Category Archives: Health Care Series

Call Me

Posted on by under EVS Journal, Health Care Series

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 →

The Crooked Timbre of Humanity

Posted on by under EVS Journal, Health Care Series, slices of life

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 →

Fiddlers in the OR

Posted on by under EVS Journal, Health Care Series, slices of life

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 →

UHC, Denials, and Wrongful Death Revisited

Posted on by under EVS Journal, Health Care Series, moralism

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 →

A Dispiriting Day in the OR

Posted on by under EVS Journal, Health Care Series, slices of life

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 →

UHC, Denials, and Death

Posted on by under Big Data, Health Care Series, Palestine

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 →

The Hard Domination of Everyday Life

Posted on by under Health Care Series, libertarianism, MTSP Discussion: Philip Pettit's Republicanism

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 reading →

Fajr Scientific Banned from Gaza

Posted on by under EVS Journal, Health Care Series, Palestine

Two 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 →

Gaza Medical Evacuation Initiative

Posted on by under General announcements, Health Care Series, Palestine

Fajr Scientific, a Texas-based volunteer medical group specializing in surgical procedures, is organizing a series of medical evacuations for Gazan children with complex war injuries. The plan is to evacuate these children from Gaza to the United States and place them in U.S. hospitals “willing to provide essential treatment and support.” I don’t know how many hospital executives read this blog, but if you know any, or know anyone who does, please send this post along to anyone willing to have their hospital participate. Continue reading →

Philip Pettit’s Republicanism: A Series (5/6)

Posted on by under book review, Health Care Series, libertarianism, MTSP Discussion: Philip Pettit's Republicanism, political philosophy

4200 words, 25 minutes’ reading time

For part 1, go here. For part 2, go here. For part 3, go here. For part 4, go here.

5. Pettit on employment-at-will
I said above that I agree in a broad way with Pettit’s critique of employment-at will. Let me put it this way: I agree that employment-at-will, at least as currently practiced in the American labor market, is a highly problematic institution, one that frequently exemplifies domination for just the reasons Pettit gives. But while this may sound like substantial-enough agreement, I think it conceals some subtle but significant disagreement. In this post, I want to work through some of the agreement and the disagreement.

Though Pettit doesn’t put things quite this way, I think we can probably agree that two things make employment-at-will problematic. One is its asymmetric character. The other are the stakes involved when it’s invoked and exercised. Continue reading →