Monday, February 6, 2012

three odd meals and a sponge bath

I rarely eat Jell-O. But I do know at least one thing about the famous dessert that jiggles. I am aware that it is a staple on hospital trays in America, as I have spent much more time than desired by the bedside of some people very close to me in recent days and years.

While unfortunately passing through America’s divisively recognized health care system, I have closely watched as medical teams have treated patients for breast cancer, invasive skin cancer, congestive heart failure, misdiagnosed meningitis, pneumonia, sepsis with a side of pneumonia, weird viruses, plus a variety of complications and my own hernia to boot. And I have awaited the results of many MRI’s, CT scans, EEG’s, spinal taps, surgeries, cultures, blood tests and chemotherapy or radiation sessions along the way.

Quite a pile of invoices have passed through my hands as well. I suppose that my sampling would be classified as anecdotal, but I have seen that chemo, as an example, averages about $7500 to $10,000 per treatment, here in the Northeast. I know that treating a blood infection for about a week in a New York hospital, with no surgery involved, runs about $90,000. I know that a bilateral mastectomy and reconstructive surgery goes for about $80,000, plus roughly $50,000 for the time in the hospital. Add in a host of tests, lab work, biopsies, and doctors you may never see and the total comes in around $150,000. Of course, complications may arise and this can heap on another $50,000 or $100,000 to the tab.

Adding in the knowledge that, even on the routine calendar of events, my hyperactive tendencies compel me to roll up my sleeves and chip in with my surroundings it’s not surprising, I suppose, that some fellow participants in the caretaking have suggested that I would make a good nurse. From my perspective though I don’t think I could cut it. Blood, needles or long and nighttime hours wouldn’t deter me, but I am a bit germ phobic and I’d probably end up with some yet to be discovered syndrome originating from an overdose of Purell. Still, aside from habitually retrieving fresh Jell-O and applesauce snacks from the fridge at the nurse’s station, I have had to take on additional roles.

Taking tasks at hand has meant making a decision to leave an emergency room I was already in at midnight with a very sick 3 year old to get to another hospital that I suspected may be less crowded. I knew he couldn’t wait and I also knew he was not going to get cared for quickly enough if we stayed at hospital number one. Luckily, the decision was correct and he got the care he needed in time at a facility across town.

A separate 4am emergency room visit with a different patient, joined me by the side of a doctor who had just come off his own back surgery. As he was limited in his motions, it was fortunate that I was already familiar with the draining and lifting techniques needed and I was ready to actively help out as few others were around at that hour.

And sometimes monitors just beep and beep and beep, with nobody paying attention. It’s as if the beep is background noise. But after watching uterine contractions on a fetal monitor, for a long enough already labor, I was pretty sure I knew how it worked. So when the nurse tried to convince me that the high and erratic spikes shown on the screen were due to the lap belt slipping I sought out the second opinion of a doctor anyway. It turned out that the spiking was due to the choking that was occurring around the neck, by the umbilical cord that was then wrapped twice around the baby’s throat and body. Luckily all ended well.

Certainly there are many excellent and dedicated people working in the medical arena in this country and I have met more than a few. But hospitals are largely understaffed, which is shocking considering how much they charge for each procedure. Physical therapists sometimes take hours to arrive. And when they finally do descend upon a room they often find a sleeping patient. Infections are a huge concern. Every day that someone I know is in a hospital I worry about them catching MRSA or C Diff or some other strange bug that needs to be treated by three different antibiotics for thirty days.

And for all the administrators in attendance, efficiency seems to be at best random. Why should a novice like myself have to work tirelessly on the phone, calling three doctors and a supervisor to get a trans esophageal echocardiogram (I didn’t know it existed either), that was ordered on a Wednesday, done by Friday in order to get an otherwise finally healthy patient discharged and save the additional $30,000 it would cost to instead wait until Monday-as weekends there so resemble a holding pattern.

Sure the medical, diagnostic and technological intelligence is high. But attention to the fundamentals is slight. And I think that is a big part of what’s wrong with much of the health care system. Washington wants to pile on regulations. Doctors want to pile on tests. And the insurance companies want to pile on paperwork.

How about putting on some additional people? Sure, everyone right away thinks additional money and that costs will go up. But, specifically, how about deploying some hard-asses to stroll the halls of the hospitals to police the care that is given? I’m thinking about enough deployment to match the number of library cart attendants who drop books on trays, next to bowls of uneaten macaroni and cheese, alongside patients who sleep all day from being kept awake all night.

Maybe the hard-asses would be able to move the pace a little more quickly, maybe they could be there on nights and weekends and maybe they would make sure that alerts and beeps get attended to promptly. And I am confident that when trimming from a tree that charges $10,000 per day and who-knows- what per procedure, the hard-asses could more than offset their benefits package and even reduce costs as well.

Whether or not the system is really interested in reducing costs is entirely another matter.

This is not to say that I don’t approve of President Obama’s quest for health insurance for everyone and the elimination of pre-existing condition hurdles. But, in a system in which no one really knows what anything costs, meaningful reform would probably be better served by a more hands on and close at hand approach than by regulation and legislation.

I look forward to viewing the upcoming invoices from my most recent eight day visiting venture inside the halls. I may even return to the hospital with a Keurig in tow. After all, folks rolling up their sleeves in a five figure per day institution shouldn’t have to leave the confines of a 250,000 square foot building to get a cup of coffee while slogging away in the ER at midnight.

© 2012 Christopher’s Views


  1. " Sure the medical, diagnostic and technological intelligence is high. But attention to the fundamentals is slight. And I think that is a big part of what’s wrong with much of the health care system. "

    You have summed it up BEAUTIFULLY!

    Aloha from Waikiki
    Comfort Spiral

    > < } } ( ° >

  2. I don't like hospitals, don't always trust doctors and keep my association with them to a minimum. Fortunately, for me I have a doctor who likes me anyway and I do trust him. That being said, you have indeed summed it up very well, Christopher. Good to see your post this evening and thank you as always for stopping by mine and for your comment. Hope you have a good week. Stay well.


  3. It's a bleak view that should scare anybody who has the misfortune to get sick. Your analysis seems pretty solid to me, and your fix is an intriguing one. I have come to appreciate the French system for its efficiency and inclusiveness, but wonder when it will start to fall apart - it's only a matter of time before the deficit hunters take aim at health care. It is still incredible to me that the US, alone among the major western economies, does not have universal medicare. An excellent pice, Christopher. I hope you don't have too many more occasions to find yourself in the ER.

  4. I'm Canadian and our health-care system is probably in a worse state in some ways. Cuts being made, waiting lists growing, hospitals it's definitely not a case of the grass always being greener. It does seem that there is such a lack of common sense and accountability in the day-to-day function of these institutions.

  5. You might have been talking about the NHS, with one enormous difference: It's not insurance premiums which keep it going but tax payers. Free at the point of delivery, and here's one vey lucky lady not to be living in the US. In the US I wouldn't be living, I'd be dead.

  6. def feel this...we were without insurance for about 5 wife now gets it through work but i have def been there and still paying for some...and more recently i am there with psychiatric patients as well and its a mess...

  7. Invoices from hospitals are meaningless. They are based on what insurance companies will allow them to bill. True reform is needed and it needs to start somewhere.

  8. perhaps we could set up some sort of hard ass consulting firm, or freelance as patient advocates
    I too have been caretaker for my mom, my aunt, my son, neighbors and friends
    one of them told me she was positive she would have died in the hospital just from being ignored had I not been there with my big mouth and list of patient rights

    so well written christopher
    so sad that it has to be written
    if only we, as a nation, were as good at healing as we are at killing