The typical Cook County patient

I am on my sub internship as a 4th year at Stroger Cook County Hospital in Chicago. This hospital deals with the undeserved, the poorest of the poor in Chicago. This note I found on the second week of my rotation by an attending doctor, greatly sums up about 50% of the patient we care for at this  facility:

"I saw him today and know him very well from before as multiples times before, whines about being examined, refuses blood work and threatens to leave AMA. I have informed him that his condition is potentially lethal and he should cooperate. At times becomes verbally abusive."

It describes a patient I was taking care of. He had heart failure and was admitted for worsening of his heart failure. He had edema in his feet and an extremely difficult time breathing. 

Stroger is a special place, blood draws never get done because they are not enough phlebotomists. The ones that they do have are lazy (I used to be one I know what it takes to draw blood, and it is simple job). If a patient is in the bathroom or not in there room for a minute, the phlebotomist will put "patient refused blood draw", just so they do not have to work. 

The transporters are also horid. They never want to take their patients to their procedures on time. 

But overall the patient you see are shocking. For example, in the last week alone I have seen 4 patients on my team with chronic hepatitis C with liver Cirrohsis killing them slowly. I have also seen a case of a patient with Hepatitis B who has a tumor called hepatocellular carcinoma, this tumor comes in patients with chronic hepatitis B infection. It is a very rare tumor and the patient I saw had a highly advanced tumor. 

My current patient is homeless and we think is faking symptoms so he has a place to stay. A test for arm weakness is to raise the arm over the head and let it drop. If the patient is truly weak and has no use of an arm, the arm will hit them in the face. If they are faking, when you let go of the arm over their face, they will let it drop, but before it hits their face, they move the arm so it misses their face. My patient keeps doing this. He is here for a home, and I do not blame him. It was 1 degree today, and maybe 5 degrees yesterday, and that was not including wind chill. 

Cook county Hospital is a crazy place to work. Very eye opening to see how sad the conditions some people are in. We are fortunate to be middle class and have insurance and have good care. Cook County, patients do have good doctors and residents, but its the facilities and the stage at the disease most patients are in, that there is not always alot of hope.  

-MD in 14