Robert

Robert came into the clinic a couple of weeks ago and complained of dizziness, “heart racing,” diaphoretic (sweating), with some shortness of breath and feeling like he had “water in left ear.” His blood pressure was 82/52 (normal is 120/80).

He was seen by the doctor but kept saying “I just got too hot.” We gave him some water to drink, and told him we would recheck his blood pressure in half an hour.

In half an hour, he was still very shaky and his blood pressure was 90/60 with a heart rate of 88 and irregular.

I consulted with the doctor, and we decided that he had to be transported to the Emergency Room. Since he had come to the clinic alone, we had to call the ambulance.

Ugh. I always hate to call the ambulance, and for a number of reasons – it is frightening to the patient; it is frightening to the other patients at the clinic; they always send the fire truck because of where we are located. But, the Emergency personnel are great, and they always try to help us minimize the chaos. So, we sent Robert to the hospital via ambulance.

The following Tuesday he was at the clinic again. I sat down with him to see how he was doing. When he saw me he said, “Thank you.” He had been in the hospital from the evening we sent him until the following Monday. They diagnosed him with A-Fib, or atrial fibrillation. A-Fib is an irregular heartbeat that can increase the risk of stroke.

To treat the A-Fib, he was started on Coumadin. Coumadin is a “blood thinner” that has been around for a long time. I did not think it should be too expensive – though I was wrong about that. We do not carry Coumadin at the clinic because it requires frequent monitoring with a blood test. Not having medical staff here makes it impossible for us to monitor the medication.

We sent him with his prescription to the local Wal-Mart. We were to make a referral to the local cardiologist for follow-up care.

Robert called me the next morning; his prescription for Coumadin would have cost him $380 for a month’s worth. The pharmacist called and got the prescription changed to a generic formula; it still was going to cost him about $25/month. He got half of the prescription filled. I’m not sure what he will do when he runs out of the medication.

I’m not sure what to do. Without the ability to monitor the medication, it is very dangerous for him to be on it. Without the medication, his risk of stroke is increased. With the medication, his risk of bleeding is increased.

What he needs is a Primary Care Provider that knows him and can manage the medications, the risks and the benefits. He needs care that is available to him every day of the week ­– not just on Tuesday evenings.

How can we continue to debate the need for healthcare reform, for healthcare expansion? We are not talking about fictional characters – we are talking about real people, with real lives.