So I have rabies. My children are probably rabid as well. At least this is what everyone, and I mean everyone, has told me. This is the problem with having too much information—the ability to assess risk goes out the window and you find yourself weighing matters in fiscal terms you thought only Tea Partiers were capable of. And, yes, you too join the ranks of the paranoid.
Four weeks ago my sleepy thirteen year-old man child son stumbled into my bedroom at 6:30 am with, “There’s a bat in my bedroom.”
This one tiny statement sparked as catalyst to a series of events crystallizing the issues surrounding the abysmal state of health care in this country.
Because I devour science and nature articles at an admittedly alarming rate, I knew the formula: sleeping child + bat = rabies risk (though miniscule). But I also knew bat populations are being decimated by white nose fungus. So when I knocked the little brown bat from his happy perch on the window trim into the pile of dirty clothes on the floor, and he displayed his entire wing span of about five inches and opened his tiny mouth, I only thought of the lack of white fungus. Lifting him out the window in the pile of dirty clothes to freedom was my first mistake.
My second was calling the county health department.
I will not bore you with a transcript of the three days of telephone calls it took for me to determine who, if any member of our family, should receive the rabies shots or how and where I should go to actually get the shots. Oh, and how to finance them. I did call county health a total of eleven times, my own doctor five times, the state of Ohio six times and our local country hospital eight times within the first two days. I do have a job by the way—I just so happened to be on winter break from teaching so I had nothing better to do that research a potentially fatal disease.
The end result? Four shots were required at about $700.00 apiece. All three of us (myself, Cora, 17, and John, 13) would receive them. Luckily, my insurance would pay everything and all I was responsible for was a $25.00 co-pay for each shot—a total of $300.00 for all of us. Pricey, putting a dent in monthly bills, but the alternative? Foaming at the mouth, paralysis, and a horrible death.
Here’s the irony. My physician doesn’t stock or order the injections because they are so expensive. I then called county health again to make certain they did not offer the series. They don’t because 1) the expense is “prohibitive” and 2) they are off on the weekends and the injection regime requires a strict schedule of 0, 3, 7 and 14 day intervals and, well, this might land on a Saturday or Sunday. Public health rests on the weekend I guess.
I geared up and called 22 local physicians in my health care plan in my area. All refused to stock the injections—I might not show up for the full series was the excuse. I assume they thought I might feel a little foaming at the mouth was acceptable.
I called the hospital again to find out what I would have to pay out of pocket for each injection—it took two days to get an answer: somewhere between $500.00 and $700.00 a pop—they couldn’t really pin a dollar figure down for me. Kinda like gasoline prices, it could fluctuate by the hour the nurse happily told me. I just had to wait for the bill. My family deductible is $800.00 and out of pocket $4,000—at $2800 apiece, I was looking at maxing out all totals with the very slim chance one of us came in contact with rabies.
I contacted the state again to determine exactly the risk of rabies (very minor—only 6% of bats carry rabies). I called Ohio State University’s veterinary program (all vets are inoculated) and asked who their vendor was – if I could locate that clutch of syringe wielding doctors then I could fall back to the $25.00 copay. OSU stated they could not release the name of their inoculation source. I called the hospital at OSU—they don’t even stock the injections and they had no way (read: no field box in their software program) to transfer inoculations from the vet school to the hospital. Yet, everyone concurred that this was a serious problem and we all better get on a schedule within a day or two.
So I called the state rabies program again and spoke to Dr. Smith, (her real name) a lead scientist and head of the rabies program in Ohio who assured me that just my son needed the vaccine—good news! The charges dropped from $8,400 back down to $2,800. But we needed to hurry. After all, it’s lethal. But a 6% chance? I had just downsized to a new home and with moving, had no money.
The people who ultimately helped with risk assessment were veterinarians at three different practices who all confirmed that yes, bat rabies was in the area and the Ohio Public Health state map on the web depicting one case in Green and Montgomery Counties was completely wrong.
After more calls to the doctor and the hospital folks, I was directed to enter the hospital through different doors: either ambulatory care or the emergency room. Each entry point impacts the fees, the amount my insurance will pay and the duration of time actually spent getting the shot.
On day three, John and I enter the ER. Five hours later we leave.The scenario in the ER was as follows:
1. Check in –15 minutes, nice smiling receptionist, no eye contact. Makes two copies of my insurance card. I sign six sheets of paper and they ask John if has fallen down recently.
2. Put in a room after waiting 30 minutes.
3. 30 more minutes roll by because they cannot find the injection. Pharmacy sent it down, we are reassured, but they don’t know what happened to it after that.
4. Another hour rolls by. John is offered turkey sandwiches and soda. Finally serum is found!
5. Nurse does not know how to reconstitute injection and pours over the four point font type trying to figure this out at the nurses’ station. She keeps telling those around her that she’s “got this.”
6. A physicians’ assistant comes in after two and a half hours and tells us our use of the emergency ward is abusive and we should have gone to ambulatory care. I explain I was informed the nurses are sent home when they are finished at ambulatory care and that can be anytime between 1:00 and 3:00 in the afternoon. My son, after all, is in school.
7. The nurse appears with the syringe. The shot in the arm takes a second at the most. Now we wait for 30 minutes to see John has an allergic reaction. There is none.
8. Nurse checks vitals, hands me a CDC sheet (which I had read on line before), complete with a cartoon bat and a raccoon and something catches my eye….the first shot must be accompanied with human rabies gamma globulin.
9. Nurse reads sheet, steps into hall and confers with another nurse.
10. She calls from the hall: “Good catch Mom.”
At this point we have spent four hours in the ER. Even though I have remained very calm and respectful, a nurse dressed like an attorney comes in to listen to my frustration over the series of unfortunate events. I leave to have a hissy phone conversation in the bathroom with my best friend in New Jersey. Upon my return to the cramped ER room, I find John was asked how much he weighed because the dose of gamma globulin is based on weight. Now, at 13, my son is a bright boy. But he cannot hang on to a single pair of socks, his lunch bag, or a winter coat and he certainly has no idea what he weighs. I suggest they actually weigh him.
Just a mere 25 pounds off.
We wait some more while they find the gamma globulin and then he has four more shots one in each thigh and cheek. And we have to wait another half hour in case of a dire reaction. We came in at 4:00 right after school and we left at 9:15 to receive a shot I had called ahead to say we were coming for. A shot that is considered a public health imperative. A shot that everyone was just adamant we get. A shot no one would help us with. The second and third injections took no less than two hours each in the ER and the fourth a mere hour at Ambulatory Care (I pulled John from school early).
I am lucky. I don’t work an hourly job where that five hours might mean the difference between making it for the month or not. I have health insurance, though I don’t think it’s going to end up paying for much of the $2,800. Bills take months to get and are inscrutable to read. I am not afraid to ask questions or speak up. And yet, I was stonewalled at every juncture. Those people who want to get rid of what little health care coverage we have are the same people who are going to need it—they’ve just been lucky so far. But they will get sick, have an accident....or wake to a sleeping bat.Me foaming at the mouth? You bet, but not from rabies.