Wednesday, March 15, 2006


Her anxiety prevents her from getting on a public bus and safely and confidently navigating the world. Among other things, she witnessed the gang-style murder of her husband a number of years ago and the subsequent alcohol abuse has impaired her brain.

The only reason she is in a psychiatric day program now is because we were able to apply for a "Prescription for Transportation" from Medicaid for that specific address, as well as other places where she regularly goes for medical care.

That said, in order to take advantage of this transportation service, one must call at least 24 hours in advance. The call must also be placed before 2pm. If you get sick after 2:00 and need an appointment the next day, you're on your own. Oh, and sometimes the taxis contracted for the rides don't show up, but if you miss a ride, you're also out of luck.

Are there allowances for urgent appointments? No.

Are there allowances for next-day appointments booked after 2pm? No.

Can the person be sent to a facility where a prescription for transportation has yet to be submitted? No. And the submission and approval process takes weeks, even if your new chemotherapy regimen is beginning on Monday and you have no other resource for transportation.

A case in point: I receive a call from the day program that my patient has a three-day-old laceration on her finger that seems to possibly be infected. The finger is cold, dark, and she has lost feeling in parts of the digit in question. Can we see her today? Sure. How can we get her to the clinic when her transportation will only take her to the pre-ordered destination and no other? Beats me.

I hem and haw, clear my throat, tap my fingers on the desk, roll my eyes. Does the day program have taxi funds? Stupid question. Does the patient have money for a taxi? Stupider question. Could the patient take the public bus? Even stupider question, unless they could give her a few milligrams of Valium first. Call an ambulance? Let's see---$800 in taxpayer money for a lacerated finger that isn't even bleeding. What's a poor Nurse Care Manager to do?

I check my schedule. There's a forty-minute window, at best. I race across town and pick her up at the day program and bring her back to the clinic. After a cursory examination, I pull a doc into the room and have him take a look. He agrees with my assessment: no infection, no need for steri-strips. She may have cut a superficial nerve and may or may not regain all sensory function. Keep the knuckle supple and don't immobilize the finger. Bacitracin and Band-Aids and keep it clean. Watch for decreased sensation or change of color or temp. I pack a goodie bag with the necessary tools for home self-care.

Driving her to her house in the next town, we chat amiably. We've known each other for years. The first time I met her, she was so drunk she blacked out the whole visit and never recalled that it happened. A rich history, and a significant recovery from the brink of self-destruction. I give her a gift that I had for her in the backseat of my car---new Tupperware for her to pack her lunch in for her day program. She beams in the passenger seat.

So what about all of those other people with no cars, an inability to use the public bus, lack of reliable friends and family, and urgent issues in need of urgent attention? Your guess is as good as mine.

The poor suffer in so many ways, and we often mistake their suffering for a character flaw. I put out a small brush-fire today---no big deal, but it's symptomatic of so much more. How many proverbial fires burn out of control in other unknown homes, simply for lack of access to something as simple as a ride, a friendly ear, something taken for granted by so many of us? For many, the fire never goes out, and life is one long urgency. For others, the fires are certainly of their making but seemingly beyond their control to stem. For still others, the fires are simply a matter of daily life, and the lucky few are blessed enough to find a way to assuage the hungry flames.


mary said...

OH my. I feel your pain. Add a Medicaid Managed Care Plan onto that, and you have my pain. You have kids who end up in the ER for a minor exacerbation of asthma that could have been handled in the doctor's office, except...well, except they couldn't get to that office. They COULD get to the ER via ambulance, or when the sole family means of transportation got home from the job.

In fact, you have inspired me for a blog post on just this subject. :-)


Kim said...

You put out what was a big brush fire for that patient, gave her peace-of-mind regarding that finger and a gift as well, which lifted her spirits and probably made her feel appreciated and, well, like a human being with dignity.

Most excellent.

And I read Mary's post on the topic, too!