What it's like in the front lines of health care

From a colleague in a rural practice:

1)  I saw a new patient with no insurance a week ago Friday on Sept 4.  I told him the yeast infection he had in his throat was not usual at his age and that we needed to do further workup. He rejected it and would not let me do anything but give him a swish and swallow because of no money.  He died this last Saturday after an ER visit and an emergency laparotomy for an acute abdomen.  He had a perforated rectum from a stage 4 stomach cancer that had spread from his Barretts Esophagus.....a completely treatable issue if caught early.  He was 55 years old.  Today I treated his wife for anxiety and irreconcilable grief.

2)   For those who are following my patients as I mention them dying of health care neglect....the bed ridden 79 year old guy who would not see another MD and wouldn't accept any treatment because he was afraid the costs would leave his wife with no home, as he had no Medicare secondary.   He neglected his congestive heart failure that caused liver and kidney failure.  He passed last Wednesday;  at least he only worked up a several thousand dollar bill (his ear was scratched and started to bleed two days before he died and the family had to send him to hospital as the bleeding could not be stopped. The ear bled because he had another fall, just after the last week fall and the last month fall when he decided to get up and shoot the damn deer that was eating his wife's petunias)  The hospital said he had "cirrhosis" but I had been doing his blood tests, and had an ultrasound from a year ago....not very primary, the cirrhosis..  Probably directly because he would not see an MD for three months when he got CHF for fear of costs...

[congestive heart failure (CHF) can lead to blood backing up into the liver and produce signs that look like but are not cirrhosis of the liver]

I had to pretend to be buying his home picked blue berries and pretend to accidentally find him sick to get him on to diuretic treatment this last June... He was bedridden with 19 century medicine the last three months.

3)     Also for those who know about my previously mentioned patients:  the homeless man who was living under the covered bridge is now dead as well as of two weeks ago.  He had been employed until November 06 and should have been on SSDI because we helped him apply in 2008 before the 2 year deadline, but they rejected him because of inadequate documentation of his disability...schizophrenia and organic brain damage with seizures secondary to a beating by teenagers which resulted in blood coming out of his ear.  He couldn't get to an ER, and couldn't see to drive anywhere, had no family.  There is no outreach here, so he could not get to the city for a workup by the federally funded clinic.  My report and the report of the monthly visiting nurse practitioner from the clinic was not enough for SSI.  So he lived under the bridge until he died of some blow to the head that left a lot of blood all over the ground and that gave him a flight in a coma to the tertiary care center in [major city] where thay spent, I am sure, more than he ever made in his life in the last four days of his life.  If he had had SSDI he would have been in a local apartment (preventing the attack by another teen if that is what happened) and been on medication (that prevented the seizure and fall if that what was happened).  The county police called him a transient and have closed the case..  He wasn't transient, he was just an unemployed mill worker. Probably a quarter of this community is about 3 months away from possibly living the life he led in the last two years. People are not happy.  I will report if there is any vigilante activity.

     .  Welcome to 21 century American medicine;  at this point all I can do is document.