The Price of a Miracle

One of the great milestones in the birth of a child is anxiously awaiting the medical bills said birth had generated. Recently, I sat down and attempted to determine the amount of billable services that one vaginally-delivered healthy child could generate. The total, from the in-office pregnancy test until hospital discharge, was $15,677. Now in our case my wife suffered from post-natal pre-eclampsia and had to be readmitted to the hospital within the first week which generated another $6,110.07 so in our particular case the total would be $21,787.07.

Of this total, $10,577.45 was for use of the hospital facility. Since the physicians and anesthesiologist bill separately this meant that I was paying more for the structure itself than the medical talent utilizing it. Now I fully realize that this fee includes nurses, equipment, labs, meals, utilities, and apple juice but it should also be noted my wife was housed in a non-critical care unit at a not-for-profit hospital in an area with a low cost of living. 

As outrageous as the cost of inpatient care has become, the real cash cow is outpatient surgery. When my wife had her tonsils removed at a local outpatient facility, she spent a grand total of six hours within the building for a 30-minute procedure. The surgeon billed $550 but the facility billed $8,100. For those keeping score at home, that works out to $22.50 per minute.

I have to wonder how it got so expensive to spend time at a not-for-profit medical facility. For instance, had my wife and I reserved the 1,100 square-foot Premier Suite at the Central Park Ritz Carlton in New York for the same dates it would have only cost us $4 per minute (and that include cocktails, hors d'oeuvres and valet parking).  I say this not to suggest that they provide comparable services, but to provide a point of reference for value. How is it that a not-for-profit medical facility in the south can cost five times more per minute to operate than a decidedly for-profit luxury hotel in the most expensive metropolitan area of America?

As for the medical professionals, no one is stacking paper like the anesthesiologist. For the twenty-eight minutes he spent in my wife’s room administering the epidural he billed $2,448.00 which averages out to $87.43 per minute. To put that in perspective, the per-minute rate for the OB that actually delivered the baby was half that.

Fortunately, my wife and I were only responsible for about 17% ($3,724) of the total cost of our son’s birth because we have deductible health insurance as part of a sizable risk pool administered by a large insurance company. This is important because our company is large enough to negotiate service discounts that I as an individual would be unable acquire. For that privilege, we pay $3,912 per year in premiums and administrative fees and I consider that a deal because I get several discounts for being non-smoker and submitting myself to an annual physical.

I am decidedly middle class and the fact that I am only on the hook for 20% of the medical bills* I generate prevents me from filling bankruptcy. However, if the cost of routine medical procedures continues to outpace middle class income even 1/5 of my bills could be financially catastrophic. Perhaps I am being too critical and these prices scarcely allow hospitals to keep their doors open, but if that is the case I have to wonder why they are so eager to continue expanding them.

*Even that 20% only applies to charges incurred at in-network facilities by in-network physicians. Were I to go “broken arrow” and find myself at a hospital out of the approved network my financial exposure would be much greater.

A Baby Story (The Relapse)

The first week after the birth of our son was an interesting one. My wife was running low on the pain medicine they had given her at the hospital so she called the prescribing physician to get a refill. Now I realize that anyone requesting a controlled substance must be properly vetted, but I must admit that we were both floored when the nurse asked my wife, “Now exactly where does it hurt?” One can only assume that when a new mother calls her OBGYN six days after a vaginal delivery the answer would be somewhat self-evident. Despite this, my wife calmly replied that the majority of the pain seemed to be radiating from her recently traumatized nether regions. This apparently satisfied the nurse (I suppose if my wife had slipped up and said “my husband’s knee” the screening process would be deemed a success) who agreed to call in the refill.

While on the phone, my wife mentioned that she had a nagging headache and that her feet were still extremely swollen. They asked that we check her blood-pressure and when we discovered it was north of 160/110 a chain of events was set into motion that would end with us spending the evening in the emergency room. Like many medical trauma centers, this one was a dangerous combination of understaffed and overwhelmed. It took several hours to see a doctor and in the interim we met an interesting woman I will call Dottie. You see, it was Dottie’s job to draw blood from each and every patient who visited the ER that evening and she accomplished her task with unparalleled skill and spontaneous outbursts of evangelical fervor.

Each and every statement she made was punctuated by the verbal affirmation of God’s wisdom and/or mercy. Our conversation went as follows:

Dottie – “What brings you to the ER this evening?”

Us – “Well, we just had our first child and…”

Dottie – “Thank you Jesus!”    

Us –“…indeed… and they fear that my wife is suffering from post-natal pre-eclampsia so..”

Dottie – “Lord be with her! Glory! Glory!”

Us – “…we were told to bring her here to get checked out.”

Dottie – “Little boy or little girl?”

Us – “Boy”

Dottie – “Little boys are straight from heaven! Praise the Lord! So how long have you two been married?”

Us – “Almost ten years.”

Dottie –“Father, be with ‘em in Jesus’ holy name!”

It deserves to be said that during this short exchange Dottie had filled at least four vials of my wife’s blood with such prodigious skill and efficiency that for a moment I suspected she had taken a few samples from me when we initially shook hands. At any rate, we were eventually assigned a room within screaming distance of an ill-tempered woman who insisted that she wished to see “a f-----g doctor.”

After six hours, we were admitted to the hospital and given a room in Labor and Delivery while we awaited the counsel of the on-call physician. When he finally arrived and ordered my wife be given a 12-hour dose of magnesium, a rather sensible question arose from her assembled family: “What exactly are the side effects of subjecting the human body to high levels of an alkaline metal normally used in the manufacturing of sparklers?” Such a preposterous question did not even merit eye contact from the good doctor who dismissively replied that magnesium treatment was “better than having a seizure.”

One can only hope that Dr. Sunshine’s side job was not as a hostage negotiator. I realize that you went to medical school and get to use the word “sabbatical” in casual conversation, but I don’t feel that listing the side effects of a rather specialized treatment falls outside you purview. I can only imagine the packaging on Tylenol if this guy ran the FDA:

Directions: Take 2 capsules every 8 hours

Side Effects: Better than an aneurism and no worse than disembowelment

Fortunately, the nurses assigned to my wife’s care were warm, informative, and went above and beyond the call of duty to make her as comfortable as possible. Aside from Dr. Sunshine, the only other complaint I have concerning our second stay in L&D would be the provided “napping chair.” I do not know which state penitentiary the hospital commissioned to build this monstrosity, but it has all the features a worried spouse needs. In addition to creaking like a drawbridge each time you recline, it is equipped with wheels that somehow only move when you are attempting to sit and a leg rest that simulates an old football injury. I informed the nurse that I would be willing to pay cash for the privilege of taking an ax to the chair at the moment of my wife’s discharge.  

Helpfully Unhelpfull

After eight years of faithful service, the motherboard on our home computer finally bought the farm. This placed me in the position of purchasing a dependable (yet cost-effective) replacement. Based on past experience with their desktop hardware, I selected Dell and had been perusing their website for several minutes when a small pop-up asked if I would like to chat with Dell employee. I was connected to April, who was undoubtedly a 55 year-old male inmate at a state penitentiary, but who nevertheless proved helpful and generated a quote for a tower and monitor.

It was several weeks later before we had the funds to order said PC, so by the time I plugged the quote number I was not sure it would still be good. Fortunately, everything went through fine and a few moments later I received an order confirmation e-mail and a promise that I would receive further correspondence once my order was on its way.

A few days later, I received an e-mail from a Dell employee identified as Shravani who seemed to be informing me that the monitor I purchased was not available. I replied that they could simply cancel the order for the monitor and send me the tower. Having waited until the next day and received no response, I called the customer service number and was bounced around between a handful of unfailingly polite employees before the matter was resolved and I was told that my tower was on the way and the monitor order had been canceled.

It was at this exact moment that Shravani responded to my e-mail to tell me that the tower was unavailable and they had shipped me the monitor instead. When I relayed this dismaying turn of events to the phone representative I was placed on hold after which I was informed that Shravani was correct and that the tower was no longer available. He reiterated the “good news” that my monitor was still already on the way. I replied that I am sure it will look amazing once it is “plugged into the imaginary computer I just bought.” I was immediately placed on hold while he conferred with the shift supervisor. 

When he reappeared and I pointed out the tower was still available according to their website, I was told that it was no longer available at the price on my quote (it had elevated $140). It was as if I was trading commodities instead of purchasing a computer. On top if it all, no one seemed to have any idea of who “April” was and how she had been given authority to perform arithmetic on behalf of the company.

A few hours (and three employees) later, Dell finally agreed to “do me a solid” and honor their own quote. I even managed to get them to send it next day shipping. Since it would require an adult signature, I asked them to ship it to work. When I received my shipping notification I noticed that FedEx was estimating that it would be delivered on President’s Day. Since the office was going to be closed, I simply went online and had the delivery redirected to the nearest FedEx/Kinkos location. I even took time to brag to my co-workers about how cleverly I had circumvented this logistical delay.

That Monday, I checked FedEx’s website and was chagrined to discover that the package showed undeliverable because the business was closed. I called the main FedEx number and spoke to a customer care specialist who told me they had attempted the delivery at my work address but that no one was there. When I responded that I had redirected the package several days ago for that very reason she replied that they would redirect it to the FedEx/Kinkos location tomorrow.      

I responded that this would defeat the purpose of the re-direct since I would actually be at work the next day thus making a Kinkos delivery less convenient than the original destination. She advised that I drive to the nearest distribution center and pick it up that day before they transferred it.

I arrived at the distribution center and informed the woman at the front desk that I was here to pick up a package. I gave her my name and tracking number after which she informed me that it was to be delivered to Kinkos tomorrow. I assured her that I was aware of the box’s destination and wished to prevent it from getting there by picking it up now. She grimaced and apologetically explained that I could not get the box now because she “was the only one here” and apparently FedEx has a very strict parcel buddy-system I was unaware of. She requested that I leave and come back in a half-hour.

On my return trip, I was finally able to procure the package. On the drive home it occurred to me that both FedEx and Dell had created an intentionally unhelpful infrastructure staffed by ceaselessly polite employees. This allowed each company to be as infuriating as possible without presenting the customer with anyone acceptable to yell at. At each and every juncture I was apologized to and reminded that I was a valuable customer just before being told that they were unable to accommodate any reasonable requests I made.

Narcissism Dating

I recently came across an article on The Huffington Post called “6 Ways to Recognize and Stop Dating A Narcissist” written by their Chief Love Officer Sandy Weiner. Normally I would avoid such a piece but the coincidence of locating a “Chief Love Officer” with a suggestive surname was too much to pass up. Plus, I have a natural affinity for succinct numbered lists that claim to decode complex psychological problems.

It turns out that narcissists tend to be “charming, exciting, intoxicating nice guys” whose emotional deficiencies are so well disguised they lure people into forming “soul connections.” I believe that Mrs. Weiner has succeeding in sowing seeds of discontent and doubt into even the most functional of adult relationships. No longer content dissecting actual negative behavior, we are now forced to undermine good behavior by casting suspicion on its origins. Sure Frank may be polite, charming, and treat you with respect, but what if he is simply playing the relationship long con and his behavior these last ten years are nothing more than a clever ruse? Before long I will be reading articles titled, “He may physically and emotionally abuse you with an unholy fervor, but at least you don’t have to speculate on whether or not he is a terrible person.”

The article advises that if your man exhibits even just one of the following symptoms you should “walk away, never to look back and hope for reconciliation”

• When you express your needs, he gets defensive
• When the going gets tough, he gets going
• He gets angry when you discuss exclusivity
• His actions and words don't match
• He runs hot and cold

Some of these probably should be sticking points (such as flying into a violent rage when you request he stops sleeping with all of the hostesses at your local Olive Garden) but others are irresponsibly open ended. I am not sure you should run screaming from a first date because you perceive him as sending mixed signals. Sometimes guys are just nervous and imperceptive, a combination that doesn’t necessarily indicate chronic narcissism. Don’t get me wrong, there are early warning signs that should be heeded (he won’t stop asking when your little sister will be “legal” or he refuses to explain why his roommates call him “Patient Zero”) and could potentially save someone from wasting time and energy on a dead end. However, it appears we are now just penning articles because someone out there might actually be happy operating within an imperfect union between two flawed people.

More enlightening than the article was the comment section:

Rita admits that she dated a narcissist who “threw knives” and she had to “hit over the head with a pan” so that she could escape while he was dazed.

Robert explained that men’s self-absorption is simply “looking for cues from consenting females.”

Daliah credited the article with reminding her why she “would never get married.”

Mary knew her ex-fiancée was a narcissist when he objected to her spending money on a “pony-riding party for her daughter.”

I would like to address these individually if I can.

Rita-I believe you misread the article because the real danger is not that a man with a knife will say one thing and do another; it is that he will do exactly what he says he will do.

Robert -there is nothing creepier than a grown man admitting that he spends all his time “looking for cues from consenting females.” Also, I believe you owe Rita an apology.

Daliah - there are plenty of legitimate reasons not to get married, but the comment section of a Huffington Post advice column is not the place to locate them.

Mary – I can only hope that you did not end a long-term relationship over a disagreement concerning equine rental fees.  I dare say that it is possible to maintain a healthy monogamous relationship with someone who expresses a disparate valuation of short term horse leasing.