Monkeys

Classes on "How to be the MAN" continue...Today instead of working the floor, they pulled all of us out for management classes. Wiz must have been taking his medications because he actually managed to say civil reasonable things to me in a setting outside the hospital. Usually at these things, Wiz looks at the table in front of him and doesn't make eye contact with anyone in the room, like an autistic child, but today, after my 3rd or 4th attempt at pleasant-ness ("would you like an apple? I brought two, and they're organic." did the trick)He even made a joke.
The administration building for the hospital is really interesting--it's built in a circle, with round windows like a ship. It doesn't have any square corners, which is actually a little bit unnerving, subliminally. I think I've managed to internalize euclidean structure and anything else really shakes me up. The building is also freezing--all the time--and located near the highway. For some reason, the building vibrates constantly, to the point that the powerpoint presentations shimmer. But if you're okay with sitting for 8 hours in a building that feels like it's in an earthquake at the arctic circle, listening to white men in suits who make a lot more money than you ever will drone on about compliance, the revenue cycle, and payroll, it wasn't a bad way to spend the day. On my breaks, when I could, I sat on one of the balconies that overlooked some red and gold maple trees. I tried to pretend the highway wasn't there and focus on the trees, and pretty much succeeded.
What amazes me is how much goes into making a hospital run. I can't believe this whole batch of monkeys (I mean humans) ever came up with it. I'm reading about bonobos (catching up on last month's Believer) and I don't think they're so different than we are--how did we get from there to here? I mean--this baroque insurance coding system--and whole professions dedicated to hammering out payment systems--and all the coordination--the food, the housekeeping, the billing--how on earth did we come up with it all? When I was little there was this story about a snail who's shell kept getting more and more elaborate, until eventually the snail couldn't carry it around and died. (surely it didn't die--it was a children's book after all--but I don't know--the 70's--remember Hope for the Flowers? Yuck. Hate that book. The caterpillars falling off the top of the pile...chilling)
We're all worried about the changes in Medicare, of course. Medicare pays for 40% of hospital bills. Starting in 2009, medicare will no longer reimburse nosocomial infections. So here's what's going to happen: 1)in spite of all the lovely feel-your-butt rhetoric about how this is not a shaming culture, nurses are going to be blamed for giving patients infections. 2)Hospitals--not our hospital because we're good guys (we are!) and we admit everybody--will start avoiding admitting tricky patients (like the horrible private hospital across town who turned away 19 illegal guatemalans from a car accident without triaging any of them 2 years ago, because they decided they were all Level one and needed to be sent to us--they weren't, and precious time was lost and hence, precious, albeit 'illegal' lives) 3) Docs will avoid last ditch/hail mary interventions which just might work because they're worried about infection 4)every single patient, whether he has a hangnail or chest pains will be subjected to every imaginable test within the first 4 minutes of arrival, so we can pick up on anything preexisting and get paid for what we do.
What a mess. Infection is a risk of any hospital stay. We already carry around most of the things that will eventually make us sick and kill us, the little buggies are just waiting for us to get sick enough in order to take over . Our immune systems do the job, but trauma and surgery depress our immune systems, and things that wouldn't normally make us sick, do. Of course, hospitals need to tighten up on infection control--but a lot of it is unavoidable, I think. The system's going to collapse.
Okay, that's my 1/2 hour and my soapbox. My Saab's in the shop and I have to get there before it closes.