About two weeks ago, I wrote a long post here on the killing of UnitedHealthCare (UHC) CEO Brian Thompson. Here’s a follow up. Continue reading
EVS Journal 8: More Scenes from Life on Call in the OR
Up to this point, what I have accepted as very true I have derived either from the senses or through the senses. However, sometimes I have discovered that these are mistaken, and it is prudent never to place one’s entire trust in things which have deceived us even once.
Descartes, Meditations on First Philosophy, Meditation 1
I’m on call in the OR for New Year’s Day, 8 am to midnight–an irritation after a long sleep-deprived week of work, including all of New Year’s Eve spent in the OR. I wake up on New Year’s Day, and decide, on a mere hunch or whim, to drive to the hospital mid-morning, pre-empting the phone call that calls me in to the hospital, operating instead (so to speak) on the premonition that if I go to the OR unbidden, there’ll inevitably be a case waiting for me to do, which I’ll then be in a position to “head off at the pass,” whatever that’s supposed to mean in this non-cowboy context. Continue reading
Scenes from Life On Call in the OR
EVS Journal 7
Every member of the OR EVS team takes emergency call on assigned weekends. The call shift starts at 8 am, ends at midnight, and takes place on two consecutive days. It’s an exercise in underpaid exhaustion. You get $5/hr every hour that you’re on call but not actively on a call. Once you get a call, you suit up (in scrubs) and punch in. Once you suit up and punch in for a case, you get paid time and a half: $21/hr. When you’re done with the case, you punch out–you’re supposed to punch out–and go back to $5 an hour. Overtime past midnight is penalized, regardless of when the call comes in. Continue reading
EVS Journal 6
December 16, 2020
“Out of the crooked timber of humanity, nothing straight was ever made.”
–Rabbi Immanuel Kant, Idea for a Universal History with a Cosmopolitan Purpose
Another Hava Nagila incident in the OR today. Was playing it pretty loud on repeat, twirling my rag as they used to do back in my shtetl. Nineteen year old co-worker Ron goes, “Oh man, turn that Arabic shit off!” Arabic! 😂
Ron keeps ordering Alexa to stop, but she won’t listen. Once it starts, there’s no stopping Hava Nagila. And if Alexa is on shuffle-repeat? We’re talking eternal musical recurrence. Either you love your fate, or you don’t. I do. Ron doesn’t.
I’m celebrating the vicissitudes of fate when the Director of the OR walks in unannounced. She seems flustered, startled, even annoyed. I don’t know what she expected out of a cystoscopy turnaround in OR 1 by her crack EVS unit, but Employee #1027742 twirling a rag to Hava Nagila and pretending to be Tevye the Fiddler was perhaps not it. Continue reading
I started an “EVS Journal” back in 2020, when I worked in environmental services in the operating room of a small community hospital in west-central New Jersey. I’ve decided to start posting edited versions of them here, for whatever interest they might still have.
EVS Journal #5
December 15, 2020
Seth, Bilal, and I are doing a late turnover in OR 2. Alexa is playing Christmas carols. I get annoyed.
“Two Muslims and a Jew in here, and we’re listening to Christmas carols. Why?”
Without a word or reaction, Seth commands Alexa to play “Hava Nagila.”
“That’s better,” I say.
“I hate this fucking song,” Seth rejoins. Hava Nagila continues. Continue reading
The questions you ask determine the answers you get. If you ask the right questions, you have some hope of reaching the right answers. If you ask the wrong ones, you’ll likely reach the wrong answers. If you give up on asking, you get nothing but what you started with, so that if you begin in ignorance, you end there.
The debate about the killing of Brian Thompson threatens to begin and end either in misdirection or reinforced ignorance or both. Stuck between two competing brands of outrage–one exulting in Thompson’s death, the other outraged at the exultation–we’re in danger of losing the denials/reimbursement plot altogether. I know I’ve posted on this issue already, but think I’ve found a better way of saying what I was trying to say in that post, one that does a better job of asking the right questions than my last post did.* So here is UHC, Denials, and Death, Take 2. Continue reading
I started an “EVS Journal” back in 2020, when I worked in environmental services in the operating room of a small community hospital in west-central New Jersey. I ended up posting the first three entries of the Journal here at Policy of Truth (1, 2, 3), but posted the majority on Facebook under a private setting, largely to avoid repercussions at work. I’ve decided to start posting edited versions of them here, for whatever interest they might still have.
EVS Journal #4
December 4, 2020
A dispiriting day in the OR. It had nothing to do with the case load, which was moderately heavy in a normal way, but arose from something I’ve so far avoided mentioning in my daily missives here: the War Between the Shifts. I trained on the day shift (8:30-5) but now work on the night shift (technically, 3-11:30, but more like 3 to midnight). Each shift has a different supervisor, but the de jure supervisor of the day shift outranks the de facto supervisor at night. Continue reading
This post has been superseded by a new and improved version written a few days later (Dec. 18, 2024).
Let me just get straight to the point: I have a real worry about how people are reacting to the UHC killing. It’s not the usual worry that we’re being mean to Brian Thompson. It’s that a lot of what people are saying shows a misunderstanding of how the health insurance denials process works. I work in health care denials management on the provider side, and have in fact dealt with UHC‘s denials reps. I have no sympathy for them or for the insurance industry generally. UHC is the apex predator in an industry of predators. But on the whole, I don’t think it makes sense to say that insurance denials kill people. I’ll grant that excess mortality and morbidity are possible through an insurance denial, but death-through-denial is not the modal case of premature death or even close to it, and it’s a mistake to suggest otherwise. Continue reading
In a bunch of recent posts (here, here, and here), I’ve been piling on employment-at-will, mostly from the perspective of the aggrieved employee. Employment-at-will, I’ve argued, has problematic consequences for employees who are terminated at will, without cause. Terminations-without-cause incentivize arbitrary, unaccountable exercises of power in the labor market of the sort aptly described as “dominations” by Philip Pettit in his account of republican freedom.
Continue readingTwo weeks ago, I posted here on Fajr Scientific’s Gaza Medical Evacuation Initiative. I’ve just learned that the initiative has been canceled, as the Israeli government has now banned Fajr from operating in Gaza. This decision comes a few weeks after the release, by 99 physicians associated with Fajr and similar medical organizations, of an Open Letter to President Biden and Vice President Harris, providing medical testimony and forensic evidence that the Israeli military had, among other things, been executing Gazan children by shooting them directly in the head and chest.
From the letter (bold type in original):
Children are universally considered innocents in armed conflict. However, every single signatory to this letter saw children in Gaza who suffered violence that must have been deliberately directed at them. Specifically, every one of us who worked in an emergency, intensive care, or surgical setting treated pre-teen children who were shot in the head or chest on a regular or even a daily basis. It is impossible that such widespread shooting of young children throughout Gaza, sustained over the course of an entire year is accidental or unknown to the highest Israeli civilian and military authorities.
Here is the appendix to the letter. This article contains images of X-rays showing bullets lodged in children’s heads and throat (the trajectory in the latter case being through the forehead). Here’s a link to The New York Times essay discussing the evidence (may be paywalled). Continue reading
Policy of Truth 