And then my head exploded

So it's Tuesday. And I'm seeing my 9:30 patient at 11:45; she has a really insane congenital cardiac abnormality  - one we don't often see in this country - about which she is relatively cavalier. She has had more hospital admissions than she can count, including one last month which required an ICU stay (from which she signed out Against Medical Advice, and which she completely forgot to tell me about). And she has 2 kids at home. And now she's 13 weeks pregnant.

She's been to see me twice, and we've talked - at length - about how this pregnancy could, quite literally, kill her, but she wants to keep going. She finally went to see the cardiologist, and in addition to upping the doses of all her medications, he agrees that she should be on blood-thinners in order to avoid a clot forming in her stretched-out heart and traveling to her lungs or brain. The bottom of his note says: Anticoagulation to be initiated through OB office.

That's me.

The blood-thinner that we use - a drug choice based on easy dosing and safety in pregnancy - is an injectable. It is also extremely expensive. It is only covered by some insurances; getting this coverage is possible, but I know from long experience that this is going to take some work. Then there's also the matter of getting injection supplies, and teaching her how to self-administer an injection, and arranging a nurse visit for teaching. And on and on.

So I go over to the office of the social worker to get this process started; but now it's 12:00 and there's a big "Out to Lunch" sign on her door. So I call the other office and no one's answering the phone. I page the number the message gives me; no response.

I am reluctant to let this patient out of my sight without handing off  the next step - this wouldn't be the first time that her follow-up has been less than stellar. But it's now 12:15. I have at least 4 more patients to see, at least one of whom has been here for 3 hours.

So I say to the patient: OK, this isn't working. I'll take your number; you go get your labs drawn, and come back.
She says: Um. Ok. But I don't know my phone number.
I say: You don't know your number?
She says: It's a new phone. Wait, maybe I can get it to tell me my phone number.
She plays with the phone, to no avail.
 I, confident in my tech-nerdness, say: May I?

I play with the phone, to no avail. It is, however, quite a nice phone.

I ask my patient if there's anyone she can call who WILL know her number. We try her boyfriend from the office landline; no answer. We try her mom from the landline, no answer. I try to get her to call my cell phone (HUGE no-no here, in giving out my number, but I am, as you can tell, desperate); there's no reception for either of our cell phones in Big City Hospital.

Finally, I say: Go outside. Call someone. Anyone. Ask them to tell you what number they see on their caller ID. Write that number down. Please. Then come back in and tell me. And THEN we will get the social worker to help you. And then we will get your blood thinner, without which you may get a blood clot and die. OK?

She says: OK. She goes out.

She didn't come back.

Dammit. I didn't even get her labs drawn.