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Into
the maw of the American health care system
Melvyn D. Magree Originally published in the Reader Weekly September 11, 2008 Many people laud the American health care system as the finest in the world. Some of these people use anecdotal evidence to “prove” that others are worse, like someone died in a hospital in Ontario. Other people laud European systems as having better outcomes, especially considering the cost to individual patients. Let me relate my own recent visits to an emergency room and the resulting hospital stays. We have been tearing up carpet, staples, nails, and tack strips in preparation for having our nice maple floors refinished. This means we spend a lot of time on our knees bending forward. In recent years my tummy has not liked my bending from the waist and would need a Tums or two now and then. As I was pulling up tack strip on Sunday, August 24, my tummy revolted. I made it to the bathroom in time, and then I felt better. On Monday we went to the fitness center but I wore out on my routine with the weight machines. In the afternoon I continued on the tack strip but only made it four feet before my tummy revolted again. This time it was many trips back and forth between the bathroom and bed. My abdomen was constantly sore and two old injuries on the edges of my ribs seemed to meet in the middle giving me pause about my heart. I do have an “innocent heart murmur”. I have had three prior incidents involving my heart, all proved negative. My wife called nurse online and before she finished, I felt better and talked to the nurse myself. She repeated to me that she had to say that we should call 911. However, within an hour I felt worse again and my wife called 911. I heard the fire truck come down the hill, heard its air brakes, heard the driver set the chocks, and then saw three fire fighters at my side. Their faces made me feel better. They went through the usual steps of checking me. The ambulance arrived and the fire fighters briefed one of the paramedics on my condition. We have a rather narrow stairs, and so they asked me if I could walk downstairs to the gurney. I did and they strapped me in the gurney on the porch. In the ambulance they gave me oxygen, a bit of nitroglycerine, and some aspirin, one or more of which made me feel better. They tried to give me an IV also, but hit a valve. Gosh, I learned some anatomy I didn’t know before. I also relearned how bumpy Duluth’s streets are as I rode along in a Ford E-350 van. At the emergency room I was wheeled down a succession of corridors into a large room with a hospital bed in the middle. The paramedics and some nurses pulled up on the sheet under me and with one smooth motion transferred me into the bed. Then, they started hooking me up in earnest: IV, electrodes on my chest for the heart monitor, finger clamp for temperature or pulse or something, and maybe a few other things. A succession of nurses, technicians, and doctors came to see me. I was almost on autopilot giving my name, date of birth, address, and telephone number. A couple of technicians took an X-ray of my chest. They had to try several times because their portable machine was balky. I know my back and abdomen weren’t too happy with all the bending forward I had to do. I was in the ER over shift change with a succession of nurses and doctors. Sometimes things were slow and they chatted for a while. Sometimes it was a quick check and they had to help someone else. All were responsive, courteous, and cheerful. Sometime after midnight I was moved up to the cardiac care unit. I was placed in one of a suite of four single bed units. I was surprised that none of the other units was occupied. Maybe I was even pleased in that it meant I had sole access to the single toilet. Ah, the toilet! What fun and games when you are hooked up to an IV. Untangle call button/TV control from other cords. Take oxygen tube out of nose and over my head. Make sure IV cord is not tangled in bedside. Get out of bed without getting tangled in sheets. Unplug IV unit from wall socket. Pull unit this way and that out of room and across hall. Find place in bathroom to put unit. Pull up hospital gown without dropping it into toilet. Return to room. Plug unit into wall. Get tubes and sheets in order. Repeat one to two hours later. And this is all made worse because I have an IV constantly drip, drip, dripping fluid into my vein. The doctors determined that I had not had a heart attack and ordered an ultrasound of my abdomen. The ultrasound technician moved the device all over my abdomen, but the only thing he noted was that I had gallstones, but small and not many. I did remember having some momentary sharp pains in the ER. When I got back to my room I was given a good breakfast and sat in bed with the newspapers and my iPod. A doctor came in later and told me I could go home after lunch and ordered a follow-up visit with my primary physician in about four weeks. The next morning we took the bus to the fitness center, but I did only five walking laps around the track. After all, I gotta get my twelve times a month to get my twenty dollar rebate on the monthly fee. I was feeling a little weak and bought some beef jerky from a vending machine. From there we walked over to the Co-op to buy some groceries. I also bought a Naked Juice to get some more good sugar. We took the bus home without incident. I felt well enough to give the tack strip another try, but I only lasted about ten minutes. I became really tired and nauseous and I didn’t feel like any lunch. After awhile, we called the doctor’s office and arranged to see a nurse practitioner. She had some blood tests made, prescribed some anti-nausea pills, and scheduled what we thought was gall bladder surgery on Friday. When we got home I lost the anti-nausea pills and took some more. I didn’t feel well enough for supper and lay in bed most of the early evening. The abdominal pain started building up and my wife drove me to the ER. I walked in, checked in, got a barf bag, and waited and waited for three hours. To be fair, at least two ambulances came in during that wait. I have no idea how many other people had worse, more pressing problems than I did. Eventually I went through the swinging doors, onto a gurney, was checked some more, and moved up to a double room, all hooked up on oxygen and an IV. Everybody expected that I would see a surgeon about gall bladder surgery the next day. The next morning I got no breakfast because everybody expected me to have surgery. They said a surgeon would be by later. Meanwhile, my wife brought newspapers, my laptop, and my iPod. When I checked my email I found a message about my previously scheduled visit to a surgeon. It was only a ten-minute consultation! I spent my day reading the newspapers, getting on the web to an increasingly weaker wireless link, and listening to my iPod. Oh yes! And my complicated trips to the toilet. No lunch, no supper, just the IV. Finally about 7:30 in the evening a surgeon came by. After some poking, prodding, and questions, he determined that there was only a 50/50 chance that my gall bladder was the problem. He said I should have a gastro-intestinal exam (GI workup). Oh, goodie, now I can eat and go home. Not so fast. Unfortunately for many, the surgeon was called to the ER and hadn’t dictated his orders. I was stuck there for another night, another night with the IV. At least, we got to watch the last 20 minutes of Barack Obama’s acceptance speech. Along about 10:30, the surgeon returned and apologized profusely for the delay. It was past time for checking out. He did let a nurse know I could have food, and she brought me a vending machine sandwich, a banana, and a small carton of milk. But I still had to have the IV!! The next morning a hospitalist visited me, said I could leave after breakfast, and ordered the IV out. Shortly after a late breakfast my wife picked me up and we headed home –ordered not to bend over! A week later, I’m still reluctant to do much physically. Because of the floor refinishing, we are “in exile” at our cabin. It is very frustrating with all the path clearing and wood splitting that needs to be done that will have to wait for some other time. By the time you read this I will have had my GI workup. I hope that exam finds something conclusive that can then be dealt with. What have I learned about the American medical system? There are a lot of caring people trying very hard to help other people. Sometimes things may be quiet and they can chat; other times there is far too much to do at once. The only thing I can think of is that doctors should have iPhones into which they can dictate orders and phone them in. Software exists to take dictation and translate it into text. This should help the information flow and get people out of the hospital faster, reducing some costs. ©2008 Melvyn D. Magree |