Friday, May 22, 2009


I’ve just read another one of those impatient internet rants asking when the Obama administration is going to get serious about addressing the medical industry mess. Well, I've learned first hand that the only reason it's called "managed care" is that if they choose to make great effort, they can just about manage to care whether you live or die.

Thus my response to the rant: Who cares? The problem, like most that are rooted in human greed and indifference to others, is not fixable by government. At least, not unless it proposes something akin to a “national health” like what they have in the UK. Correct me if I’m wrong, but I understand that in such a system, government can mandate that the front-line health care professionals be paid a decent enough wage that the jobs will attract people who are able to read medicine bottle labels. But “socialized medicine,” as the AMA’s lobbyists love to call it, is apparently horrific to most Americans. You want to hear horrific? I’ll tell you horrific:

I literally live across the street from a hospital, so when I needed an emergency room in 2006, that’s where I went. I wouldn't have gone otherwise; local legend has it that the hospital was built by the mob (this is New Jersey, after all) for the express purpose of providing abortions for their girlfriends (since the next nearest hospital is a St. Something-or-other in Hoboken) and the discreet treatment of bullet wounds. To my dismay and great frustration, my ER visit resulted in a two-week stay there that became one of the most nightmarish experiences of my life. I began my efforts to be transferred out of there on Day One, but they were efficiently thwarted by the hospital.

And that was the extent of its efficiency. All but one of the nursing staff understood English so poorly that communicating basic needs was impossible. And on the rare occasion when I was being treated by someone with a command of the language, they had the disturbing tendency to say -- usually to a colleague, as if I weren’t right there -- “I’ve never done one of these before.”

I got to be a practice dummy for an anesthesiologist draining an abscess from an internal organ for the first time. This procedure involved inserting a narrow, sharp-ended metal tube, connected to a collection bag, between my ribs and into my liver, piercing layer upon layer of muscle tissue in the process. In order to see where the tube had to go, they kept sliding me into the CAT scanner, leaving to look at the image on a monitor in another room thirty feet away, then coming back and trying to find the target based on their memory of the image they’d just looked at. Kind of like playing darts blindfolded.

Before this farce began, I heard the famous magic words “You might experience a little discomfort,” which, as you surely know, is doctor-speak for “You will suffer the kind of agony that will make you pray for death.” So, had my head not been full of excruciating fireworks, it would have been full of questions.

You see, the abscess had previously escaped detection by CAT scan. (My symptoms and the doctor's tests, by the way, led them to speculate, in my presence, that I had anemia, hepatitis, or AIDS. I’d always thought doctors shared a diagnosis only after they had reached a carefully-considered conclusion; I didn’t realize it is apparently now customary for them to think out loud or share their guesswork with the patient.)

Anyway, after three days of head-scratching by various specialists -– right-handed head-scratching, to be sure, otherwise they wouldn’t have been able to keep staring at their watches while they were doing it -- the real problem was finally discovered by a very persistent ultrasound technician with a hand-scanner, who literally saved my life by devoting more than ten minutes of her time to just one patient.

So, of course, if this needle-like tube weren't being inserted; removed so I could be returned to the CAT scanner; and then reinserted into my liver no fewer than twelve times (I was counting), I would have been wondering why they were even using the CAT scan (and muttering, in my hearing, that they were having trouble seeing the abscess) in the first place.

If I hadn’t been thinking things like “At least St. Sebastian didn’t get it all in the same place,” I would also have been wondering why this invasive procedure was being performed by an anesthesiologist -- much less one who was unfamiliar with the hospital and its equipment because this was a Saturday and he was substituting for “the regular guy.”

The long recovery period with intravenous antibiotics, the drip pole for which had no casters but had to be lugged into the bathroom with me, was a little slice of heaven unto itself. The bathroom door had a huge sign mounted on it spelling out what this chamber of horrors called “The Patient’s Bill of Rights.” One of them, in boldface type and set apart from the rest of the text in its own emphatic paragraph, was the statement that the hospital staff was trained to behave with the utmost respect for the patient’s privacy. A woman who seemed to speak no English at all had been coming around twice a day to draw blood and take my vital signs. On one occasion I was on the toilet when she arrived. I called out to her, explaining my situation, and asked that she come back later. Instead she barged into the bathroom, thermometer held out in front of her like Van Helsing waving his crucifix -- walking right through the door bearing the pledge to respect my privacy.

She was forcibly removed from the room, without blood sample or vitals but, alas, with her job intact, only because my bellows of indignation were loud enough to be heard at the nurse's station at the other end of the corridor. At least I'd found a solution to the problem of those little call buttons being ignored as I lay there, creating several thousand dollars worth of work for my chiropractor, on a plastic mattress with the thickness and consistency of a chaise longue cushion.

As I said, my incarceration in Sweeney Todd Memorial Hospital proceeded immediately from an emergency room visit. Legends aside, the main reason I wouldn't have chosen the hospital, had I been given an option, was that my PCP (Primary Care Physician, not animal tranquilizer) did not have "privileges" there. As if toiling in Dante's Ninth Circle could be called a privilege. Perhaps because of this, the attending physician, who was a stranger to me, never filed the discharge report, or perhaps the hospital simply lost it. So, although I enjoyed a full recovery after the surgical insertion of a porta-cath and four months of twice-daily intravenous antibiotics, to this day I have no idea what, exactly, caused a strain of streptococcus I can’t find with a Google search to create an abscess in my liver, which I was told a squadrillion times was “veddy, veddy rare.”

The epilogue: Six months after I thought my insurance company had paid their share of the bills, and all the co-pay checks had been written, a new bill for several hundred dollars arrived. . .from a collection agency. The young man in the hospital billing department informed me that it was my responsibility to get the insurance company to reimburse the hospital, because the insurance company was saying that the bill was not presented in a timely manner. In other words, their logic was that somehow their f***up was my problem.

A little net-surfing and a cursory phone call revealed that the practice the hospital was engaging in was illegal. So the next time the young man repeated the phrase “This is between you and your insurance company,” I replied, “No, this is between your boss and the district attorney’s office,” and the harassing phone calls came to an end.

So let Obama talk about mandating health insurance, and let the insurance companies tantalize the terminally gullible by dangling ideas they have no intention of implementing unless ordered by law to do so, such as ending the practice of charging higher premiums for “pre-existing conditions” -- you know, like having been born. There will be no meaningful change in the system unless we can figure out a way to weed out the unqualified, poorly educated, inadequately paid, and just plain incompetent from the ranks of the practitioners. Or stop doctors from defrauding insurance companies by overcharging for simple procedures. Or preventing insurance companies from promoting, and doing business based on, the premise that getting sick is always the patient’s fault.

But all of that, as we know all too well, is – in the present United States, at least – simply impossible.

1 comment:

greenbushboy said...

When I needed an MRI done on my spine because I herniated two discs and couldn't walk at all, I ended up, courtesy of Blue Cross, talking to some guy in Sri Lanka. He saw no reason for me to have anything done except to take aspirin. I told him I would get the Tamil Tigers to kill him, shoot his dog, and do unspeakable things to all of his female brethren if he didn't okay it. Next week it was okayed so I understand somewhat your pain.

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