Comparison of Care: Why One Child Will Die After a Dog Bite and Another Will Survive an Incurable Heart Condition

By Caroline Smith

As I finish my post-operative care routine for my nine-day-old patient, I notice that the cerebral oximetry machine is not picking up a strong signal. Despite troubleshooting, I am unable to figure out how to fix the problem, and I head to the Pixus to get a new sensor. Unfortunately, this one does not work either, and we must use a smaller sensor to pick up an adequate signal on this very sick baby. As I meticulously apply the sensor, a nurse jokingly chides me, “Don’t worry, those only cost $200 a pop.” I must look horrified, because another nurse turns to me. “That’s only a tiny drop in this baby’s bucket,” she says, “Every few minutes spent waiting downstairs costs thousands and thousands of dollars.”

Go back two months ago, and I sit in the Emergency Room of a small hospital in Cuzco, Peru. I feverishly fold cotton into two by two gauze so that I can clean and dress a child’s wound from a feral dog bite. The child arrived shaking with shock, carried by a friend of his employer since his parents are both either dead or gone. Cleaning this wound will cost the child three nuevo soles– the equivalent of less than dollar. This appears to be a good deal, but we do not have any sterilized tools or soap for me to wash my hands, so the child will likely come back with a nasty infection despite my best efforts to keep the wound clean. They will need antibiotic injections and pills, as well as additional curación—wound cleaning and debridement—to make it past this simple dog bite to their thirteenth birthday. Hopefully his employer will pay for these as well, since my young patient is just barely scraping by as it is.

Isn’t there some sort of happy medium between these two children? For nurses here in the United States, cost of care is just starting to make its way into daily practice and conversation. In most other countries in the world, healthcare costs are the conversation.  Many people do not realize that costs of care make medical decisions for a significant portion of this country as well, mainly the poor, uninsured, and under-served. With changes in insurance and healthcare policy, the conversation about healthcare costs is about to change drastically in this country, and care providers will be at the center of these changes.

As a Clinical Assistant and future nurse, I am acutely aware of the materials side of healthcare—the cost of the cerebral oximeters, the chest tubes, the sterilized supplies. Since I work in the Intensive Care Unit, I have also been exposed to another side of healthcare costs, one that is a touchy subject for most people. How far do we go to keep a patient alive? Do we save a life that will inevitably be short and painful? These questions still perplex me, but a new one surfaces in my mind. Why do some patients, both in the United States and abroad, have to ask, “Will I live after this dog bite, flu, asthma attack?”

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Caroline Smith is an RN at Boston Children’s Hospital and was a contestant in the 2013 Costs of Care Essay Contest.