Pittsburgh, Pennsylvania (API) Nurse Claire Simonton, an RN at local Hazelton Hospital, has seen many types of patients in varying conditions cross the threshold of her emergency room over the past four years. She's dealt with overdoses, gunshot wounds, toys swallowed by children, etc. But nothing prepared her for the frankly sickening sight last Friday night when Dr. Saul Jacobs wheeled out an EKG machine for a 15-year-old girl who'd come in with a broken arm, witnesses said. "Wait a minute," said Simonton. "That's an EKG."
"Yeah," said Jacobs. "Do you have a problem with that?"
"An EKG?" repeated Simonton, her jaw practically lying on the floor at the utterly flagrant use of an unnecessary procedure meant to overcharge the insurance company. "Really? an EKG."
"You know, we just want to be sure the girl's OK."
"With a broken arm? You're worried about her having a heart attack? Am I on crack? Am I going blind? Or am I actually watching you bring in an electrocardiogram for this girl?"
Simonton and Jacobs sat picking over this mordant rhetorical question for several minutes while the patient, Nancy Wallis, sat in confused silence holding the broken arm, an injury she'd sustained in a Friday night fender bender.
"I just want to make sure I understand this correctly," said Simonton, laying on the ironic sing-song rhythms, Jacobs thought, a little bit thick and with a great deal of sanctimony, "That girl has a simple broken arm, and probably just needs a splint. But we're going to give her an EKG. How about doing an echo-cardiogram as well? Or how about a PET scan on her brain? Or why don't we do extensive blood work and a stand-up MRI?"
"Well it can never hurt."
"I wish you'd stop saying it like that."
Simonton and Jacobs traded such barbs for several minutes using lots of patronizing rhetorical flourishes and sneers in the five minute conversation, their icy exchange playing out against the backdrop of the most farcical aspects of American health care, specifically doctors' declining fees for service, an economic fiasco that has them scrambling to overbill insurers and rip them off however possible through procedure miscoding, double billing and other kinds of accounting shenanigans.
"Gee," said Simonton looking over the girl. "You don't seem like you're about to die of a heart attack at all. How strange. And here I thought you were 80 years old. I guess nobody can really be sure about anything these days unless we've first checked it with outrageously expensive modern medical equipment. Why as far as I know, you might have a heart like an 60-year-old obese smoker on steroids."
"I'm not sure what's going on," said the patient. "I just busted up my arm a little. You guys are freaking me out."
As they wheeled the EKG over to the girl and began performing the expensive procedure, Nurse Simonton continued her stream of wry badinage.
"Oooooh!" said Nurse Simonton. "Her heart looks good. In fact, it looks like any heart you'd find in any 15-year-old girl. How'd that happen, I wonder?"
After 30 minutes the exchange ended when Jacobs went home for the night, first delivering a parting shot.
"You really ought to watch your mouth in front of the patients," he said.
"Take it up with my union rep, asshole," answered Simonton.