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An interesting article I just cut out of the WSJ. It's emotional, controversial, and makes for a good read. I cut out a lot of things from newspapers, and I wonder what I will feel ten years down the road when I open up my scrap book and see this article again.
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TB or Not to Be
An illegal alien has a brush with death--and gets up to work again.
BY KATRINA S. FIRLIK
Thursday, May 11, 2006 12:01 a.m. EDT
http://www.opinionjournal.com/editorial/feature.html?id=110008362
Several months ago, I had an unusual encounter with an illegal immigrant. He was only 25, from Guatemala, and had been in the U.S. for only three months. He'd been doing landscaping work until he was admitted to Greenwich Hospital in Connecticut, with an excruciating headache. The medical team discovered that he had active tuberculosis, so fulminant that it had even invaded his spinal fluid. Thus, the headache. Needless to say, tuberculosis meningitis is not the type of thing we're used to seeing in Greenwich, or anywhere in the U.S., for that matter.
He ended up in Greenwich Hospital because the one in the town where he'd settled, the neighboring and much less well-to-do Port Chester, had shut down after going bankrupt. That hospital had cared for a large number of patients just like him: no insurance, no English, no papers. When a hospital serving such a demographic goes bankrupt, it leaves a needy population to seek free care elsewhere, passing on the same risk of financial distress to neighboring hospitals, like propagation of an infectious disease.
He'd been in the hospital for a month by the time my surgical services were called upon. He was staying in a private isolation room. His strain of TB was proving to be multi-drug-resistant, and the medical team just couldn't clear it. I was paged by an intern on a Sunday morning. The story: Over the course of 24 hours, the patient had developed a rapidly progressive weakness in his legs to the point where he couldn't even stand, and had lost bladder control. An MRI revealed a large mass that was compressing his spinal cord to an impossibly thin strand. The mass spanned an incredibly lengthy 10 vertebral segments, nearly from the base of his neck to the top of his low back. I'd never seen anything like it. Neither had the internist, the infectious disease specialist, the neurologist or the radiologist. We don't work in the Third World.
I took the patient to the operating room and spent the rest of my Sunday in the hospital. I wasn't thrilled. I wore a special mask designed to hug the face tighter than most OR masks, but the thought crossed my mind that I was putting myself and the entire OR staff at risk. I made the longest incision I'd ever made in my surgical career, carefully opened 10 segments of spine, and worked away at the inflammatory mass that was plastered to his spinal cord. I called a pathologist in to examine the pieces of specimen I was removing. He heard the full story, refused to contaminate his equipment, and left.
It wasn't possible to get more than half the mass out without risking even more damage to his spinal cord, so I stopped, forcing myself to settle for the less-than-satisfying achievement of having at least decompressed the spinal cord by removing the bony elements from behind (unroofing the spinal canal to allow for more room). Would he ever walk again? Doubtful. In fact, I'd phoned another neurosurgeon while in the OR, just to talk through this case. He'd never encountered anything similar either, but convinced me that the patient wouldn't even live long.
The patient spent an additional six weeks in the hospital after surgery, not because of surgical concerns, but because the medical team still couldn't clear his infection. His sputum samples kept coming back positive. After 2 1/2 months on multiple antibiotics, he was finally clear to leave the hospital. He left in a wheelchair. I knew I'd never see him again.
Why should our hospitals have to eat the cost of disease brought in by undocumented workers? I found out that his bill totaled $200,000. This excludes professional fees, meaning everything that would have been billed separately by the many physicians treating him over 10 weeks (including what I'd have charged for surgery). We all worked for him free.
How many other diseases are being brought in by how many other undocumented and unexamined workers? Somehow, here, a social worker was able to track down the friends and relatives who came to the U.S. with this patient. They all tested positive for TB, and were all working behind the scenes in local restaurants.
I'm certainly in favor of figuring out a way to offer health insurance and proper medical care to all Americans (as long as whatever plan is enacted doesn't compromise the quality of care or the incentives for medical innovation). But I don't think we can justify the same for just anyone who wants to jump over the borders. And how do you handle the PR quandary when other patients in the hospital, there for elective gall-bladder or knee surgery, ask questions? I know what goes through their minds when they see the isolation rooms with ominous warning signs, as nurses get fully gowned, gloved and masked before cracking open the doors.
I thought I'd never see this young man again, but I was wrong. Six months after surgery, he walked into my office. Walked in. No wheelchair, no walker, no cane, not even a limp. Not only that, he told me (through a translator) that he was looking for a new job. I thought about all the American workers I'd operated on, for far less serious problems, who were quick to bring in disability paperwork after surgery, hoping I'd deem them permanently disabled, unfit for any line of work. And at that moment, the resentment I'd felt six months earlier was replaced by something quite different--admiration.
Dr. Firlik, a neurosurgeon in Greenwich, Conn., is author of "Another Day in the Frontal Lobe," just published by Random House.
________________________________________________________________
TB or Not to Be
An illegal alien has a brush with death--and gets up to work again.
BY KATRINA S. FIRLIK
Thursday, May 11, 2006 12:01 a.m. EDT
http://www.opinionjournal.com/editorial/feature.html?id=110008362
Several months ago, I had an unusual encounter with an illegal immigrant. He was only 25, from Guatemala, and had been in the U.S. for only three months. He'd been doing landscaping work until he was admitted to Greenwich Hospital in Connecticut, with an excruciating headache. The medical team discovered that he had active tuberculosis, so fulminant that it had even invaded his spinal fluid. Thus, the headache. Needless to say, tuberculosis meningitis is not the type of thing we're used to seeing in Greenwich, or anywhere in the U.S., for that matter.
He ended up in Greenwich Hospital because the one in the town where he'd settled, the neighboring and much less well-to-do Port Chester, had shut down after going bankrupt. That hospital had cared for a large number of patients just like him: no insurance, no English, no papers. When a hospital serving such a demographic goes bankrupt, it leaves a needy population to seek free care elsewhere, passing on the same risk of financial distress to neighboring hospitals, like propagation of an infectious disease.
He'd been in the hospital for a month by the time my surgical services were called upon. He was staying in a private isolation room. His strain of TB was proving to be multi-drug-resistant, and the medical team just couldn't clear it. I was paged by an intern on a Sunday morning. The story: Over the course of 24 hours, the patient had developed a rapidly progressive weakness in his legs to the point where he couldn't even stand, and had lost bladder control. An MRI revealed a large mass that was compressing his spinal cord to an impossibly thin strand. The mass spanned an incredibly lengthy 10 vertebral segments, nearly from the base of his neck to the top of his low back. I'd never seen anything like it. Neither had the internist, the infectious disease specialist, the neurologist or the radiologist. We don't work in the Third World.
I took the patient to the operating room and spent the rest of my Sunday in the hospital. I wasn't thrilled. I wore a special mask designed to hug the face tighter than most OR masks, but the thought crossed my mind that I was putting myself and the entire OR staff at risk. I made the longest incision I'd ever made in my surgical career, carefully opened 10 segments of spine, and worked away at the inflammatory mass that was plastered to his spinal cord. I called a pathologist in to examine the pieces of specimen I was removing. He heard the full story, refused to contaminate his equipment, and left.
It wasn't possible to get more than half the mass out without risking even more damage to his spinal cord, so I stopped, forcing myself to settle for the less-than-satisfying achievement of having at least decompressed the spinal cord by removing the bony elements from behind (unroofing the spinal canal to allow for more room). Would he ever walk again? Doubtful. In fact, I'd phoned another neurosurgeon while in the OR, just to talk through this case. He'd never encountered anything similar either, but convinced me that the patient wouldn't even live long.
The patient spent an additional six weeks in the hospital after surgery, not because of surgical concerns, but because the medical team still couldn't clear his infection. His sputum samples kept coming back positive. After 2 1/2 months on multiple antibiotics, he was finally clear to leave the hospital. He left in a wheelchair. I knew I'd never see him again.
Why should our hospitals have to eat the cost of disease brought in by undocumented workers? I found out that his bill totaled $200,000. This excludes professional fees, meaning everything that would have been billed separately by the many physicians treating him over 10 weeks (including what I'd have charged for surgery). We all worked for him free.
How many other diseases are being brought in by how many other undocumented and unexamined workers? Somehow, here, a social worker was able to track down the friends and relatives who came to the U.S. with this patient. They all tested positive for TB, and were all working behind the scenes in local restaurants.
I'm certainly in favor of figuring out a way to offer health insurance and proper medical care to all Americans (as long as whatever plan is enacted doesn't compromise the quality of care or the incentives for medical innovation). But I don't think we can justify the same for just anyone who wants to jump over the borders. And how do you handle the PR quandary when other patients in the hospital, there for elective gall-bladder or knee surgery, ask questions? I know what goes through their minds when they see the isolation rooms with ominous warning signs, as nurses get fully gowned, gloved and masked before cracking open the doors.
I thought I'd never see this young man again, but I was wrong. Six months after surgery, he walked into my office. Walked in. No wheelchair, no walker, no cane, not even a limp. Not only that, he told me (through a translator) that he was looking for a new job. I thought about all the American workers I'd operated on, for far less serious problems, who were quick to bring in disability paperwork after surgery, hoping I'd deem them permanently disabled, unfit for any line of work. And at that moment, the resentment I'd felt six months earlier was replaced by something quite different--admiration.
Dr. Firlik, a neurosurgeon in Greenwich, Conn., is author of "Another Day in the Frontal Lobe," just published by Random House.
The current system unfortunately is a bastardized compromise. We can play to the conservatives by not granting amnesty and being "tough on immigrants." Then we can play to the liberals by letting them trickle in by not closing our borders and just endlessly redeporting the ones we find. Now we have a subclass of immigrant Americans and this is one of the results. However, it's pretty much expected. We have 200 years of tradition on hating the new guy: Natives, Irish/Scottish, Catholics, Western Europeans, Eastern Europeans, Africans, Asians, Muslims. The current group just so happens to be the Mexicans and other SA's.
