Children'S Hospital Discharge Papers: Fill & Download for Free

Modern vaccines are incredibly safe. They have to be since they're given to healthy people, and often in very large numbers (hundreds of millions) so that even very rare adverse effects will be detected.That said it's worth discussing three vaccines that are/were relatively unsafe: (1) Vaccinia (no longer routinely used); (2) RSV vaccine (never fully introduced); (3) rotavirus vaccine (withdrawn from the market).Vaccinia (the vaccine against smallpox) has the highest adverse effect rate of all the commonly-used vaccines of the 20th century. Serious adverse effects from vaccinia occurred in roughly 1/300,000 recipients; death, in about 1 in a million. That's pretty safe, as just about anything goes (only slightly higher than the risk of dying from lightning strike), but again, the bar for vaccines has to be very, very high, and once smallpox was eradicated the widespread use of vaccinia was stopped.The RSV vaccine story is tragic, if interesting. Respiratory syncytial virus (RSV) is an extremely common virus of children; it only causes severe disease in a tiny fraction of infections, but because it's so common it ends up accounting for many childhood hospitalizations and deaths. A vaccine made in the 1960s didn't cause any harm directly, but actually made subsequent RSV infection more serious in many cases - the opposite of expected. I believe this was detected during clinical trials, so a relatively limited number of people were vaccinated, fortunately. (More information on my blog at http://www.iayork.com/MysteryRays/2009/01/14/why-a-vaccine-failed-and-maybe-a-fix/)Rotavirus, like RSV, is a very, very common childhood infection that causes large numbers of hospitalizations even though most cases are mild. One vaccine was introduced that turned out to cause very rare severe adverse effects - between 1/10,000 and 1/30,000 recipients. Their clinical trials didn't have the power to detect such rare events, but after they showed up the vaccine was withdrawn and was subsequently replaced by different ones that don't have these effects.The positive effects of these new rotavirus vaccines, by the way, seem to be spectacular, vastly reducing childhood diarrhea - see the graphs I reproduced at http://www.iayork.com/MysteryRays/2010/04/20/rotavirus-vaccine-and-herd-immunity/ or read the paper -Reduction in Acute Gastroenteritis Hospitalizations among US Children After Introduction of Rotavirus Vaccine: Analysis of Hospital Discharge Data from 18 US StatesCurns, A., Steiner, C., Barrett, M., Hunter, K., Wilson, E., & Parashar, U.J Infect Dis. (2010) 201 (11): 1617-1624http://jid.oxfordjournals.org/content/201/11/1617It is almost certain that the withdrawn vaccine would have similarly prevented rotavirus infection, saving vastly more lives than the very rare adverse effects took; but lives saved by vaccines are invisible, while deaths are not, and vaccines are not susceptible to the ordinary sort of cost-benefit calculations that actuaries perform.As another side note to the rotavirus vaccine withdrawal, it nicely disproves one of the main contentions of the anti-vaccine loons, who like to claim that adverse effects are common, yet ignored for profit. Here we have a very rare adverse effect that was quickly detected and that led to prompt (and costly) removal of the vaccine from the marketplace - exactly the sort of thing they claim doesn't happen.

She always turned up. Every few months.Pale, cachetic, with the smell that only blood drying on clothes for days can make.I've been bleeding again. A lot.Vomit or stool?Both. For days. I've lost count how much.Alone?Alone.So pale, So thin. Like paper. I knew her history from memory. NCPF. I knew the blood bank would remember her too.One bag, two, sometimes eight over a period of hours. The haggling with the blood bank would be incessant after the first two to four life saving bags granted. Ask her relatives to donate!, the say. That's your job, her group is rare, we can't spare no more.We wouldn't give up. Persuasion. Promises of departmental blood donation drive, whatever it took.Drip by drip the blood would trickle into her veins bringing her back, only to flow out again.NCPF wasn't a terminal diagnosis. It was painful to watch this cycle. We advised drugs, She went off them. I felt she couldn't afford them beyond a point. We tried octreotide that came in hospital supply, and terlipressin that we paid for from money collected by residents and purchased by guard bhaiya.She didn't go to the gastroenterologist for banding despite repeated requests.Irritable and aged,in considerable pain. Unpleasant. Seeing her for rounds filled me with despair, frustration, anger and most of all, pity. Navigating through those emotions, I tried my best with what I had.She took what we could give her, and then we discharged her once stable.Each time she was discharged, her son, her able bodied and earning adult son would pick her up. Moments that I did get to see him, I would ask. Threaten with fatal consequences. Explain the disease, even advised to go to other hospitals where interventions could be done. Cajoled, all but begged.To no avail.There were other sons who I never saw.Daughters whose phone numbers I tried, the ringing clear as bells, never interrupted.This time she was admitted when she was too far gone. Refractory hemorrhagic shock. Her bag fell on my shoes as they wheeled her in.Out came all the discharge papers some penned in my unruly hand, some in my co residents pearly writing. Lists upon lists of medicines that I knew she didn't take. Referrals that were never followed.She passed away, in the midst of day, as if melting into the stark white sheet that covered the bed.Her whole family came to ask what went wrong with the treatment, to lament on the loss of their mother.To lament, not to grieve.A woman died alone of a manageable disease with living adult children who could have helped her. They failed her. The system that is poorly equipped to deal with illnesses and without enough infrastructure failed her. That she was mourned in death but ignored in life,the society failed her.That cases such as these would be shared or remembered by my fellow doctors across our country is the darkest fact of all.That in today's climate,despite a doctor's best efforts, while reeling from the loss of a patient, the doctor may be blamed, assaulted and attacked is perhaps darker still.

Original question: Why do people in America die due to lack of health insurance if it is illegal for a hospital to not treat you due to a lack of ability to pay?There’s a phrase in the American healthcare system that describes this. It’s called “Treat and Street”. The only requirement in the law is that a patient who is *actively dying* or in active labor must be stabilized or allowed to give birth. That’s it. Nothing else is guaranteed. No medications, long term care, no follow up. Nothing. They can write you prescriptions, but they don’t have to provide the medication. Not even the first dose.Have cancer, diabetes, or literally any other long term chronic illness? Sorry, nothing for you if you’re not dying.Actively dying? They’ll start your heart, get you breathing, but as soon as you’re able to do that on your own it’s back onto the street with you.Treat and Street.My fiance is disabled. During the eight year struggle to get him on social security disability (not for the money, we didn’t care about that, we just wanted that sweet, sweet, medicaid coverage so he could see a regular doctor), our only option for healthcare was the emergency room. In my state at the time, you could only qualify for medicaid if you were under the age of 18, pregnant, blind, over 65, or receiving social security disability or ssi payments. That’s it. Since he didn’t fit any of those categories, he didn’t qualify, and since my job didn’t offer health insurance for me, much less any kind of family plan that would have covered him, he was uninsured.He has fibromyalgia, which can be exacerbated by cold weather. We were living in a house with minimal heat in the winter time. When his pain was at an 8–9 level for almost a week, he hadn’t slept in three days, and his facial muscles were visibly spasming under his skin, we finally broke down and accepted the fact that we were going to get another $1500+ medical bill from the ER and I took him in.This ER was the only option within an hours drive. This was also an emergency room where a woman who came in with no insurance and chest pains had died in the waiting room three weeks before. When we got into the ER, it wasn’t astronomically packed. It was relatively quick to get checked in. His temperature was normal, heart rate up, blood pressure high, I pointed out the visible spasms in his face to the nurse, but she didn’t really look. We sat in the waiting area to wait.Beside us were two frat boys from the local college hooked up to IV fluids. According to the story they told their friends on the phone while waiting, they were there because they’d gotten drunk the night before, were dehydrated, still a little drunk, and had hangovers. They also had good insurance through their parents. I don’t know how long they’d been there, but they were taken to the back less than an hour after we arrived.After three hours of waiting, my fiance had found a way to curl his 6′5″ frame into the fetal position on one of those little loveseat style chairs you see in doctor’s waiting rooms. The ones that are only about twice the width of a regular chair. He was shivering and pale. He was having trouble staying conscious. I could still see the spasms in his face. I got up and asked the nurses how long it was going to be. By that time, nearly everyone who had been in the waiting room when we arrived had been called back. We were told that there were people in worse condition than he was who were going to be seen first. I asked if they could at least check his vitals again to get current readings. It took nearly twenty minutes of arguing before she agreed. Temperature normal, blood pressure high, pulse high. She noticed him losing consciousness and became frustrated with him, shaking him to wake him up so she could get the blood pressure cuff on him.After six hours of waiting I went to the nurses again. Everyone who was in the waiting room when we’d arrived had been called back by now. I was still told it was going to take more time.At nine hours of waiting, we hadn’t eaten since the night before, since we came in mid morning and had skipped breakfast, thinking we wouldn’t be there that long. I went to the vending machines and got us some crackers and soda, coffee for him. We were still told to wait.At twelve hours of waiting, I called his mother, a respiratory therapist who had worked in several emergency rooms in the state. I was exhausted, I was crying. Did she have any suggestions of what I should say to the nursing staff to make them call him back? She suggested some things, like asking for his vitals to be run again, point out the time, show them his bracelet that showed how long we’d been there. I’d already done all those things. She agreed to drive nearly an hour to meet us and scream at people until they let him be seen.At fourteen hours his mother had gotten held up with car trouble and still hadn’t arrived. I had to leave to pick up my children because my mother, who had been watching them for us, had to go home. It was nearly midnight. I wrote down my cell phone number in case he couldn’t remember it and slipped it into his pocket, made sure he was awake again, and left.Less than half an hour after I left the waiting room, I got a call. It was him. He was ready to be picked up. When he told me of the “treatment” he’d received, I was LIVID.Apparently, just a few minutes after I’d left, he was called into the room. He was left there for around fifteen minutes before a doctor came in and glanced at his chart. He told her what was happening. Asked her to come and look at the spasms in his face. She stood four feet away from him at the door and told him to open his mouth. She never got closer to him. She never put her hands on him to check his condition. She told him he had a cavity, wrote him a prescription for an antibiotic, and walked out. Nothing for pain, narcotic or otherwise, no muscle relaxers for the spasms, no testing, not even an actual physical exam. Not even an Advil. A nurse came in the room five minutes later with his discharge papers, and they almost didn’t let him use the phone in the lobby to call me before sending him out to wait on the sidewalk. I turned around, picked him up and took him home. We never did get the prescription filled because we couldn’t afford it. Three days later, the spasms finally subsided. Six months after that when his father paid for him to go see a dentist for a cleaning and to check the “cavity” he was given a clean bill of health. No cavities.The problem with the Treat and Street method is that if you give patients the minimal amount of care possible, you can avoid having to treat. If you’re not looking for something that actually requires care, you won’t find anything that requires care, and you can just send the patient on their way. If you diagnose facial spasms from four feet away as a dental issue, you don’t run the risk of finding something else involved, like the seizure disorder that he was diagnosed with three years later that causes everything from full body seizures, to yes, painful localized muscle spasms.The icing on the cake, the insult added to injury, was after that 14 hour wait to diagnose a dental problem he didn’t have while ignoring his neurological problem, we got a bill from the hospital. $2100 for the privilege of being ignored, misdiagnosed, and shuffled off like trash.Treat and Street.