Inside out

The political cartoon of the day features a patient lying in a hospital bed labeled "US Heath Care System." Equipment packs the room preventing the nurse and the masked and gloved surgeon, labeled "Obama," from touching the patient. The nurse questions, "Where do we start?"

The letters section contains comments from a physician decrying the criticism of a retired multimillionaire hospital administrator and a taxpayer who points out all pay the price of the uninsured using hospital emergency rooms as their sole access.

So where do we begin? With the only avenue open to each of us. Ourselves. The physician must take the time to get the results of the test done last week rather than simply ordering another one from the laboratory she owns. The health care administrator must stop ordering supplies exclusively from the company on whose board he sits. The politician must look at the big picture of affordable health care not the plan that will garner the most votes in the next elections.

And the patient? The patient wants everything done and wants it, well, yesterday! We are all patients. If we do not require health care at this moment we will in the future. You can bet on that. Where do we begin? Start eating better. Increase physical activity. Drink more water. Reduce stimulants (caffeine, sugar, electronic media) and depressants (alcohol). Get more fresh air. Don't smoke tobacco. Go to bed at a reasonable hour to get enough rest. These simple measure will not only reduce health care costs. Lifestyle changes such as these will decrease illness as well reducing the need for many of the costly advances now available.

A new norm

As I closed my eyes after the last twenty-four hour shift as an OB hospitalist the realization hit me concerning my new patient population. My final delivery of the night was one of a 16 year old having her first baby with her mother and her older sister in attendance. If she had delivered yesterday she would have been 15 when her first baby was born.

The baby weighed 4 pounds and 11 ounces. Small in size due to the fact that she was six weeks early, the early arrival was due to the fact that her mother and her aunt, her mother's older sister were smoking pot and doing lines of cocaine last night just before the bag of waters broke. The patient unabashedly told me this story which was confirmed by the urine drug screen.

This is the new norm for me. Teenage moms, positive drug screens, no fathers in the picture. No one employed, no insurance, the government attempting to pick up the tab.

Today social services have been notified. The patient and I have discussed and she has agreed to injectable contraception that will last for three months following discharge. Still I have the feeling that this entire screen will repeat itself in her life all too soon.

And what will happen to this baby. Born six weeks early, withdrawing from drugs to a single teenage mother living with her single grandmother. How will she ever have a chance?