No good deed goes unpunished

So what was the “official” reason? I asked, stoking thin air with the middle and index fingers of both my hands to denote the quotation marks.

“I guess I endangered a patient’s life by sending her to see a cardiologist,” snorted Debbie, sarcastically, her face still hard with anger, dark eyes nearly blazing.

There was a moment of silence between us while her words soaked in.

Then, despite the worry of being unemployed in the worst economy of our lifetimes, despite the unjust nature of working in medicine, despite small personalities with big titles—the ridiculousness of the whole thing stuck us and we began to laugh.

Yep. Yesterday my wife got fired. Her unforgivable sin: She put a patient’s welfare before the almighty dollar; and in modern American health care, you might as well throw yourself under a metaphorical bus.

Here’s what happened: Last week a regular patient came into the private practice medical clinic where Debs worked until yesterday. This woman was having surgery in a little over a week, and at the pre-op appointment the surgeon had detected an enlarged heart. He told her he’d feel better if she had a visit with a cardiologist before the cut her open.

The patient wanted to know if she could get a referral. Debbie knew that, unless you are on a gurney being unloaded from an ambulance, the odds of getting in to see a cardiologist in less than a week are a zillion-to-one. Still, she told the patient she see what she could do. Debs called the cardiologist’s people who normally would have laughed until they threw up. However, apparently God loves this woman. The cardiologist’s office had just received a cancellation. Debbie’s patient could have it, but they needed a referral ASAP.

Debbie booked the appointment for the patient, filled out all the paper work and took it to one of her providers and explained what was up: regular patient, surgery in a week, surgeon would be happier if patient saw cardiologist, miracle of miracles, we can get her in, but ya’ gotta sign here. The provider signed the document and Debs didn’t give it another thought. There were other medical brush fires to put out. If she’d been in the military she probably would’ve been given a medal for showing initiative.

Or maybe not. But she should’ve been.

Now, Debbie worked at a satellite office. The main office is over in Santa Fe, about 75 miles away. Every couple of months there’s a staff meeting at the main office. Thursday the boss called Debbie and asked her to come in an hour early so they could “sit down and discuss some things.” Debbie knew this couldn’t be good news, but didn’t expect to be asked to drive 150 miles to be handed a termination letter and curtly told to clean out her desk by day’s end. But that’s what happened.

Of course I read the letter and the “official” reason she was fired was acting beyond her scope of practice, which is nonsense. Filling out referrals was part of her job, as is scheduling patients with other practices. It’s not like she forged a doc’s signature on the fucking form.

Debbie spent the rest of the day and half of the night trying to re-play the brief conversation she’d with her ex-boss, wishing her mind was a tape recorder. Eventually scraps of the conversation came together and everything made sense. Well, made sense when you add in the fact that her ex-boss is an erratic crazy woman obsessed with titles and licenses and keeping people in pre-defined boxes. Oh. And obsessed with money, too.

Referrals are typically given at an office visit. With time pressing, there was no time to get the woman on the schedule. Several days after all this happened some bean counter realized the practice had missed an opportunity to make a buck.

Now remember that Debbie didn’t actually make the referral. She didn’t sign it. She just showed initiative and got everything ready. The provider could’ve said, screw this, I need to see the patient. Instead the provider chose to sign the document, presumably based on the information Debbie had gathered from the patient. And let’s face it, referrals are harmless. It’s not like the patient came in and said, “Hey this other doctor said I should have a prescription for Oxycontin.”

Referrals are pretty much handed out like business cards. In fact, they really only exist because of insurance. Otherwise, if you wanted to see a cardiologist, endocrinologist, dermatologist, urologist, ophthalmologist, or any other ologist, you’d could just pick up the phone and made an appointment yourself. In fact, many people whose insurance don’t require referrals do just that.

But, you can’t fire a provider for making that kind of mistake. That would lose too much money in the long run. But if you are a shorted-sited, money obsessed, crazy, paranoid person who wants to keep all the staff in a state of fear, a medical assistant makes a great sacrificial lamb.

So what did we do? Well, my family has a good tradition for times like this. We celebrate both victories and disasters. So Debbie, Rio, and I went out to dinner at the Steaksmith, the same place we celebrated my writing awards a few posts ago. Rio had a hard time wrapping his brain around why we’d celebrate something bad. We celebrate bad things to remove their sting, I told him, to show that our spirits can’t be conquered. Rio still didn’t get it, but ordered the scallops anyway. He’s not the type to look a gift horse in the mouth.

Then our drinks came. Roy Rodgers for Rio. Kula and Cream for Debs. Half-liter of cab for me. We raised our glasses. F’em. F’em all, I said. “F’em,” repeated Debbie, and clinked my glass.

“What’s ‘F’em’ mean?” asked Rio. I bent over and whispered the answer in his ear, with the added explanation that if we were at home there’s be no need to censor ourselves, but that in public places it sometimes pays to be circumspect.

“Ah,” said Rio, “F’em all indeed.” And he clinked his glass against mine.

Then he added, “I like our family’s tradition of celebrating disasters.”