Making that hospital cheddar

Drug pricing is really strange, and even more so in a hospital where the costs are completely hidden from the customer. We sold some lady a bottle of 100 tabs of 500 mg acetaminophen for $12. You can get five times the number for $9 on Amazon. We also had some weird formulation of some anti-spasmodic, maybe gablofen or cyclobenzaprine or something. It cost $400 but the official price is $8000 (which I think is a cash price but insurance and medicare might get discounts.

It reminded me of that story in Time a while back about how outrageous medical prices are and how people who didn’t have insurance or had shitty insurance were completely fucked by hospital cash prices. Except if you’re supported by the Saudi royal family, I guess.


Muscular dystrophy is scary as fuck

I haven’t been talking about the hospital because there’s been some drama in terms of some other people at the site and the preceptor and the school’s department. It’s kind of a pending mess but I don’t think I’ll get in too much trouble.

Anyway, today we saw a 18 year old kid with muscular dystrophy. It was the stuff of nightmares. He was in a wheelchair, and he had a normal size head on a nine year old’s body, all thin and frail and atrophied. He could still move his head and his face, but everything else was mostly paralyzed by not having muscles. He was mentally 100% there, just didn’t have any muscle tone. His family was there. They looked upper-middle class. The dad was a large man, the kind of guy who probably was expecting a kid he could throw a football with. The mom was dressed nicely and generally patient.

Also last week I saw some more adopted kids. Like, the mom was white and the kid was very black and I just wonder why you’d adopt a kid who wouldn’t live into adulthood.

Not to put a racial thing on it, but I find that the white kids are usually in for genetic disease while the black kids are in for preventable disease. Like one kid had fetal alcohol syndrome, and another was playing jumping on and off a moving train and severed both legs. Race, man.

Money might not buy love, but it will buy medical care.

So I was rounding in the pediatric ICU and we were standing in a big group. The kid wasn’t mobile or alert, and had breathing problems. I didn’t know exactly what was wrong with him, some sort of palsy or brain damage I would guess. It might have been genetic because I think he had a brother in the ICU too.

So we’re just standing in a circle talking, and then the parents walk in. The dad is impeccably dressed in a casual suit. The mom is wearing a burka. Not a hijab, a full-on burka. He walks over like he owned the place and the nurses (all female) immediate scoot out of his way, while the MDs/pharmacist/me (all male) don’t budge an inch. The hospital likes treating foreign Saudis because they pay for their month-long stays in the ICU with cash.

Edit: Two minutes after they walked by, a big fat jewish doctor waddles past us wearing a yamaka, and with that willow-y hair that hasids have. Multicuturalism is weird.

Day 3: Endless Meetings

Today I sat in endless meetings, at first with a clinical pharmacist, and then with the pharmacy manager. First I met with some palliative care people, there was a chaplain and some nurses, and some people with letters after their name that I’ve never seen before. Everyone was female but me. They were talking about the fucked up kids who were the most fucked up of all and their stays would last months and they would talk about the families and stuff in more depth. Turns out that people with fucked up kids tend not to have good families.

Then I sat in a meeting about PCA, patient controlled analgesia, which is where the patient presses a button on a machine to get a hit of morphine. There was something about nurses or doctors inputting information incorrectly into the machine, and the number and position of tubes that come out. Also the pharmacy manager talked about changing the hospital drug order sheet because some doctors were filling it out wrong. The hospital still takes physician orders on paper because the electronic system is shit. Sometimes a nurse walks it to the window, or they can come via a pneumatic tube system. Everyone at the meeting was female but me.

Then I walked to one of the pharmacists for half an hour about random shit, like school and the profession and how shit retail is.

Then I go to a long meeting that’s like a training for nurses where they talked about pain; the pharmacist talked about pain meds and used sophomoric examples to illustrate shit how the various medications work. Also a male RN talked the one-to-ten pain scale with the faces and stuff.

I followed around the really materialistic Chinese pharmacist. She had a giant rolly bag, like the carry-ons people take onto planes. It was Chanel. She was dressed in expensive clothes, and decked out in jewelry as per ushe. She told me that she holds the record for highest GPA ever in the pharmacy program. She graduated with a 3.96. She likes to dispense random advice. She gave me that quote today about teaching as the kindling of a flame and not the filling of a bucket. That was Socrates and she really bungled it.

Also when she was on rotation a few years ago, someone brought a goldfish into her Walgreens and told her it was constipated because they hadn’t changed the water and it was still clear. She suggested mineral oil (and then I laughed in her face as she said it because that def wouldn’t work) and then she suggest Miralax (or was it senna?) and that worked apparently.

Anyway, she’s basically the perfect product of the Tiger Mother and the child that all Chinese parents would want. It’s disgusting.

Parenthood: First Impressions from a Children’s Hospital

My second relatively fun day at a Children’s hospital. I went on rounds and one of the cases was a girl with autism and epilepsy. The mom wouldn’t give the kid any anti-epilepsy drugs. She was treating her with herbs and vitamins and shit. She had milk thistle on, and some supplements like zinc and lithium, and she fed her kid some special formula with bizarre ingredients that it took the hospital five days to ship in. Also the kid was on some diet, not even a fad diet, but like a diet straight off a wacko health site where the kid ate fermented food — not even normal fermented food like cheese and stuff, but like weird meats and foul broth. Internet healers think it’ll cure autism, which she thinks was caused by the MMR vaccine. Her kid was a frequent flier. She had been to several other children’s hospitals, and her mom had lists of which doctors could and couldn’t treat her kid, like obviously she was dismissing the doctors who weren’t okay with her retardation. Be glad at least that natural selection is removing her from the gene pool by killing her offspring.

Also we talked to several parents today during discharge, none of them looked happy. Their kids to be fair are extremely fucked up and wheelchair bound and full of palsy and seizures and every sort of human frailty.

One white couple had clearly adopted an asian girl, and I guess the girl probably had neonatal problems because she was real messed up. So that sucks for the parents, who just wanted to have a kid but will probably inherit a living breathing heartache if the kid doesn’t die soon (prediction: the kid is going to die soon).

Hospital rotation — first impressions

First day at a children’s hospital. They have kids who are really fucked up, like they have palsy and seizures and neuropathy so they can’t eat or walk or breathe. Erryone rolling all day in they wheelchairs. They see the kids who have intense problems, congenital deformities or like car crashes and burns and stuff. They also have some kids from an Arabic oil country whose government apparently pays exorbitant prices for US healthcare, and those families try to prolong their stays as long as possible even though their kids are pretty stable.

I was reading a case today, and the mother had all sorts of fucked up genetic problems, and then she went ahead and had kids, and her kid had fucked up genetic problems. Also she smoked all through her pregnancy. Fucking people.

But the people at the hospital are pretty cool, much better than what I did last semester. They’re actually interesting, unlike my mentor last summer, who was like the archetypical maidenaunt from an Ibsen play.

The two central pharmacists today were Chinese. One of them doesn’t do anything. The whole time I was there, she was looking at jewelry and talking about her dog. She gave me some pretty good life advice. She was actually really smart, but she epitomized nouveau riche. She cared about brands and status and salary, like that stuff was front and center. That’s a big problem with Chinese and Koreans. They readily jettison their traditional values and replace them with materialism, but it’s fine because at least she had a sassy personality and a sense of humor. She talked about the Great Gatsby party she went to. You know someone missed the point of The Great Gatsby when they go to parties like that.

The other central pharmacist is my mentor person, who’s responsible for making sure I don’t kill anyone. She’s half cambodian, half chinese. She has really round eyes and double eyelids, not sure if she had the Asian eye surgery. She’s really outgoing and friendly. The pharmacy has really good banter, although everyone is female.

Also an old white dude who used to be the pharmacy director took me to lunch (the cafeteria). It was alright. He seemed to be one of those types in half retirement, quietly wandering the supermarket aisles of his professional career.

Hamburger Helper was legitimately a shit TA

So my old insane roommate Hamburger Helper was my TA and quickly established her reputation as a really bad TA. She was really strict and everyone thought she was weird and hated her. I had already made up my mind about her, so I couldn’t objectively judge her as a TA, but Sticks just told me that the lab director called her into her office one day and asked her what was wrong because she had gotten the lowest reviews in TA history. I treated her normally, mostly because I was afraid of her. Her coworkers are apparently afraid of her.

It’s nice to have one’s hatred vindicated by public opinion.