231 BPM

Image from Unsplash

Prologue:

A couple years ago my wife fell in an airport. An ambulance was called and she was tended to by an ER in Dallas. Unfortunately, nobody called to make sure that the ambulance or the ER was in-network¹ and we were on the hook for around $10,000.

The Story:

On Friday the 28th, I arrived at my parents house and got on the sofa to relax and watch some football. After a bit I started feeling really tense in the muscles in a way that is strange for me. I remember that coming first because I thought that I needed to ask my wife for a massage when she got there and that’s something I almost never need (that she frequently offers because she needs them and I give them). After that, though, I started feeling pain in my chest. That pain just kept getting worse. I was having a heart incident (not an attack, though) and it ultimately landed me in the ER and for three days in the ICU. I feel better now.

As this was happening on that Saturday afternoon, I was remembering the airport. I was also thinking about we had already hit our out-of-pocket maximum of $13,800. I really, really did not want to get hit with tens of thousands of dollars of medical bills. So I got on the app on my phone to find an ER that was in network. Except that the app wasn’t working. As this was happening, the intensity of the pounding in my heard kept increasing. Then next thing I did was grab a laptop to log in there. However, when I put in the password I got a message telling me that my password had expired and needed to be changed. The changing of a password is actually a complicated ordeal involving verification emails that end up delayed or in spam folders because Google and Microsoft consider them suspect. It can take five or six before one gets through.

I didn’t have time for that. that was the end of it for me. Not just in the sense of my quest to avoid needlessly spending five figures, but mentally and emotionally I just broke down. Even if I thought my did I think my wife was prepared to knock me over the head to drag me to the nearest ER. As it was, I just broke down and did what she told me to do and sat there and thought about how we were going to pay for this. We actually ended up at a deceptively titled urgent care clinic, where my care was delayed by the fact that they required you to use a smartphone to check in. After ten minutes of failure with that they let her use a pencil and paper.

By the time they got to me, my heart rate was so high that it was above their equipment’s ability to give an accurate estimate. They said “somewhere between 200 and 240 beats per minute”. They were absolutely not equipped to take care of me so either they would call an ambulance or I would sign a bunch of paperwork telling them that I had declined that offer so that I wouldn’t sue them. I wanted Clancy to drive me² to *at least* avoid that expense but she flat out refused explaining that she wouldn’t be able to forgive herself. She was already feeling bad for having indulging me as much as she had, when apparently my situation was far more severe than I had signalled.

In the ER, my heart rate peaked at 231. I was cold, clammy, sweaty. I wasn’t dying, but much further delay would have threatened permanent damage. And there were concerns about blood clots. It took about a half-hour to get my heart rate below 170, which was cause for celebration. More intervention and it stuck at about 140, which is my intense exercise heartrate except that I was literally just laying there. They were having to put so much in the way of “calm the heart down” drugs that they were making my blood pressure itself perilously low.

I was in the ICU for about three days while they tried various things to get my heartrate under control. One the second day they put a scope down my throat and zapped my heart, which was pretty successful (which is good because if that hadn’t worked they would have put the scope back down my throat and “fried” it, was the word that they used) but then I failed the stress test so they had to do a heart catheter. The heart cath turned out fine, though, so they let me go on the fourth day.

A day later I drove to Central Texas where, by the way, my second daughter was born very early on Halloween morning. That’s a story for another time.

The Angle:

There are a number of ways to approach this story. A testimonial of a heart scare. Missing the birth of my daughter while I was in a hospital across the state. But what really jumps out at me is how much time and energy I was spending with an out of control heart trying to verify which ER I could go to that wouldn’t risk financially breaking us. This is not a very realistic burden to put on people. It’s not a humane one.

Some will point to this and say “Single payer will fix this!” and they’re not wrong. Whatever problems may occur from single payer, it would fix this. The thing is, though, that there are other ways to fix this. Multiple other ways. I think the arguments for in-network and out-of-network with negotiated rates (versus consistent pricing) are weak at the start but however we manage that we need to find a way to do so that do not involve people risking heart failure trying to log onto a website to find out whether their hospital visit will cost $0 or upwards of $40,000. Any conceivable advantage to negotiating rates or giving patients “skin in the game” really doesn’t justify this sort of thing (at least when it comes to ER activity).

As it turns out, it looks like {fingers crossed} the hospital was in-network. My parents and brother both also said that the family would have taken care of me had it come down to it. So, in multiple ways, this isn’t about what would have happened to me personally if I’d incurred a giant medical bill. We wouldn’t have faced financial ruin in any event. It is, however, another reminded that whether you believe in single payer or market medicine, our system is not a defensible one.

1. Actually, the airport was contracted with a single ambulance agency, so it literally didn’t matter if we’d checked because there was only one ambulance authorized to enter and they were out of network…
2. I knew exactly where the hospital was. It was practically visible from the parking lot.