pain is not going to be seen before someone who can’t breathe. Period. As I’ve said before, don’t be a dick.

So here’s how the process works, and pay attention so next time you go to the ER, you don’t ask a retarded question.

After you check in, a nurse will triage you. This means he/she will do a basic evaluation to determine if your complaint is bullshit or not. The bullshit-o-meter is based off of two main questions.
1.) “Does this patient need immediate life saving intervention?”
2.) “How many resources will this patient need?”
The answers to these two questions will determine your place in line, and basically how long we have to watch you go “Ahh. Ahh. My jammed thumb hurts so bad” off in the corner while we quietly mock you behind your back. The nurse will have assigned you a number between 1 and 5 in the computer system. This is your ESI (Emergency Severity Index) number. ESI 1 means you require immediately life saving intervention like, you know, when your heart stops. ESI 5 means you should have stayed the fuck home. “But Dexter, how can the nurse determine that in just a few minutes of interaction?” Because we went to mother fucking school that’s how. Oh, and by the way, our bullshit-o-meter works when you lie too. “I’m here because my back hurts and someone stole my pain meds….oh….and I have chest pain.”
“I’m sorry to hear that. We’ll call you when we can” *assigns patient an ESI 5*.

Every damn day I get the following questions and complaints:
“How much longer? I’ve got things to do”
“How come people that came in after me are already being taken to a room?”
“My ear hurts so bad. I need a doctor now or I’ll sue.”
“This is a joke. This is supposed to be an emergency room. I’ve been here 6 hours”

Fuck, I once actually had a mother bring in her 3 year old with a fever, and stand outside another patients room trying to get our attention. While we were actively performing CPR on a dying man, this woman said, “Excuse me. How much longer? We’ve been here an hour and my son is really warm” I shit you not this lady actually wanted us to kill someone because she was too stupid to give her kid some Tylenol at home. The thought of stabbing this woman crossed my mind briefly. She’s lucky her child was there. Instead we all collectively told her to kindly fuck herself.

So now you know how patients are picked to be seen. Don’t bitch when people are seen before you. That’s a good thing. That means you’re not dying

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Favorite Complaints

Serious question:
You ever wonder why ER wait times are so long?
If you replied “Yes. Yes I have,” then the answer is because assholes come to the ER for dumb reasons. If you replied “No. Not really,” you’re the asshole. Thanks to the EMTALA (Emergency Medical Treatment and Labor Act) regulations, no ER can deny you care for any reason. That means if you show up, and tell the nurse “I came to the emergency room because I’m lonely, and I just want someone to talk to,” he/she cannot legally reply “Man the fuck up. This is a place for EMERGENCIES.” It is for this reason that you have to sit in the waiting room for 8 hours with a broken arm while all the rooms are filled with assholes. Combine those assholes with the Affordable Care Act, and you’ve got a perfect storm of newly insured assholes coming to the ER for dumb reasons and healthcare workers unable to act out their fantasies of cuntpunching said assholes. Thanks Obama. So, for your reading pleasure I’ve put together a list of my top 10 favorite reasons people decided to increase your wait time.

#10. 19 year old girl.
“I swear I’m pregnant but I’ve taken 3 negative tests.”
Dis bitch actually came to an ER because she didn’t believe the three pregnancy tests she took at home. She wasn’t having any symptoms other than a missed period, but God dammit, “I know my body!” she proclaimed. “Nice to meet you Becky. Here’s your discharge paperwork. We recommend a follow up with a psychiatrist”

#9. 42 year old woman with her 9 year old son.
“My son got hit by a car yesterday. He says nothing’s wrong but I’m like ‘Dude. Somethin gotta be hurting'”
The little fuck trophy was playing in someone’s driveway when they accidentally backed into him. Kid didn’t even fall down when he was “hit”. Apparently the moms anxiety overcame her and she just couldn’t handle the thought that her child was fine

#8. 18 year old woman with her 5 month old girl.
“My 3 year old daughter fed my baby Ice Cream. She gonna be OK?”
Mother fucker yes! Aside from the therapy both your children will need later in life to try and cope with the fact that they have a retarded mother, your baby will be fine. By the way, do the math on those ages…

#7. 22 year old man.
“I almost got hit by a car yesterday”
Son of a bitch! This guy almost got hit by a car…yesterday
“Wait so, you didn’t actually get hit?”
“No no no. But it came real close”
“Ok? And why didn’t you come in yesterday?”
“I felt fine yesterday. Today I’m worried it might happen again”
“You came to the ER because you’re worried that you might almost get hit by a car again today?”
“Yea” *Looks at me like I’M the idiot*

#6. 34 year old woman
“I just got out of rehab and I guess my tolerance ain’t what it used to be. I’m super tired”
What’s the first thing you do when you get out of rehab? Shoot up, of course! She calls 911 because she feels more tired than she usually does after her standard heroin dosage. “I’ll save you! Here comes you Narcan. Have fun puking your guts out in 30 seconds.”

#5. 18 year old woman
“I got my period at work and I’m cramping really bad. I wanted to go home early but my boss said if I don’t come back with a doctors note, I’ll be fired”
She literally came to the emergency room for a doctors note. Bitch, this ain’t the first time you lost an egg. Shove a plug up your bearded oyster, take a Midol, and deal with your own shit like a grown up.

#4. 28 year old man
“I keep going unconscious when I sleep”
The fuck? Is this some Inception shit right here? Dude actually thought he kept passing out after he fell asleep. He suggested we watch him fall asleep and see what happens. As much as I’d love to sit here an watch you get a few REM cycles going, I think I’ll go stab myself in the ear with a spoon. “Nice to meet you Brad. Here’s your discharge paperwork. We recommend a follow up with a psychiatrist”

#3. 42 year old woman
“I think my tit popped”
She got punched in the tit during a bar fight and now felt like her implant was leaking saline. The fight started because she was showing her new tits off to another woman’s husband. It didn’t take long for us to notice her right headlamp was shining quite a bit brighter than her left that night. Sorry you wasted all the money you just spent on those things. I’m sure some of your “clients” will still like you just the way you are.

#2. 55 year old man
“It’s cold and wet outside”
An Urban Outdoorsman was brought to us by ambulance because it was raining and cold. Don’t you dare say “Aww. You can’t deny people shelter from the cold!” Fuck off. This was in Florida where the lowest temps of the year are like 68. This douche had just been evicted from underneath his bridge, and his cardboard box wasn’t waterproof on its own. Homelessness isn’t anything to laugh about but when you act like a dick and abuse the ambulance service, I’m gonna call you an asshole, and tell you we’re out of turkey sandwiches, and fucks to give.

Here’s my favorite
39 year old woman
“I think I have new monya”
I couldn’t help myself. I said “Are you sure it’s not old monya?”
“Oh yea I’m sure. I got a shot for that a while ago.”
Fuck. I realize Pneumonia may not be the easiest word to spell but fuckin A lady. This grown ass woman legit thought she had taken steps to prevent Old Monya from getting her, but now this new strain of the disease had found a way into her system. We made sure to give her a shot to help treat this improved Monya that bested her previous vaccine

So there it is. Just a few examples to show you why your wait for the ER seems to be getting longer and longer. It’s not because of assholes like me being “slow” or “lazy”. It’s because of assholes like these that are either to dumb to realize they’re being an asshole or just don’t care that they’re being an asshole.

American Healthcare

The health insurance and hospital billing system in this country is fucking ridiculous. Emergency rooms alone will drain people of their life savings in a matter of minutes. The following is a piece of text taken directly from hospitals website regarding their charges:

Emergency Department Charges
Emergency Department charges are based on the level of emergency care provided to our patients. The categories, with Category I representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies, or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.
 
Charges
Category I
$172.00
Category II
$327.00
Category III
$478.00
Category IV
$878.00
Category V
$1,246.00

If you should find yourself truly sick, and end up racking up enough resources to fall under the Category V bracket, you might as well tell them to pull the plug. Not only will you get slapped with that $1,246, but the doctor will bill you for each minute he/she spends at your bedside. Then you’ll get additional charges for all the medications we give you while you’re there. medical-billTo give you a comparison on how much meds cost in the ER, here’s an example. You can buy a bottle of Tylenol over the counter for $3.99 at most pharmacies. In the ER, we will charge you $4.50 per pill. Should you be so unlucky to have a stroke, fear not, for we’ll give you a clot busting medication that has the potential to save your fucked up leg, arm, and face. It’s called Tissue Plasminogen Activator or TPA. Guess how much a single dose of this medication can cost. Did you guess $30,000? Correct! Thirty thousand mother fucking dollars. Do you know how many hookers you could buy with that kind of cheddar? Click Here to find out.

I digress. So after your Category V bill, your doctors bill, and your medication charges, we’ll then charge you for any and all procedures we do while you’re in the ER. That means everything like checking vitals signs, placing an IV, drawing lab work, EKG’s, X-rays and CT’s, etc. Let’s talk about some of these tests. For those that don’t know, an EKG tests one aspect of heart function based on the electrical waves we can measure.KernFig1 The test involves placing ten or twelve stickers on your chest, arms, and legs, attaching wires to said stickers, then printing out 6 seconds worth of electrical wave measurements. The whole test can be performed in under a minute if you are cooperating, but since the results of this test can diagnose a heart attack, we’ll go ahead and charge you $800 for it. No biggie. After all of those charges, we go back and tally up all the supplies we used on you while you were in the ER. Things like needles ($3.75), alcohol swabs ($1.85), band aids ($2.90), gauze ($12.50), and saline flushes ($8.25) rack up your bills even higher. Mind you hospitals buy these supplies in bulk for fucking pennies each.

All this is just for your ER visit. Should you happen to fall into Category V, there’s a good chance you’ll be admitted to the Intensive Care Unit for at least a night or two. For that we charge $2,851/night. That’s one expensive ass hotel room. That’s just the cost for the room by the way. Don’t forget about the supplies, procedures, meds, and doctors bill. You think an doctor specializing in intensive medicine is cheap? Yea they didn’t spend all those years in school to work out of the goodness of there heart.

I once had a friend who broke his pelvis falling off a roof. Long story short, he lost a shit ton of blood, and spent a week in the surgical ICU before spending another week on a regular unit. His total hospital bill between the ER, surgery, the ICU, and Med/Surg unit was over $700,000. Do you know how many hookers you can buy for seven hundred thousand mother fucking dollars? Click Here to find out.

 Here’s a personal story. Not long ago my wife found my 1 year old son with an unknown pill in his mouth. Poison control was unable to identify the pill so they recommended a visit to the ER. It was later determined that the pill was Losartan which is used for blood pressure management. We went to the ER , which I happened to be working at by the way, and all they did was check vitals signs, observe for an hour, recheck vital signs, then discharge. I’m not complaining about the care. My son needed nothing else, and if I had a sphygmomanometer (blood pressure measurer) at home, I would have just kept him home. Thanks to the “Affordable” Care Act I was paying $1,200+/month for insurance for my wife, my son, and I. My insurance only covered 45% of ER visits after I paid my deductible. Before you say it, fuck you. I know it’s shitty insurance, but it’s all I could afford. So for the 92 minute ER visit with no supplies used, my bill totaled $1,342.58. Later I asked for an itemized bill to see what I’m paying for. The lovely people that handle insurance and billing informed me that if I had answered “no” when they asked if I had insurance, the bill would automatically have been reduced to 25% the initial cost.
So with insurance I paid 55% oangry-dudef the ER bill,
and without insurance I would have paid 25% of the bill. Fuck me sideways and call me Jane. Welcome to the American healthcare system people! Needless to say, I promptly canceled my current health insurance. Instead I take that $1,200/mo, and save it for a day when I might actually need it. The maximum tax penalty I would face for not having insurance is a fraction of the cost I was paying out of pocket to actually have insurance.

 So Dexter, what’s the point of all this? I’m not recommending anyone cancel their health insurance, or suggesting that I have a way to fix this fucked up system. However, in light of the fact that we’ll be choosing between a criminal or everyone’s racist drunk uncle for our next POTUS, now might be a good time to make good on your promise to denounce your citizenship, and move to a country with free healthcare.