Healthcare, autonomy, and no easy answers.

When I went to the ER a couple weeks ago with a high fever and severe abdominal pain, they did a pelvic exam and a vaginal ultrasound. These were absolutely necessary to rule out life-threatening conditions--I could have had an ectopic pregnancy or an ovarian torsion, and no one wants me to die because they were too demure to check out my no-no places.

But I was sick to the edge of rationality and had been given a combination of medications that were extremely sedating and confusing. I was in and out of consciousness, and when I was conscious it was in a numbed, blunted, incoherent sort of way. It was not a condition in which I would customarily be able to consent to vaginal penetration. Not that I was really asked; the conversation was more like:
"This is going to go in your vagina now. Scoot down a little."
"Mmmrf?"
"Nurse, scoot her down a little."
"Mrrf."

In the world I normally live in, "mrrf" is not considered enthusiastic consent.

Medicine isn't subject to the same rules as sex, and for good reason. The doctor wasn't doing this for his personal enjoyment, and my life was potentially on the line. The medications weren't given to make me more malleable but because I was crying and puking. Messing with the vagina of a confused sick woman isn't an evil scheme but an unfortunate necessity in a bad situation.

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My least favorite thing to do when I'm working in the ER is restraining children for catheterization. It's not so bad with babies, but with kids who are old enough to say "no, no," it makes me fucking hate myself. I don't think "sometimes you can't stop strangers from holding you down and doing painful things to your genitals, and your parents will just sit there and watch" is a message I ever want to send to a kid.

I can't even always play the "but it's necessary" card on this one, either. Most of our child catheterizations are not because the kid can't pee, but because the kid can't pee on command and we need a urine specimen. A lot of the time with some patience the kid probably could pee in a cup or stick-on external bag. Or, very often, we find the kid's problem by other means and it has nothing to do with their urinary tract, and if we'd waited thirty minutes we'd have known we didn't need to catheterize. So we're not doing this stuff because it's fun, sure, but we're doing it for convenience, not necessity.

I've considered refusing to participate in this sort of thing, but then someone else will just do it, and what the hell difference does that make? If I made a big enough stink I'd get fired while someone else went on and did it anyway.

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Later in my hospital stay, I started feeling much better. Not great, sure, but no longer dependent on hospital services. My problem had been diagnosed, I could walk, and I could take adequate fluids by mouth. I asked to leave.

And I was told "well, we'll see about that." The nurse and the first doctor I asked told me it was simply out of their hands, so sorry, but they'd try and pass it along, the whole "competent non-criminal adult would like to leave" thing. I thought about removing my IV since it was very uncomfortable and I knew I didn't need it, but I was afraid that being a competent non-criminal troublemaker would lose me what little respect I had.

Of course, I could have walked out the door and nobody would have physically grabbed me, but there's this thing called "AMA." Against Medical Advice. If you leave AMA--without your doctor's permission and all the proper paperwork--your insurance doesn't pay. So sure, you can have your freedom, as long as you've got twenty thousand dollars handy.

Four hours after I asked to leave, the correct doctor came and talked to me. He told me he wanted to keep me another night just to be safe. I begged to go. I negotiated. I felt scared as fuck because he could have said no and that would have been it. My freedom was up to this stranger's personal opinion. In the end, though, I managed to plead my way out. Five hours after that, the correct paperwork was done and I was allowed to leave.

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My second least favorite thing in the ER is dealing with psych patients. If you walk into an emergency room of your own free choice and tell us that you are having hallucinations or you feel suicidal, we will take you back, take away and lock up your clothing and possessions, and tell you that you cannot leave. If you ask to leave, we will first calmly explain that you cannot, then badger and condescend to you, then threaten to physically restrain and forcibly medicate you.

Policy states that if someone attempts to leave non-violently, if they simply walk toward the door, we should try to talk them into staying but not lay hands on, and call the police when they cross the property line. (The police, of course, will lay all the hands they need to, as will we when we take the patient from the police and throw them in restraints.)

This policy is not followed. If you are deemed a psych hold and you walk towards the door, several burly men will throw you to the ground and hold you down. A bed with straps will be brought. You will be taken to a private room ("private" from the public, not from the five or six strangers in there with you) and have psychoactive medications injected into your buttock. They will then secure you spread-eagle to the bed. With good behavior you might be released in as little as an hour. Acting upset or angry about being restrained, or being aggressive in your requests to be released, are not considered good behavior.

Of course, most of the people we do this to really are completely psychotic. They really wouldn't be safe out on the street and they might be a threat to others as well. Of course you can't let a guy who randomly attacks people at Satan's behest just walk out because Satan told him to. But far too often we restrain people who talk to Satan but don't hurt anyone. Once someone gets the label "crazy," all's fair. And if they don't like it that's just evidence of how damn crazy they must be.

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Like the title said, there's no easy answers. Healthcare can't follow the same rules as casual social interactions. Procedures on the genitals aren't sex and keeping someone until their safety can be assured isn't kidnapping. A healthcare system that made it easy for patients to opt out of everything unpleasant would be up to its ass in corpses and lawsuits within a week.

But a healthcare system that makes it difficult or impossible for human beings to opt out of pain and confinement is... it's enough to get me reading the "Help Wanted"s again, I'll tell you that.