Right to Live
by Gordon Sun
Table of Contents|
parts: 1, 2, 3, 4
“I’m sure there’s an explanation.” Chapman’s face twisted. “But seriously, they don’t even have preventive coverage?”
“Probably a lousy job, no benefits.” Nguyen shrugged.
“Probably...” Chapman trailed off as Rodrigo and Schuster joined their conversation. “The numbers come back?”
“Yes, they did,” Schuster replied. “Should be on your tablet.”
Chapman tapped at the device, his eyes darting over the figures. “Is this right?” he asked quietly, pointing to the glucose reading: 406 mg/dL. “It’s almost six times upper limit of normal.”
“Machine was calibrated off the corporate standard this morning, sir,” Rodrigo replied.
“Bicarb’s low too,” Chapman said. “And the pH is 7.29...” The pediatrician fell silent, his face lined with worry.
Schuster and Rodrigo looked at each other. “You want me to retest the boy?” Rodrigo asked.
“No, there’s no need.” Chapman knew where this was headed: they needed a hospital.
Nguyen spoke up. “Should I contact—”
“Yes, make the call,” Chapman interrupted. The case manager ducked away. Turning to Schuster, he said, “Linda, get the IV supplies from the truck.”
“Done.” The nurse quickly left the room and headed out the front door.
“What’s going on?” Sue Miller’s voice suddenly cut in. “Why’s the nurse leaving?”
“Sorry,” Chapman said. “We were just finishing a conversation. Linda’s coming back shortly.” He whispered to Rodrigo, “Can you get the urinalysis equipment ready, too? Just in case.”
Rodrigo unpacked another device from the dolly, taking out a urine specimen cup and dipstick. Meanwhile, Chapman rejoined Sue and Danny Miller in the family room, sitting down heavily in an unoccupied chair. “I have some concerns,” he began.
“Concerns?” Sue asked, eyes widening.
“Yes.” The doctor rubbed his chin tiredly. “Although it’s quite possible your son simply has a bad stomach bug, our data suggest something more serious.”
“More serious?” Sue felt dizzy.
“Unfortunately, yes,” Chapman said. “What I’m seeing may be consistent with, ah, something called DKA. Diabetic ketoacidosis.”
“Wait, diabetes?” Sue asked incredulously. “How’s that possible? He’s a healthy boy.”
“Unfortunately, a third of all DKA cases involve newly diagnosed diabetes,” Chapman replied. “It can be triggered by any number of external factors. Stress, infection, certain medications, and so on.”
“Goddammit. This can’t be happening...” Sue closed her eyes. “Please tell me it’s treatable.”
“Yes. While Danny’s condition is serious, it’s treatable.”
Sue sighed in relief. “I don’t suppose it can be treated with a medication. Um, insulin?”
“Insulin is indeed part of the regimen. However, the overall treatment plan is highly complex and frankly unmanageable in a home setting. There’s also the issue of needing to rule out a few other conditions, also serious, that can cause DKA. We can start everything here, but we need to get Danny to a hospital right away.”
“Hold on,” Sue said. “A hospital?”
“White Sands is contracted with a few very good, very private in-patient facilities in the area. So, it’s no problem for me to bring in patients for hospitalization.”
“A hospital,” Sue repeated. “Christ, I can’t afford a hospital. How long is Danny gonna be there?”
“Excuse me,” Nguyen called out, waving a tablet in her hand. “We need to talk.”
“Oh, our case manager. Just in time,” Chapman sighed, and Nguyen joined their conversation. “Isabel, can you show her?”
“Of course.” Isabel flipped the tablet around.
Sue read the text and groaned. “The bill.”
“Yes.” Chapman leaned forward, elbows on knees. “At this point, we’ve completed standard consultative services. If we’re to continue, this outstanding balance must be cleared first. Excuse me, I think Linda is coming back with some supplies.” He went to the front door and let the nurse back inside.
“I paid 450 dollars already for the consultation,” Sue said to Nguyen.
“That was an initial contact fee, covering only the appointment and travel time,” the case manager responded. “It doesn’t cover professional fees and clinical services.”
Sue’s face darkened. “I don’t recall this being explained on the phone.”
“Again, the fee you mentioned covers booking of the home visit,” Nguyen continued. “There’s no way for anyone to know ahead of time what kind of testing will be done and what sort of intervention Dr. Chapman might recommend, which impact the incidental costs. This is why fees accrue over the duration of the visit and are tabulated at the end, the rates based on your insurer or aligned market rates. It’s no different than going to a dentist or optometrist.”
Sue got up slowly, trying not to wake her now fitfully dozing son. Then, clenching her teeth, she took Nguyen by the elbow and walked her away from the family room and into the hallway. “But eight thousand dollars? Really?” Sue hissed.
“We have to recoup costs like any business,” Nguyen said, shaking off Sue’s grip on the sleeve of her business suit. “Put yourself in our shoes. If we can’t afford to stay open, we can’t help anyone. You can’t expect us to treat people for free, right?”
“But it’s such a ridiculous amount,” Sue said.
“It’s actually par for the local market,” Nguyen replied bluntly, frown lines appearing in her forehead.
“Well, it’s totally unreasonable,” Sue asserted. “I mean, I already know hospitalization is just not affordable. I... I’m not gonna be able to do this without at least some kind of installment plan.”
“We no longer accept installments. All payments are upfront. Too many people trying to dodge bills nowadays. And frankly we don’t like working with debt collectors. It’s a hassle.”
“What the hell.” Sue shook her head in disbelief.
Chapman, who had been talking with Schuster separately, now rejoined the group. “I hope things are being worked out,” he said. “I strongly urge that we get Danny to a hospital as soon as possible. He’s not looking well. At the very least we need to get an IV in him and start some fluids.”
“Well, why are you telling me?” Sue asked crossly. “Just do it already.”
“Well, you see, there’s the matter of...” Chapman trailed off, nodding at Nguyen.
Nguyen tapped on her tablet. “It will be 945 dollars for the IV placement and equipment, plus 1 liter of normal saline solution.”
“Oh, hell.” Sue scowled. “This can’t be happening. That’s extra, too?”
“Ms. Miller, whatever we do here from this point on is meaningless if we can’t monitor the boy in a controlled environment with all the proper medications and tools. We can only do this in a hospital. Home visits are best for health maintenance, diagnosis, minor illnesses—”
“Dr. Chapman,” Schuster called out, “we may have a problem.”
“What is it?”
“Danny’s having trouble waking up.”
“Oh, that’s bad,” Chapman said. The group rushed back to the couch. Sue knelt by her son, shouting “Danny! Danny! Wake up!” into his ear and shaking his shoulder vigorously. Danny moaned incomprehensibly. His eyes opened briefly but were unfocused and glazed over.
Chapman crouched down, pulling an electronic stethoscope out of a coat pocket. “Need to listen for myself,” he murmured. The pediatrician secured the earpieces in his own ear canals and placed the bell over Danny’s chest. Danny was still breathing on his own but more rapidly. Chapman also noticed that the boy’s skin was now sweaty and pale.
“Marc, Linda, I need a new set of vitals, and get the CGM and airway kits out. Just in case.”
“Anything else?” Linda asked.
“Did you bring the insulin?”
“I don’t understand, what’s happening to Danny?” Sue said in growing panic.
“Your son needs immediate medical attention,” Chapman said. “His situation is going to decline the longer we wait.”
“Then treat him, goddammit!” Sue snapped. “You’re the doctor!”
“Isabel, please,” Chapman said in exasperation.
The case manager came forward. “Every intervention we do here or in the hospital will add up. Here.” She showed them the table, where the “initial” cost of $8,000 was grayed out in a corner of the screen. Starting with the IV and the saline solution, a running tab of studies and treatments recommended by the physician had begun in the middle third of the screen, a blurry scroll of numbers that had already climbed past $35,000.
Susan’s head spun in confusion. “What’s this?” she finally managed to say.
“It’s the cost of care,” Nguyen replied.
“And you want this paid out now?”
“The 8,000 dollars, yes. The moving number... well, we wanted to show you in real-time what the costs are. We do this for all our new clients.”
“I don’t believe this. I don’t believe this,” Sue said angrily. “This is... sick.”
“We’re giving you fair warning, that’s all,” Nguyen said. “You don’t have insurance, so in the interest of transparency we’re showing you exactly how much everything costs.”
Sue’s back started to throb again. “And you won’t start further treatment until I pay 8,000 dollars?”
There was a brief silence. “Yes, per our clinical policy.”
“How high is it gonna go, the cost of Danny’s care?”
“I don’t know. You’ll have to ask Dr. Chapman about treatment regimens. Hopefully he recovers quickly.” Nguyen’s voice was cold, detached.
“And if I can’t pay?” Sue asked. Her voice became pleading, her eyes reddening. “I literally work 80-plus hours a week at a job with no benefits. I can’t afford child care, healthcare, anything beyond... beyond the basics. Dammit.” Sue wiped her eyes with her fingers.
“Then I hope you figure something out.” The case manager paused. “Well, there’s always the other option.”
“What other option?” Sue asked.
“The MOM Act.”
“The MOM — no, that’s unacceptable.” Sue’s tone immediately soured. “We are not going there.”
“We have a contact, Sergeant Brandt, in the local recruiter’s office,” Nguyen continued. “He can help. I’m sure you’d pre-qualify without a problem.”
“I’m not gonna enlist.”
“Why not? You know the law: if you lack sufficient assets, they’ll pay for all medical care for you and your dependents immediately upon signing up, with some deployment contingencies. It’s quite straightforward. They’ll even pay for medical or dental school if you’re accepted, obviously subject to academic performance and such. Medicine or Military. Simple choice.”
“You talk about this so easily, like you read it in a book,” Sue said bitterly, tears beginning to trickle down her face.
“You need to serve for only ten years to be in the clear,” Nguyen was on autopilot. “Marc’s a veteran.” The technician nodded in acknowledgment.
“I have a bad back,” Sue replied in disgust. “It’s not like I’m gonna be of any use.”
“The whole point of the MOM Act is that you don’t have to be especially healthy to serve. Good enough for government—”
“And get deployed?” Sue continued, wiping her eyes. “You think I don’t know the odds of that? My sister’s a Marine. She’s spending her glory years driving a truck or God knows what in the Pacific. I just know someday I’m gonna get an email saying she’s been killed in—”
“Hold on,” Nguyen said. “Maybe—”
“This isn’t about me,” Sue interrupted. “It’s about my son. And tell me, who’s gonna take care of my son when I’m gone? Danny’s got no one. No one!”
“You realize they’re discussing a mandatory draft now. It could all be a moot—”
“What the hell do you care?” Sue yelled. “You sick little bitch. All of you—”
“Okay, I think we all need to refocus on what’s important here,” Chapman said, waving his case manager away. “Danny needs care. He can get it, but you’ll have to pay the consultation bill now and be able to guarantee payment upon discharge from the hospital once Danny’s recovered. I just want what’s best for Danny.”
“What’s best for Danny is for you to do your job!” Sue snarled.
“Believe me, I wish there were a better way. But if we start giving out freebies to everyone, our business would be kaput.” Chapman shrugged in resignation. “Look, this is hardly the first time we’ve been in this situation. We can make some calls. The MOM Act was written specifically with scenarios like this in mind, okay? Sergeant Brandt will help you out, try to ensure that they don’t send you off somewhere until after Danny’s better and safely at home. But you’re going to have to decide, sooner or later, what’s more important.”
The vital sign monitors continued to beep softly.
Copyright © 2019 by Gordon Sun