I spent a couple of hours today attempting to transfer a critically ill patient from rural Emergistan. He had a life-threatening infection and needed a procedure.  (Out of respect for patient and HIPAA privacy laws, that’s all you get. Sorry!)

My ER secretary called about 12 hospitals, up to about 225 miles away from our little Appalachian garden-spot of healthcare.  I spoke with many transfer lines, nurses and physicians. I told my story over, and over and over and explained that my critical access hospital did not have the staff, or really the ICU bed, to give the patient what he needed.

Finally, as hours passed, we found a bed and a specialist and (thank you Lord!) a helicopter with clear skies.  We almost didn’t have the helicopter because the pilot had worked near his shift limit.  Patient was transferred. I pray he is well.

The whole saga made me think about a few things.

First, despite the mess of COVID, many people in large, urban medical centers still have no idea how little is available in rural America.  We don’t have the specialists or the beds that our patients so often need.

Second, if it weren’t for COVID, many health-care policy folks (and too many urban physicians and hospital administrators) wouldn’t really give a raccoon’s furry, striped tail about what happens in rural America.  It’s just not on their radar.  It isn’t lucrative.  It can often be complicated.  And rural health, resources and culture are often wildly misunderstood.  I was asked ‘can’t your interventional radiologist do it?’  I don’t even have a radiologist on site.  Years in teaching centers leave many physicians completely unaware of what it’s like outside those centers.

Third, we all take for granted that everything is available, all the time.  Cardiologists and cardiac cath labs.  Neurologists and stroke intervention.  Obstetricians and newborn nurseries for complicated deliveries.  Helicopters for trauma care.  A gastroenterologist just to take out a piece of meat stuck in an unfortunate esophagus.  All of these things are precious and in the long eons of human history and suffering, the fact that they exist and are available at all is simply incredible.

And yet, these things aren’t always available. Even though COVID has improved (and please don’t start on omicron; we don’t know enough yet), we still have staffing shortages due to burned out or fired nurses, physicians, medics, techs and all the rest. Consequently we have even fewer beds for the sick. We have equipment shortages and people suffering from diseases not treated during the lock-downs. We have addiction and mental illness, we have violence, and the normal daily chaos of medicine.  Resources and staff are harder to come by than we might think.

Fourth and final, it’s a good time to be really careful.  This is not the time to take up chainsaw juggling, to try that little ‘bump of meth’ at a party (because why not?).

It’s not the time to put off going to the OB when the contractions are starting in earnest.  It’s not the time to ignore that chest pain until three am on an icy morning.

We humans are more fragile than we think. And the system of modern medicine on which we depend even more so.  After all, humans have been living, reproducing and dying for say, 100,000 years?  Whereas modern medicine has only been modern medicine for maybe 75 years (and that’s a stretch).

Please be careful. Be alert.  Please think before you act.

And remember that COVID or not, healthcare resources can still be vanishingly scarce.

Nowhere more so than in ‘the outer darkness,’ beyond the populous cities and suburban areas of America.





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