En bref: If your child comes in with croup, and the doctors are concerned enough about it (croup can be very mild, or occasionally a kid will come in with what sounds like impending respiratory failure) to recommend he stay for observation...listen to them. If you happen to be at the Hoosier Healthwise hospital, which gets all kinds of funding to help pay for hospital stays when patients cannot...listen to the financial counsellor. If you happen to be currently going through a bankruptcy, and are completely broke, and have no insurance (except your wife's, which kicks in on the 15th of September - whereas today is the 11th), please consider that the doctors are not saying "we would like to watch your kid just to be on the safe side." Please consider that the doctors are saying "your child's breathing is so close to total collapse that we don't feel like we can responsibly allow him to leave this hospital." Please consider that we are afraid, given the degree and intractibility of your child's stridor, that he might suddenly go into respiratory failure and die.
Don't you think, O Best Beloved, that any rational parent, when told by a doctor - several doctors - that their child is not stable enough to leave the hospital, would then say "okay, we'll do what it takes and worry about the bills later."? The father of A apparently disagrees, as he was threatening to leave at 10 AM when we did morning rounds, before the hospital could "suck one more fucking dollar from me." When it was explained to him that his room billing went from midnight to midnight, he informed us that he was leaving, no matter what condition his child was in, at 11:30. That was as long as he was going to let us keep his kid. Because they couldn't afford this, and the hospital wasn't doing anything to help his kid (observing, pulse ox, and two overnight neb treatments with epinephrine back to back apparently don't count, because we didn't do more treatments or something) and we were just keeping the kid here to make more money.
I am speechless. We've explained to him multiple times that his kid isn't in a stable or safe condition. We want him here, where we can have him intubated and breathing 100% oxygen inside of the two or three minutes it would take to get him in the car. Where, should his airway close off as it is obviously threatening to do, he can get the help he needs. We want him in the hospital because it's the best place for him to be. We're fucking doctors. We want to do the best fucking thing for our patients.
JL called S, the social worker, and they discussed our options. It's going to be up to R, the first year post-MD - the intern on call tonight - to deal with the situation. To decide whether he thinks that this kid is going to have to stay regardless of his parents' wishes. Because since A is 18 months old, witholding necessary medical treatment from him can be qualified as abuse. And we can call security and have Dad escorted out, and file a report with CPS against the family, and we can make goddamned certain that A stays here, if we think that his situation hasn't improved enough for him to be safe going home. But we have to be certain that that's medically necessary. What a nightmare.
Is your child's life not worth more than money? Do you not understand? What gives?
I'll leave the rest for another time, as Angel forgot to bug me for bed at 11 and it is now after midnight, and I have to be up at 5:30. Good night.