9z: Postphenoconversion care. Bureaucratic doublespeak.

Holding steady at about 10 zombies per day, give or take. Like I said earlier, the rate-limiting step is really the capacity of the ICU. They’ve got four separate code teams that are basically earmarked for the zombie conversion service. I was pretty impressed by that, but Nick pointed out that it’s approximately the resources that a moderately busy surgeon would require. Since we know when the codes are going to happen, that takes a lot of stress off of the teams, and the whole show can be run by one or two anesthesiologists and a couple of NPs. Also, instead of the two rooms that we were using in the CPTLD for the conversions, we are now using a couple of operating rooms, sometimes more than a couple. That’s a lot easier than working in the CPTLD, not only for the resuscitations but also for security.

None of the zombies we are doing is exactly best-in-show. As I mentioned earlier, the decision on which zombies get changed back into humans is based less on their chance of surviving the transition and more on the type of insurance that they had before they were zombified. For this reason, we have almost exclusively been doing wealthy, elderly white men, regardless of their states of health before zombification. This means that while they may not necessarily do all that well with the transition, the conversion and aftercare are all paid for. Dr. N has assured me that the Institute is in the process of lining up resources to help pay for converting the uninsured. The attitude seems to be that if they’ve waited this long, they can wait a little longer until we’ve sort out the reimbursement side of things. I have to admit, this reasoning doesn’t appeal to me much – it’s pretty much the opposite of why I went into medicine – but after Dr. N went over it with us a bit, I guess I see the logic to it. I would be really upset if a patient’s family were to be bankrupted over care that I was providing.

The conversion process itself is still a work-in-progress. For a very short time, they were trying to place peripheral IVs and/or IJ lines in the zombs before the conversion, assuming that they would all need some kind of resuscitation. Turns out it’s hard to place a line in a zombie. There isn’t really an easy way to stop them from moving around, aside from restraints (which have their own problems); also, it’s really hard to place a line in someone who happens to have a MAP of zero. So now we place an IO line in the right shin. Starting yesterday, nearly all comers are getting rocuronium and rapid-sequence intubation immediately after conversion, after someone rolled off the table after I bit them. Some of these guys had been therapeutically anticoagulated for atrial fibrillation and whatnot before their zombification, meaning and they’ve already had enough chances to bang themselves up during their period as undead revenants – they don’t need a hospital fall on top of all that.

Nick and I are still kind of throwing around different zombie-related research ideas. Nick sent a proposal to Dr. S, who is however very busy these days. Apparently he and the CEO have flown to Washington to meet with some of the appointees in the new administration. It’s no secret that the Institute has been heavily in the repeal-and-replace camp regarding the Affordable Care Act. What’s coming next is anybody’s guess, but the CEO was on the news the other night: “The Institute’s emphasis is and always will be the wellbeing of our patients, regardless of race, creed, color or socioeconomic status. We look forward to finding a solution that will enable us to be true to our ideals while remaining competitive in an increasingly challenging environment.” When you really parse it, that sounds like a ton of meaningless crap, but at least we are part of the conversation. I guess.

As far as the new administration’s attitude toward zombie-care is concerned, I am cautiously optimistic. While I am not sure that any of them have any direct zombie experience, I recall reading that one wealthy cabinet nominee (I have forgotten which one) had tried to have a winning racehorse zombified so that it could potentially keep racing. He was going to import a zombie jockey from Monaco and everything. Of course, horses don’t zombify, so that wouldn’t have worked out, but I suppose some interest in the subject is better than none at all.

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