I was new to case management (a whole 3 months under my belt after 20 years of acute care nursing) when I received a call from the care coordinator. A young man in a rural state was in ICU following a whipple procedure for his pancreatic cancer. His family was distraught as he was so ill and they wanted him moved to a “better” out of state facility. The challenge was that his insurance plan did not cover transport unless it was to a higher level of care.
I quickly researched the patient’s diagnosis and procedure, called the facility and spoke with the staff nurses. “John” was too unstable to be moved. He was progressing as expected. John of course was too ill to speak with me.
I called the family; they were scared to see their younger brother so ill. He had been fine except for several trips to ER for stomach pain. I explained the diagnosis, procedure and usual recovery course to the family. After this initial conversation, the family calmed down. They thanked me for my help as no one had taken time to explain things to them. I sent them written information to review and help reinforce what we had discussed and gave them my number to call if they had any further questions.
As John improved, I kept in weekly contact with him and his medical team. Surprise! John was discharged home on a Saturday, without warning. I spent Monday trying to find John. The hospital was unable to give me any information other than he was sent home.
I called “John’s” home phone, but his phone had been disconnected. I finally found one phone number for someone with the same last name (small town). I called the number and found that this was the “John’s” brother (no, I did not break patient confidentiality). John had lost his job due to his prolonged absence and was unable to pay his bills and had lost his health insurance. John called me back from his brother’s house and explained to me that he was unable to afford his post op medications. I must have made about a billon (perhaps an exaggeration) calls trying to find someone to pay for John’s meds. Desperate and not knowing any better, I decided to call the surgeon’s office. I explained the situation to the office nurse. I begged her to please let the surgeon know that his patient was unable to obtain his medications and that I could not find any willing resources. She called me back several hours later and told me that the surgeon had set up an account for John at a local pharmacy and that he just needed to pick up his medications. I provided John with a list of local resources to assist him with continued healthcare coverage and living expenses. That was the last I heard from John. I did however send a thank-you note to the surgeon.
What have I learned? A case manager needs to have many skills, including being a detective and a therapist. You never know what you can get unless you ask for it. When you get it be sure to send a thank-you note, it might encourage repeat behavior.
