A letter to a frequent flyer with actual medical problems

Dear Obese Woman with Poorly Controlled DM, HTN and COPD;

We would like to take this opportunity to thank you for allowing us to be your Emergency Room of choice for your thrice-weekly 'medical events'. The chance to serve you has never lost its appeal. The fact that you have always been horrendously rude to all of the staff involved in your care, from tech to RN to MD, as well as to the family members who dragged their asses out of bed at 0300 to sit by your bedside and have abuse heaped upon them is completely understandable. After all, you are a very sick woman.

Of course, the fact that you have repeatedly refused to put down the beer, the cigarette, or the bacon cheeseburger has greatly increased the level of 'sickness' that you have achieved. But I digress.

We appreciate the chance you have provided for us to brush up on our IV skills. I must say, the one who gets the 22g in your pinky finger is highly regarded at the nurses' station for at least 10 minutes.

And the fact that inserting your Foley catheter has always been a two-person task (one to hold panus traction, the other to go diving in the depths of the unwashed kootch), allowing us to tie up an additional person that could be doing something else, indicates that you must be Somebody Important; somebody that it has always been our pleasure to serve.

We are aware that you could have greatly reduced, or even eliminated, your trips to the ER by simply being compliant with your medications, (most of which can be purchased at Wal-Mart for $4.00), and we have always seen that as a vote of confidence in our excellent care.

And the fact that everything from the ambulance rides to the Cardene drips to the Bi-Pap to the insulin to the serial EKGs and cardiac enzymes have always been paid for by our local, state and federal government medical aid programs means that reimbursement for your care has always been prompt and accurate. Except when it wasn't. But that's ok. As long as you could afford your Budweiser and Marlboros, we've always been happy to serve you.

So you can understand how sad we are tonight, having seen you for the last time in our ER. We worked so very hard to make sure you could come back and see us another day. Your visits mean so much to us, after all. But alas, asystole is not a rhythm oft recovered from, and though the medics did their best, as did we, your family will just have to spend the 0300 hour in bed from now on, as they won't need to be here, by your bedside in the ER.

Though the tube in your throat isn't helping your COPD much anymore, and the 20 g in your thumb won't be used for Cardene or Insulin tonight, and well, we didn't bother with the catheter, since there's no such thing as a stat Foley, we can tell you with utter certainty that you are in no way hypertensive.

And we consider that a success.

Thank you again for choosing us for your medical care-
The ER Staff