Health Affairs

Health Affairs, 24, no. 3 (2005): 811-816 doi: 10.1377/hlthaff.24.3.811 © 2005 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

This Article Full Text (HTML) Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Haidet, P. Articles by Osorio, G. Search for Related Content PubMed PubMed Citation Articles by Haidet, P. Articles by Osorio, G. Related Collections Access To Care Ethical Issues Hospitals Business Of Health Military Medicine Personal Experience ("Narrative Matters") Consumer Issues

Narrative Matters

You Gotta Draw The Line Somewhere

Paul Haidet and Georgina Osorio

PREFACE: Determining the when, why, and how of health care isn’t always straightforward. When should a patient be hospitalized? Who’s responsible for doing what? How should a final illness be handled? The answers—and approaches to health care—can run the full human-response gamut. Rules and attitudes that don’t always reflect reason or compassion can take charge. Such is the case of a rehab patient seeking a respite admission to a hospital told us by physicians Paul Haidet and Gina Osorio. We hear from hospital staffers focused on moving the patient off their turf (and onto someone else’s) and from others trying to maneuver through a recalcitrant, rule-bound system to ensure that the patient is admitted. Next, registered nurse Veneta Masson recounts the story of her mother’s last days. Taking a determined "less is more" approach, Masson’s mother opts solely for palliative care from home hospice. She sets the rules about how she will die, including that she will remain at home, on her own turf. By insisting on low-tech final days in her own home (and going through the process with as much as grace as possible), she gives her daughter—and us—much to contemplate.

Michael (Patient)

 
The accident happened in early December. I was driving home and must have fallen asleep; the next thing I remembered was in the ambulance when they were telling me we were on our way to Good Shepherd Hospital. I broke my neck, hip, and leg and sprained my other ankle. I was in one of those halo things on my head and had rods holding my leg together. The orthopedists told me my hip would heal on its own. They said I could stay in the halo for a bunch of weeks, or they could do surgery and fix my . . . [Full Text of this Article]

Jacquelyn (Physician Assistant, VA Emergency Department)

 

Thomas (Physical Medicine And Rehab Resident On Call)

 

Scott (Orthopedics Resident On Call)

 

Gina (Senior Admitting Medicine Resident On Call)

 

Paul (Medicine Attending Physician)

 

Gina (Senior Admitting Medicine Resident On Call)

 

                      What's this?