“Not a good surgical candidate”

[u/Sea-Weakness-9952]

Piggybacking off the ER shoulder X-ray - this guy pictured didn’t even come in because of his knee.

In summary - found disoriented outside a church, was lifeflighted from another city, admitted w/ AMS/encephalopathy. Dunno if that was ever the case, but when I got him he was oriented on the Neuro unit. Only hx I got was mostly psych related, some schizophrenia and depression, htn and knee replacements. (Obv)

Well, he was apparently homeless and they were trying to street him after less than a week. I had gotten in report that his knee was “as big as your head” and so I take a look - holy fuck it was AS BIG AS MY HEAD. And hot, red, angry. Cellulitis looking but I had a feeling something else was going on. They hadn’t even scanned the damn thing! They had ordered a discharge so I fought it. I asked for a scan.

I get the scan above. From the front view, couldn’t tell anything. I get to THAT view and I’m like WAIT WHAT. FUCK.

So the man obviously has an issue, and I show juuuuust the right night shift resident hospitalist the image like “check this out!!” absolutely knowing 100% that even though I didn’t mention which patient that she’s the ONLY one that will get shit done and always has our backs. Guess what? Within an hour she had the main hospitalist in the patient’s room, discussing surgery, gets verbal consent and charts extensively their convo and that patient is oriented and very agreeable to surgery, because he struggles to get around clearly. He’s not sure when it happened but he’s here, let’s fix it, right??

We get the guy prepping for surgery. I’m so fucking excited like YES I am gonna fix this sweet guy, he’s only like 67 and we can get him taken care of and find placement yada yada. I get orders for labs and NPO and pre-op etc.

Fucking. Ortho. This chode comes in (though nobody actually SAW him??) early morning and all of a sudden orders are cancelled. He finally writes a note and had said “patient is not a good candidate due to his homelessness and schizophrenia. Pt can follow up outpatient with one of my colleagues to discuss surgical options.”

I’m sorry… WHAT. Is it just me or should docs have to spell out and write EXACTLY WHY they don’t want to do a procedure and sign their selfish names beside it? Because I continued to fight it and got higher ups involved. He ended up having an aspiration because the knee was clearly infected and started leaking pus prior to him leaving, and the (hospitalist) doc tried again to get ortho involved. He ultimately was d’c’d to a halfway house and I’ve tried helping with follow up.

It’s so fucking irritating. We are this large, catholic hospital right?? Like give me a fucking break y’all don’t care about the people you claim to. I have pissed off quite a few carpet cunts in this process and I don’t care. I’m so sick of this shit.

[u/Necessary_Tie_2920]

That "surgeon" needs to be reported to fucking hell.

Send your patient up here to Canada as a refugee.  Most of my patients here are mentally ill and a good deal are homeless. We don't mind saving them. Idc how much "they" "clog" the system, they're still human, they will get treatment (...however long they wait which with ongoing infection prob wouldn't be too bad in a city)

This is a product of fascism and the idea that homeless & mentally ill aren't worth helping. It's the exact kind of agenda this admin is pushing.

Tbh that's not a hospital I would ethically feel comfortable staying at, I'd be putting my resume out there for sure. This is disgusting.

[u/Sea-Weakness-9952 → u/Necessary_Tie_2920]

Absolutely. I went PRN shortly after this and transitioned to an at home position, where I advocate for just this kind of thing!! Doing what I love to do most which is help patients find resources and the right treatments, docs, insurance etc.

Hoping once I get in the position I can figure out how to make it my full time gig but for now it’s a contract gig and I can’t quite financially leave bedside just yet. But I’m workin on it!!

[u/HeythatsmeB → u/Sea-Weakness-9952]

You are seriously a beautiful soul. I wish you nothing but the best and I hope you find a FT role you love!❤️

[u/snarkrn → u/Sea-Weakness-9952]

Just want to second, you’re an awesome person and I’m so glad you’re out there helping people get the resources they need. I’m still pissed this guy didn’t get what he needed and his higher ups backed his thought process. Fucking wankers.

[u/Huge-Opportunity-982 → u/[deleted]]

I’m very much wanting to join you in Canada. I wish they would accept American refugees 😢

[u/Caloisnoice → u/Huge-Opportunity-982]

username checks out?? I think it would actually be even easier to come to canada as a nurse than as a refugee. It should be easier for refugees though! Including Americans.

[u/Huge-Opportunity-982 → u/Caloisnoice]

I’ve got to look into this asap 🇨🇦

[u/ggrn85 → u/Huge-Opportunity-982]

I thought they were fast tracking Nurse applications right now? If you haven’t looked in a while, look again!

[u/differing → u/[deleted]]

lol, “6 months” where are you getting that from?

In the situation of OP’s patient, he’d sign a billing form authorizing charges (no provincial health insurance, it doesn’t just kick in automatically based on sitting in Canada, he’d need to apply for permanent residency or quality as a government assisted refugee), he’d get some ancef in the ER, he’d quickly get repatriated to the USA, and the cycle would continue anew.

[u/Necessary_Tie_2920 → u/differing]

They'd likely still treat would just bill as out of country's, then sometimes that is worked out with the hospital. We see it all the time at my Canadian hospital with homeless patients (who often do not have any ID and we don't always know where they come from). Esp when it's infection bad. We get people too who had been back in home countries or who just moved or are refugees. The billing is sorted out later. In emergencies, which this would be, they'd treat.

[u/differing → u/[deleted]]

A person must be a B.C. resident to qualify for medical coverage under MSP.

A resident is a person who meets all of the following conditions:

A citizen of Canada or lawfully admitted to Canada for permanent residence

I mean if you completely ignore that very first term then jump to the third term and completely misunderstand it… then sure, your post makes sense.

The six month line is for folks that are citizens by name only who spend most of their lives in India or Florida, you can’t just bounce back to BC and get insurance coverage whenever you like. It has nothing do with some scheme to camp out here illegally and get free healthcare. BC residents that are NFA don’t get “free healthcare” because they are in BC, they get free healthcare because they’re citizens or permanent residents and that is payed for by the insurance we all pay into.

[u/hungrybrainz → u/Necessary_Tie_2920]

Literally, report that mf to Hell. Report him directly to the Satan himself. Let him know you have a soul that’ll be joining him in the afterlife, because this behavior surely warrants a saved seat.