A Surgical Emergency Exposes the Crisis of the Young and Uninsured

When a patient looked anxious before emergency surgery, it turned out he was worried about the hospital bill, not the surgery. He was uninsured.

By Jeffrey Swisher, M.D.

• Medically reviewed by Patricia Salber, MD, MBA
• April 18, 2021

If you’re uninsured, the fear of having surgery may be related to the bill not the procedure. ( Photo source: iStock)

Some years ago, a few months after I had made the decision to leave academic medicine for the greener pastures of private practice anesthesia, I was called in one night to evaluate a young man in his early thirties with a presumptive diagnosis of appendicitis.

He had classic symptoms(1), was febrile, and had an elevated white blood cell count. A quick ultrasound followed by a CT scan confirmed the diagnosis. Unfortunately, the scan also demonstrated free air in his abdomen. This signaled that his appendix had ruptured, making his surgery urgent.

We had some time together before the rest of the surgical team arrived at the hospital to get the operating room ready, so I was able to chat with him a little. I learned that he was an accountant with his own small firm. He rented an apartment in the Marina, was married, and was thinking about buying a house in Marin near where I lived. He and his wife were expecting their first child.

Any chance we don’t need to do surgery?

I could tell he was nervous and assumed he was worried about the anesthesia and surgery, so I did my best to calm him.

“Anesthesia is safe”, I told him. “Surgery will go quickly, and you will do just fine! You are young and healthy, and you should recover easily.”

I explained to him that a laparoscopic appendectomy usually takes less than an hour and that he would have very little in the way of post-op pain. He nodded and said,

“I’ve been having bad pain and fever for a few days. It just kept getting worse. I didn’t want to come in at all, but my wife made me. Any chance we don’t need to do surgery?” he asked.

“No,” I told him. “That’s pretty unlikely.” Despite my attempt at a friendly reassuring pep talk he still seemed doubtful and was obviously anxious and hesitant to proceed.