Digging for dollars
Feb 2nd, 2008 by Terry
There is a surgeon who comes to our hospital who performs only one type of surgery. Nothing unusual about that, is there?
He actually is on staff at several area hospitals, doing surgery at each one about once a week.
But what distinguishes this surgeon from all the others is the nature of his business. He is known as the nursing home surgeon, or more fondly, Dr. Gome from the Home. His clientele are the patients who cannot speak for themselves, and frequently have no one to advocate for them. They have been turfed out to nursing homes, where their sub-par care expresses itself in large (did I say MASSIVE?) bedsores that require his excavation services.
Which is exactly what he does. These patients, with varying levels of consciousness, are put to sleep by us in order that Dr. Gome may scrape out their gaping sacral and hip wounds. Most of them have incurred strokes or other insults that have reduced their mental capabilities, are all bent up and contractured from months of just lying in bed not moving or being turned, and are not all that aware of their surroundings or their situations.
Now, this isn’t the first time I’ve written about these defenseless patients, but I can never take care of them without wondering about Dr. Gome. How does one do this for a living? What are the perks and satisfactions besides his paycheck? How does he view his role? He is basically a technician; he establishes no relationship with these people. He can’t; they are like meat.
So, um, er, I gingerly asked him one day about the task that he has at hand, and how he views it. His reply:
I’m just the clean-up guy. I didn’t see ‘em before they got like this, and I never see ‘em again after this.
Which is true. And there you have it, folks. Dr. Gome, the clean-up guy. For the family that wants everything done, and for the patient who has had nothing done for them. Until now.
How tragic! Dr. Gome sounds like a vulture. Can you refer these patients to social service? Bedsores of the size you are describing are an issue that licensing agencies should address.
Onehealthpro
Ah, the clean up guy…
It may well be that many people see this fellow as a vulture, but let us not forget, vultures are an important part of nature. Don’t we need the ‘clean up guy’?
Sure, it may seem like a compassionless job, but is it? Noone else is there for these people, but him. Their families have left them for dead but decided to extend their suffering indefinitely, the law will allow noone to end their suffering and they have been locked away in a modern sanatorium. Afterall, if we had to see them everyday we would then have to question the laws surrounding euthanasia, can’t have that now can we? (insert sarcasm here).
So, is it the ‘clean up guy’ we should be questioning or law that force people to become breathing husks that we should question? This is particularly true when we see so many of these patients who would never want to live this way. If asked (or actually informed?), I wonder how many people, regardless of religion, would choose to live in such a way?
Maybe the clean up guy is the ONLY one with any compassion for those we have shut away for fear of confronting faith derived convictions which have sentenced them to continual suffering? At least the clean up guy is doing something….
You’ve made some excellent points. I am not convinced of Dr. Gome’s compassion, though. It appears to me that the only thing he is doing is prolonging their truly wretched existence.
As to the “bigger” picture, I’m totally with you there. I am hopeful that with our upcoming elections and a new administration in the Oval Office, this very issue can get some attention and be addressed.
Thanks for your comments, and for reading my blog.
We have a doc like this at our place. My preceptor called him “Dr. Chop”. He amputates in stages, so he gets more business, or at least, that’s how it looks, anyway.
Pt. gets metatarsal amp, waits a little bit, gets infected, gets a BKA, waits, then gets an AKA.
I didn’t really believe this until I saw the first three pts. A few things in common–All diabetics and all had the same surgeon.
He’s got to be pretty darn good at this though. If my family needed bedsore maintenence, sounds like he’d be the best man for the job.
Maybe the best way to avoid the bedsores and pathetic state of some nursing homes is to avoid nursing homes whenever possible. There are state-level pilot projects and Medicaid waivers for providing home-based nursing to elderly adults. Imagine the dignity, comfort, and independence (as well as one-on-one attention/care) this would provide. Still requires oversight, of course, but I think it’s preferable to institutionalization.
I’d like to see these programs become the norm wherever possible. Essentially, this is the same type of care my daughter, Hannah, receives at home under a Medicaid waiver. We’ve been able to raise her at home, with all her family and friends’ support, as a result.