Splinter From Hell

I was in the process of moving and when I went to lift up the base of my bed I got a splinter in my finger.

(Holds up right 2nd digit with piece of wood protruding from the medial and lateral sides just above the Dip joint.)

Great, I’m thinking. This is going to be a pain in the ass. Well sir, I’ll numb your finger and give it a gentle attempt at removal, but I think you’re going to need a hand surgeon to get that thing out. When was your last tetanus shot?
I have no idea (shakes head).

A gram of rocephin and a Td later, a little lido and bupivacaine later and the finger is dead to the world. Ok, which side did the splinter enter the finger (points to lateral side. He had attempted to pull it out himself and had broken the wood off just under the skin. On the medial side of the finger a small part of the splinter was still protruding.)

I really did not want to do this as the most likely thing that was going to happen is that the wood is going to break off in little pieces. It had been in the finger about 1 ½ hours now so it had absorbed much moisture and swollen against whatever tissue it penetrated.

After slightly enlarging the hole with a number 11 blade I gave one gentle little tug with a forcep, and, crap, just a little piece broken off. That’s it for my attempt. All I can do for you now is make matters worse. I’ll go call the hand surgeon on call and see if he can take care of you today.

I made the first call myself as the unit clerk was busy perusing the Avon catalog. Hello Dr. A., I went through the story.

What insurance does he have?

Damn, the wallet biopsy. Flips papers, uh, looks like Cigna HMO.

I don’t take that one, find someone else, click.

I trundle off to the ER to ask the docs which hand surgeon takes Cigna. The doc there has no idea. I ask the clerk which hand surgeon takes Cigna. She has no clue. I trundle off to the UC and wake up the clerk and try to get her to find out which hand surgeon take Cigna.

Clerk spends 30 minutes flipping through papers.

I can’t find it.

Well call the Cigna on call IM and see if he can help us. He should know who is the hand surgeon on call.

More time passes.

More time passes.

Call the Cigna IM again.

More time passes.

Finally the Cigna IM calls back. I go through my whole spiel again.
No body at your hospital takes Cigna. Send him to another hospital, click.

I go and update the patient on the previous conversations. Can I have your Cigna card so I can call them myself.

Sure he says as he digs through his wallet and finds the card.
Giving the card to the unit secretary. Call Cigna and ask them who we can call to take care of this patient. I go off and try and see more patients who are now standing in the hallway staring at me.

(Tip, standing in the hall staring at us, docs, nurses, techs, just pisses us off, and won’t get you treated faster. If you have a legitimate complaint, call the nurse and discuss it with him.)

More time passes.

I finish a couple patients and notice the unit secretary staring at the patient's Cigna card. I keep calling the number but it’s always busy. A little bell goes off in my head.

What number are you calling?

This number right here, pointing to the patients PCP’s number.

No, don’t call him, call the member service number and ask them which hand surgeons are in this part of town.

I trundle off to see more patients.

More time passes.

I come back from the ER after spending 20 minutes trying to go over the patients charts with the doctors. They don’t want to co-sign (a hospital policy, made by physicians) any ones charts now because they no longer get paid for the work we do. The unit secretary is back to reading the Avon catalog. What did you find out from Cigna?

They refused to talk to me. They said I had to have the hospitals CID number before they could tell me which hand surgeons take Cigna.

I waddle off to the ER again, past patients milling in the hallway and staring at me. How I would love to carry a cattle prod and shoo them back into their rooms.

I spoke to the medical director and he suggested I call Cigna back and get a list of Cigna doctors. If I was unable to get any of the Cigna docs to take him then I was to call Dr. A. back and tell him he has to take the patient.

The unit secretary went and got the mysterious CID number and called them back. They gave us a list of names, the closest of which was over 30 miles away. Keep in mind it’s now about 15:30 and we started about 13:00.

The other physician pipes up that Dr. B. takes Cigna, call him.

While the secretary calls Cigna, I call the hand surgeon. His staff, (damn their little hearts, you’ll see later) tell me he is booked and can’t take any patients today or tomorrow. Can I talk to the doctor myself? No, click.

The secretary called twelve physicians offices and was shut down each time. I called one surgeon who said he couldn’t take the patient but he had a central Cigna call list, just hold and I’ll get it for you. After 10 minutes I handed the phone to the RN and asked him to take down the number. He handed the phone to the tech after about 10 minutes. Another 10 minutes passed and a woman came on the line and gave him a number to call.

The unit secretary called the number and found out it really was not a call list of physicians on call. It was a list of physicians by specialty. We already had that.
I go and try and see some patients. When I look up again I see it’s approaching 16:00.

Call the hand surgeon on call again. I go and see more patients.

Twenty minutes goes by.

Call the surgeon on call again please.

I try and see some patients. At this point the triage nurse decided to send every patient that walked through the door whether they met criteria or not. Fourteen patients triaged to UC in one hour. Great, that’s more patients than I can see in the rest of the shift if you take into account the admissions and other inappropriate patients she dumped on me. Including the urinary retention who had a prostate the size of a basketball. After five calls to the urologist I was able to convince him to see the patient. He had a stricture and had the urologist had to use the scope and a bunch of uro tools to fix him.

Seventeen-hundred rolls around and the on call surgeon has not called back. Call him again, I request.

Five minutes later his PA calls back and detects the frustration in my voice. He agrees to see the patient after I go through the list of doctors we have already called, including Cigna.

While I am on the phone with the PA, Dr. B. calls. I tell the PA that unless he hears from me I’ll send the patient to him in the morning.

I get on the phone with a very polite Dr. B. He listens to a report of the patient who has now been NPO since the AM, and tells me to send the patient directly to his office for surgery. Which we do.

If his hellish office minions had let me speak with him this whole dog and pony show could have been avoided. Here in is one of lifes rules.

links: digg this    del.icio.us    technorati    reddit